Modificaciones normativas

In Module 3, the primary goal is to assist clients in identifying their beliefs about the usefulness of worry and to begin reevaluating these beliefs. This treatment target might seem counterintuitive at first glance, particularly since clients have deliberately sought help for their exces- sive worry and anxiety. As such, the reader might question whether clients actually hold positive beliefs about the usefulness of worry. In fact, many clients are unaware of, or hesitant to discuss, the positive beliefs they have about their worries. However, the therapist should be careful not to hastily conclude that clients do not see any usefulness in their worries, even if an initial investigation does not point to this conclusion. As discussed in chapter 2, our research suggests that indi- viduals with GAD hold positive beliefs about worry from any of the five following categories: (1) worry helps them find solutions to their problems; (2) worrying can serve a motivating function, thereby aiding them in getting things done; (3) worry can serve as a buffer for nega- tive emotions by preparing them for dreadful outcomes should they occur; (4) worry, in and of itself, can prevent negative outcomes from occurring (also called magical thinking or thought-action fusion); and (5) worrying about people or situations shows that they are caring and compassionate people. Although not all clients with GAD hold every one of these beliefs, our clinical experience has taught us that they typically hold at least some of them.

Before expanding upon ways to address this module of treatment, it should be noted that our position is not that positive beliefs about worry are always mistaken or erroneous. In fact, worry can be use- ful for a number of reasons. However, findings from many studies show that individuals with GAD hold these beliefs to a greater extent than people who do not have GAD (e.g., Dugas, Gagnon, Ladouceur, & Freeston, 1998; Ladouceur et al., 1999). Furthermore, it appears that the usefulness of worry decreases as worrying becomes exces- sive, as is the case for individuals with GAD (Pruzinsky & Borkovec, 1990). Stated differently, relative to individuals with moderate levels of worry, clients with GAD not only believe that worrying is more useful, but they appear to worry to such an extent that it is actually

Why Address Positive Beliefs about Worry?

The reader might wonder why it is that identifying and reevaluating beliefs about the usefulness of worry is a necessary treatment module. If the ultimate goal of treatment is to assist clients in reducing their worry to a more manageable level (and not to eliminate it altogether), then it might seem relatively benign to hold strong beliefs about the use- fulness of worry. However, this is not the case. Although clients pres- ent for treatment to reduce their worries and anxiety, this is largely in a “general sense.” There is often a paradox present when it comes to clients’ relationship to their worries. For example, they may generally wish to feel less anxious and worried, while concurrently believing that it is very important to continue worrying about their children. As such, when faced with the notion of actually worrying less about specific top- ics (for example, one’s children), clients may be ambivalent about change if their beliefs about worry have not been properly addressed. By taking the time to let clients identify their beliefs about the function of specific worries, and ultimately begin to challenge their actual usefulness, treat- ment motivation and compliance can be enhanced.

A second goal of this phase of treatment is to help clients think about what it really means to worry less. This can be a very emotional experi- ence for clients. Most individuals with GAD have difficulty remember- ing a time when they did not worry. Although they present to treatment in order to reduce their worry and anxiety, many have not given much thought to what their lives would be like without the constant “back- ground” of worry. Therefore, it is important for the therapist to allow clients to discuss any fears or feelings of loss they might have regarding this potentially significant change.

Identifying and Reevaluating Positive Beliefs about Worry

Returning to the issue of identifying clients’ beliefs about the useful- ness of worry, any strategy that will facilitate the identification and disclosure of these beliefs can be therapeutically useful. Since clients may hesitate to “admit” they are seeking treatment for something they believe has a positive dimension, it is important that the therapist take the time to explain that it is common for clients to see a positive side to their emotional problems. One of the main treatment strategies that we use to encourage disclosure is the lawyer–prosecutor role-play, which is described in Chapter 5. With this method, clients are encouraged to present arguments in favor of the usefulness and value of their worries. Although we have found this role-play very useful in helping clients to

identify arguments for (and against) the usefulness of their worries, other strategies are useful as well (see Chapter 5 for other helpful tactics).

Once clients have identified their positive beliefs about worry, the therapist can proceed to help clients reevaluate these beliefs. In other words, clients are encouraged to begin thinking about whether their worries are as useful as originally thought. This type of reevaluation will set the stage for the next treatment modules. Specifically, if worrying is not as useful as once believed, that is, if it does not in fact help to solve problems or protect loved ones, then perhaps clients need to develop alternate strategies for achieving these goals. The problem solving and imaginal exposure modules that follow are therefore a natural progres- sion from this treatment module. The process of reevaluation of beliefs can be viewed as the most “cognitive” of all treatment modules. The pri- mary goal is to help clients to acknowledge that their beliefs are thoughts

and not facts, and to ultimately develop a more flexible belief system. So

rather than adopting a “search and destroy” strategy, where thoughts, assumptions, and beliefs are identified, reevaluated, and replaced by more appropriate or productive ones, this phase of treatment has a much more modest goal. Specifically, cognitive and behavioral strategies are used to help clients recognize that their beliefs about the usefulness of worry are interpretations and not facts, to see that other interpretations (or beliefs) also have some merit, and to wonder if perhaps they have overestimated the actual usefulness of their worries. At the same time, clients can begin the process of “imagining a life without ”