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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00796

Approaching Cognitive Behavior Therapy for Generalized Anxiety Disorder from a Cognitive Process Perspective

  • 1King's College London, United Kingdom
  • 2Sussex Partnership NHS Foundation Trust, United Kingdom

Generalised anxiety disorder (GAD), with uncontrollable worry at its core, is a common psychological disorder with considerable individual and societal costs. Cognitive behaviour therapy (CBT) is recommended as the first-line treatment for GAD; however, further investigation into its effectiveness in routine clinical care is indicated and improvement is required in treatment outcomes for worry. Improvements to CBT need to be guided by experimental research that identifies key mechanisms maintaining core aspects of the disorder. This paper summarises how theory-driven experimental research guided selection and refinements of CBT techniques originally developed by Borkovec and Costello (1993), to target key cognitive processes that maintain worry in GAD. Hirsch and Mathews’ (2012) model specifies three key research-supported processes that maintain uncontrollable worry in GAD: implicit cognitive biases such as negative interpretation bias and attention bias, generalised verbal thinking style, and impaired ability to re-direct attentional control away from worry. Specific CBT techniques outlined in this paper aim to target these key processes. Clinical data from clients treated using our refined CBT protocol for GAD in a routine clinical care service with a special interest in anxiety disorders were collected as part of service procedures. Large pre-to-posttreatment effect sizes were obtained for anxiety (GAD-7), depression (PHQ-9), and worry (PSWQ) (d=.90-2.54), and a moderate effect size was obtained for quality of life (WASA; d=.74). Recovery was indicated for 74% of cases for anxiety, 78% for depression, and 53% for worry. These findings exceeded most previous effectiveness studies in routine care and were in-line with GAD efficacy trials. This paper also outlines the application of specific clinical techniques selected, adapted or developed to target key cognitive mechanisms which maintain worry in GAD.

Keywords: Cognitive behaviour therapy (CBT), Generalised anxiety disorder (GAD), generalized anxiety disorder, attention bias for threat, interpretation bias, Verbal thought

Received: 01 Aug 2019; Accepted: 07 Oct 2019.

Copyright: © 2019 Hirsch, Beale, Grey and Liness. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Colette R. Hirsch, King's College London, London, United Kingdom,