رفتاردرمانی شناختی با هدف قرار دادن عدم تحمل عدم قطعیت: برنامه کاربردی برای یک مورد بالینی اختلال اضطراب فراگیر

The present paper deals with the application of a cognitive-behavioral protocol targeting intolerance of uncertainty (CBT-IU) to a hypothetical clinical case of GAD. The rationale for the CBT-IU protocol is presented, as well as a description of its divergence from standard cognitive-behavioral interventions. The treatment components of (1) worry awareness training, (2) uncertainty recognition and exposure, (3) reevaluation of positive beliefs about the function of worry, (4) problem reorientation and training, (5) cognitive exposure, and (6) relapse prevention are described, with an emphasis on their application to the case conceptualization of “William” (Robichaud, this issue). Issues pertaining to the assessment of GAD and future research directions are also discussed.

Generalized anxiety disorder (GAD) has consistently been viewed as one of the more challenging anxiety disorders, as it can be markedly difficult to appropriately assess and treat. Research on diagnostic reliability suggests that GAD is often misdiagnosed, and treatment efficacy for the disorder is moderate at best, with only approximately 50% of patients identified as having positive outcomes (Borkovec and Costello, 1993 and Borkovec et al., 2002). Reasons accounting for this include the shifting diagnostic criteria for GAD across successive editions of the DSM, and the vague nature of its primary symptom (i.e., excessive and uncontrollable worry), which lacks a circumscribed trigger for anxiety. Moreover, it appears that despite the challenges in our understanding of GAD, it has received comparatively little scientific attention in contrast to other anxiety disorders, particularly with respect to process research that might better elucidate the disorder's underpinnings and thereby maximize treatment effectiveness ( Dugas, Anderson, et al., 2010). In the past few decades, however, a number of research teams have begun to develop treatment protocols for GAD that are derived from empirically driven theoretical formulations of the disorder. This positive shift in the study of GAD can be expected to ultimately increase the effectiveness of psychological treatments for those suffering from the disorder. The present article deals with the exposition of one such protocol, a cognitive-behavioral treatment for GAD for which the central target is the construct of intolerance of uncertainty (IU), as well as its application to the clinical case of “William” (Robichaud, 2013--this issue). Although there are currently several evidence-based treatments for GAD, including metacognitive therapy, emotion regulation therapy, and acceptance-based behavioral therapy (see this issue for illustrations of each), the present paper will focus only on CBT-IU and associated measures and interventions as it applies to a clinical case of GAD.