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Chapter 14 - Generalised Anxiety Disorder

from Part III - Application and Adaptations for Mental Health Presentations

Published online by Cambridge University Press:  18 November 2025

Jessica Davies ,
Paul Salkovskis  and
Kenneth Laidlaw
By
Saevar Már Gústavsson
Foreword by
Judith S. Beck
Jessica Davies
Affiliation:
University of Exeter
Paul Salkovskis
Affiliation:
Oxford Health NHS Foundation Trust & University of Oxford
Kenneth Laidlaw
Affiliation:
University of Exeter
Judith S. Beck
Affiliation:
Beck Institute for Cognitive Behavior Therapy & University of Pennsylvania
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Summary

This chapter provides a comprehensive overview of cognitive behavioural therapy (CBT) for generalised anxiety disorder (GAD). Several evidence-based CBT protocols for the treatment of GAD are presented and their clinical implications discussed using case examples. These protocols are 1) the applied relaxation protocol, 2) the Penn protocol, 3) the mastery of your anxiety and worry protocol, 4) the intolerance of uncertainty protocol, and 5) the Beckian cognitive protocol. In the chapter we present a theoretical overview of GAD from the perspective of each these protocols. The difference between adaptive and excessive worry is also discussed and how this distinction is important when it comes to identifying key maintenance factors of GAD and what needs to happen in treatment. The aim of this chapter is to help the clinician understand different theoretical accounts of GAD and why and how to use therapeutic techniques such as formulations, behavioural experiments, imaginal exposure, applied relaxation and cognitive restructuring when treating GAD. Furthermore, how to address co-morbidity with other mental or physical conditions and why working within the scientist-practitioner model is important when it comes to developing treatment plans for GAD treatment.

Keywords

generalised anxiety disorderworrycognitive behavioural therapyavoidancesafety-seekingthreat beliefsexposurebelief disconfirmationtheory A/B

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Chapter
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Cambridge Guide to Cognitive Behavioural Therapy (CBT) , pp. 141 - 169
Publisher: Cambridge University Press
Print publication year: 2025

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References

Further Reading

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Borkovec, TD. Applied relaxation and cognitive therapy for pathological worry and generalized anxiety disorder. In Davey, GCL, Wells, A (Eds.), Worry and Its Psychological Disorders: Theory, Assessment and Treatment (pp. 273–288). Chichester: Wiley Publishing;2006.CrossRefGoogle Scholar
Foa, EB, Kozak, MJ. Emotional processing of fear: Exposure to corrective information. Psychology Bulletin, 1986;99(1):20–35.CrossRefGoogle ScholarPubMed
Öst, LG. Applied relaxation: Description of a coping technique and review of controlled studies. Behaviour Research and Therapy, 1987;25(5):397–409. https://doi.org/10.1016/0005-7967(87)90017-9.CrossRefGoogle ScholarPubMed
Robichaud, M, Koerner, N, Dugas, MJ. Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice. 2nd ed. New York: Routledge; 2019.CrossRefGoogle Scholar
Salkovskis, PM. The cognitive approach to anxiety: Threat beliefs, safety-seeking behaviour, and the special case of health anxiety and obsessions. In Salkovskis, PM (Ed.), Frontiers of Cognitive Therapy (pp. 48–75). New York: Guilford; 1996.Google Scholar
Sibrava, N, Borkovec, TD. The cognitive avoidance theory of worry. In Davey, GCL, Wells, A (Eds.), Worry and Its Psychological Disorders: Theory, Assessment and Treatment (pp. 217–237). Chichester: Wiley Publishing; 2006.Google Scholar
Zinbarg, RE, Craske, MG, Barlow, DH. Mastery of Your Anxiety and Worry (Therapist Guide). 2nd ed. Oxford: Oxford University Press; 2006.CrossRefGoogle Scholar

References

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