Mastery of Your Anxiety and Worry (MAW): Therapist Guide 2nd Edition (Treatments That Work) PDF
Preview Mastery of Your Anxiety and Worry (MAW): Therapist Guide 2nd Edition (Treatments That Work)
Mastery of Your Anxiety and Worry: Therapist Guide, Second Edition Richard E. Zinbarg Michelle G. Craske David H. Barlow OXFORD UNIVERSITY PRESS Master y of Your Anxiety and Worr y -- David H. Barlow, Ph.D. Anne Marie Albano, Ph.D. Jack M. Gorman, M.D. Peter E. Nathan, Ph.D. Bonnie Spring, Ph.D. Paul Salkovskis, Ph.D. G. Terence Wilson, Ph.D. John R. Weisz, Ph.D. Mastery of Your Anxiety and Worry S E C O N D E D I T I O N T h e r a p i s t G u i d e Richard E. Zinbarg • Michelle G. Craske David H. Barlow 1 1 Oxford University Press, Inc., publishes works that further Oxford University’s objective ofexcellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright © by Oxford University Press, Inc. Published by Oxford University Press, Inc. Madison Avenue, New York, New York www.oup.com Oxford is a registered trademark ofOxford University Press All rights reserved. No part ofthis publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission ofOxford University Press. Library ofCongress Cataloging-in-Publishing Data Zinbarg, Richard E. Mastery ofyour anxiety and worry : therapist guide / Richard E. Zinbarg, Michelle G. Craske, David H. Barlow.—nd ed. p. cm. Rev. ed. of: Mastery ofyour anxiety and worry / Michelle G. Craske. Includes bibliographical references. ISBN- ---- (pbk.) ISBN--- (pbk.) . Anxiety—Treatment. . Worry—Treatment. . Stress management. . Self-help techniques. I. Craske, Michelle Genevieve II. Barlow, David H. III. Title [DNLM: . Anxiety Disorders—therapy. . Stress, Psychological—therapy. . Psychotherapy—methods. WM Zm] RC.C .(cid:1)—dc Printed in the United States ofAmerica on acid-free paper A b o u t Tr e a t m e n t s T h a t W o r k ™ Stunning developments in health care have taken place over the last sev- eral years, but many of our widely accepted interventions and strategies in mental health and behavioral medicine have been brought into ques- tion by research evidence as not only lacking benefit, but also perhaps inducing harm. Other strategies have been proven effective using the best current standards of evidence, resulting in broad-based recommen- dations to make these practices more available to the public. Several re- cent developments are behind this revolution. First, we have arrived at a much deeper understanding ofpathology, both psychological and physi- cal, that has led to the development ofnew, more precisely targeted inter- ventions. Second, our research methods have improved substantially, such that we have reduced threats to internal and external validity, making the outcomes more directly applicable to clinical situations. Third, govern- ments around the world, as well as health care systems and policymakers, have decided that the quality of care should improve, that it should be evidence-based, and that it is in the public’s interest to ensure that these changes occur (Barlow, ; Institute of Medicine, ). Ofcourse, the major stumbling block for clinicians everywhere is the ac- cessibility ofnewly developed evidence-based psychological interventions. Workshops and books can go only so far in acquainting responsible and conscientious practitioners with the latest practices in behavioral health care and their applicability to individual patients. This new series, “Treat- mentsThat Work™,” is devoted to communicating these exciting new interventions to clinicians on the frontlines of practice. The manuals and workbooks in this series contain step-by-step, detailed procedures for assessing and treating specific problems and diagnoses. But this series also goes beyond the books and manuals by providing an- cillary materials that will approximate the supervisory process in assist- ing practitioners in implementing these procedures in their practice. In our emerging health care system, the growing consensus is that evidence-based practice offers the most responsible course of action for the mental health professional. All behavioral health care clinicians deeply desire to provide the best possible care for their patients. In this series, our aim is to close the gap between dissemination and information and make that possible. This therapist guide and the companion workbook for clients address the treatment of generalized anxiety disorder (GAD). This disorder oc- curs in approximately % of the population (about two-thirds of them female), but is underrecognized and undertreated. With its characteristic symptoms ofuncontrollable, unstoppable worry about upcoming events, accompanied by chronic tension, fatigue, irritability, and difficulty sleep- ing,GAD can cause significant impairment. Most people seek treatment for this condition in primary care medical settings, where cognitive- behavioral treatments are seldom available. During the past years, we have developed increasingly effective treat- ments for GAD, to the point where these interventions compare favor- ably with the best psychological treatments for other disorders (Borko- vec & Ruscio, ). These treatments also have the advantage ofproven durability after treatment ends, with the added benefit ofallowing either substantial reduction or elimination of any anxiolytic medications pre- scribed before this treatment (Barlow, ). The approach in this man- ual was developed in our Center in the early s, and has now been substantially updated with the latest developments. We are gratified that countless numbers of individuals with GAD, in the hands of skilled therapists, have reported substantial benefit from this program. David H. Barlow, Editor-in-Chief, Treatments That Work™ Boston, MA vi C o n t e n t s Chapter Introductory Information for Therapists Chapter The Nature of Anxiety and Generalized Anxiety Disorder Chapter Outline of the Treatment Procedures and the Basic Principles Underlying Treatment Chapter The Nature of Generalized Anxiety Chapter Learning to Recognize Your Own Anxiety Chapter The Purpose and Function of Anxiety Chapter A Closer Look at Generalized Anxiety Disorder Chapter Learning to Relax Chapter Controlling Thoughts That Cause Anxiety: I. Overestimating the Risk Chapter Controlling Thoughts That Cause Anxiety: II. Thinking the Worst Chapter Getting to the Heart ofWorrying: Facing Your Fears Chapter From Fears to Behaviors Chapter Dealing with Real Problems: Time Management, Goal Setting, and Problem Solving Chapter Drugs for Anxiety and Their Relation to This Program Chapter Your Accomplishments and Your Future References About the Authors This page intentionally left blank Chapter 1 Introductory Information for Therapists The Mastery of Your Anxiety and Worry (MAW) program is designed to be presented in or more separate sessions that may be conducted either individually or in small groups. Ifadministered individually, each session should take approximately minutes. Typically, we allocate minutes for each session when conducting the program in small groups ofsix or eight. It is recommended that the therapist: () explain the prin- ciples and practices relevant to each ofthe lessons described in the MAW workbook, and () ask the clients to read the relevant material from the MAW workbook and complete the specified practice exercises between sessions. Beginning in chapter ofthis therapist guide, the major points of each session, the primary information that should be covered by the therapist, and the principles underlying the therapeutic procedures are de- scribed. Typical questions asked by patients and problems that may arise, based on our experience, are also included. Who Will Benefit from This Program? This program is designed for people who suffer primarily from worry and tension. It is ideally suited for those who meet the criteria for the diagno- sis of generalized anxiety disorder (GAD) in the Diagnostic and Statisti- cal Manual ofMental Disorders,th edition, Text Revision (DSM-IV-TR), but will also be useful for those individuals who have occasional worries or tension, but do not meet the severity criteria for GAD. The DSM-IV-TR criteria for the diagnosis ofGAD are given later. The key feature ofGAD in the DSM-IV-TRis excessive and pervasive worry for at least months. In thiscontext, excessive worry means that the intensity, duration, or fre- quency of worry exceeds the actual likelihood or negative consequences of the event that is the object of worry. In addition, the worry has the 1
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