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This chapter outlines the application of a cognitive behavioral protocol targeting intolerance of uncertainty (CBT-IU) for the treatment of GAD. The theoretical rationale and empirical support for the CBT-IU protocol are presented, followed by an overview of assessment and case conceptualization and a description of each treatment module. Intolerance of uncertainty is viewed as a higher-order cognitive process that drives the development and maintenance of the worry cycle in GAD. Negative beliefs about uncertainty and its consequences are posited to lower the tolerance threshold for the uncertainty in daily life situations, and lead to worry as an attempt to reduce uncertainty through mental planning and preparing. CBT-IU treatment components include (1) psychoeducation and worry awareness training, (2) reevaluation of the usefulness of worry, (3) reevaluation of negative beliefs about uncertainty, identification of safety behaviors, and belief testing through behavioral experiments, (4) problem-solving training and reorientation, (5) written exposure for hypothetical worries, and (6) relapse prevention planning. Each module can be flexibly applied according to a client’s particular presentation. The overarching goal of CBT-IU is to increase tolerance to uncertainty by developing more balanced beliefs about uncertainty and its consequences.
This chapter describes the nature of depression, explaining that this disorder is not only prevalent in the population, but is also characterized by relapse and recurrence. Cognitive theories of depression share the idea that individual differences in maladaptive thinking and negative appraisals of life stress account for the disorder. Most contemporary cognitive models of depression have involved refinements and expansions of Beck's original theory. Cognitive therapy aims to help individuals shift their cognitive appraisals from ones that are unhealthy and maladaptive to ones that are more evidence-based and adaptive. The effectiveness of cognitive-behavioral therapy (CBT) is based on the extent to which patients learn to use the skills conveyed in therapy outside of the actual session. CBT is well supported for the treatment of an acute episode of depression and serves as a prophylaxis against subsequent episodes.
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