Revised Beckian cognitive therapy for generalised anxiety disorder

Since its inclusion in the DSM-III, various theories and treatment approaches have been developed for generalised anxiety disorder (GAD). Aaron T. Beck was the first to offer a cognitive conceptualisation of GAD in Anxiety Disorders and Phobias: A Cognitive Perspective. This original cognitive model of GAD was initially found to be promising in treating GAD but has not been developed further. Other theoretical models and treatments of GAD have gained more research attention, such as the Intolerance of Uncertainty model and Meta-Cognitive model. This article offers a brief overview of multiple theories and treatment approaches of GAD followed by an extensive discussion about the original cognitive model and a revised cognitive model of GAD in the Beckian tradition. Specifically, this paper describes how known key psychological maintenance factors of anxiety disorders, i.e. threat beliefs, safety-seeking behaviours and selective attention, can be used to conceptualise the experience of people with GAD and guide treatment. This is done with theoretical discussion as well as clinical examples. Finally, the paper offers suggestions for key ingredients to be included in cognitive therapy for GAD and future directions for research. Key learning aims (1) To understand the clinical implications of the original cognitive model and the revised model of generalised anxiety disorder presented here. (2) To understand the role of inflated responsibility for safety, safety-seeking behaviours and elevated evidence requirements in generalised anxiety disorder. (3) To understand and be able to implement treatment recommendations of the revised cognitive model of generalised anxiety disorder.