According to the cognitive-behavioral theory


Worries and brooding can be normal or pathological depending not on their content, but on their frequency and how they are evaluated by the person, so how often they come to mind and how we interpret them.

Generalized anxiety disorder would derive from particular positive and negative evaluations of one’s worries and brooding.

Generally, in fact, those with this disorder initially present positive beliefs about their concerns: they think that it is precisely worrying that allows them to reflect and, therefore, to find solutions to their problems or prevent catastrophes (eg. “… prepared to face any eventuality … “).

Furthermore, brooding is often associated with the superstitious belief that “worrying keeps danger away.” So, for example, a mother might fear that if she stops worrying about her child’s health, he might get really sick. In the early stages, therefore, concern is deliberately sought by the person.

Later, mainly due to the fact that in the meantime the brooding becomes pervasive

the person often begins to negatively evaluate his own worries: he thinks he cannot control them and that this could be dangerous, so he “worries about being worried” ( metapreoccupation) (eg “… I’ll be sick or crazy if I keep worrying like this …”). If so, the worries are experienced as intrusive, disturbing and difficult to interrupt.

The behaviors put in place

then, to mitigate worries and anxiety (distraction, thought control, avoidance, request for reassurance) momentarily reduce them, but in the long run they maintain and reinforce them because they leave the dysfunctional beliefs about them unchanged.

Positive and negative beliefs about brooding and dysfunctional behaviors to reduce it interact with each other, generating a vicious circle; in this way the disturbance is maintained.

In the cognitive-behavioral treatment of generalized anxiety disorder, a protocol is used that involves the use of the following procedures:the-behaviors-put-in-place

Formulation of a therapeutic contract

  • which contains, in particular, shared objectives between patient and therapist and their
  • respective tasks (eg homework for the patient);
  • reconstruction of the history of the disorder (first episodes in which it occurred and detailed description of the current condition);
  • formulation of the functioning scheme of the disorder, starting from the analysis of recent episodes in which the person felt worried and anxious;
  • psychoeducation, which consists of providing the patient with information relating to the role that beliefs have on concerns in the onset and maintenance of the disorder;
  • identification of dysfunctional thoughts (eg judgments on concerns) underlying the disorder and undisputed such assessments;
  • learning techniques for managing anxiety symptoms;
  • gradual exposure to feared and avoided thoughts and stimuli;
    relapse prevention, which consists in the patient’s acceptance of the possibility that the symptoms could recur and in the renewed use of tools acquired in therapy to cope with the moment of crisis.


This protocol is applicable to both individual and group therapy.
Compared to individual therapy, group therapy allows each participant to deal with other people who suffer from the same disorder, favoring the reduction of the problem and the reduction of the subjective feeling of “being abnormal”.


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