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the subject of worry (see Cognitive Therapy of Anxiety Disorders by Clark & Beck; Metacognitive Therapy for Anxiety and Depression by Wells).
Assign the client a homework exercise in which he/she/they identify fearful self-talk, identify biases in the self-talk, generate alternatives, and test through behavioral experiments (or supplement with “Negative Thoughts Trigger Negative Feelings” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce); review and reinforce success, providing corrective feedback toward improvement.
Participate in gradual imaginal and/or live exposure to the feared negative consequences predicted by worries and develop alternative reality-based predictions. (27, 28, 29, 30, 31)
Direct and assist the client in constructing a hierarchy of feared and avoided activities such as travel, medical procedures or conditions, or social events (or supplement with “Gradually Reducing Your Phobic Fear” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Select initial exposures that have a high likelihood of being a successful experience for the client; develop a plan for managing the emotion(s) engendered by exposure; mentally rehearse the procedure.
Conduct worry exposure by asking the client to vividly imagine worst-case consequences of worries, holding them in mind until anxiety associated with them decreases (up to 30 minutes); generate reality-based alternatives to that worst case and process them (see Mastery of Your Anxiety and Worry: Therapist Guide by Zinbarg, Craske, & Barlow).
Conduct exposure in vivo to activities that the client avoids due to unrealistic worry, gradually targeting the removal of any unnecessary, anxiety-driven safety behaviors (see Mastery of Your Anxiety and Worry: Therapist Guide by Zinbarg, Craske, & Barlow).
Assign the client a homework exercise in which he/she/they do worry exposures and record responses (see Mastery of Your Anxiety and Worry: Workbook by Craske & Barlow); review, reinforce success, and provide corrective feedback toward improvement.
Learn and implement problem-solving strategies for realistically addressing worries. (32, 33)
Teach the client problem-solving/solution-finding strategies to replace unproductive worry and/or avoidance involving specifically defining a problem, generating options for addressing it, evaluating the pros and cons of each option, selecting and implementing an action plan, and reevaluating and refining the action.
Assign the client a homework exercise in which he/she/they problem-solve a current problem about which he/she/they worry (or supplement with “Applying Problem Solving to Interpersonal Conflict” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce; see Mastery of Your Anxiety and Worry: Workbook by Craske & Barlow); review, reinforce success, and problem-solve obstacles toward sustained implementation.
Identify and engage in rewarding activities on a daily basis. (34)
Engage the client in behavioral activation, increasing the client's contact with sources of reward, identifying processes that inhibit activation, and teaching skills to solve life problems (or supplement with “Identify and Schedule Pleasant Activities” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce); use behavioral techniques such as instruction, rehearsal, role-playing, role reversal as needed to assist adoption into the client's daily life; reinforce success; problem-solve obstacles toward sustained implementation.
Learn and implement personal and interpersonal skills to reduce anxiety and improve interpersonal relationships. (35, 36)
Use instruction, modeling, and role-playing to build the client's general social, communication, and/or conflict resolution skills.
Assign the client a homework exercise in which he/she/they implement social skills into his/her/their daily life (or supplement with “Restoring Socialization Comfort” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce); review, reinforce success, and problem-solve obstacles toward sustained implementation.
Learn a nonjudgmental, accepting approach to worries, overcoming avoidance, and engaging in action toward personally meaningful goals. (37)
Use techniques from acceptance-based therapies including psychoeducation about worry, mindfulness, cue detection, monitoring and decentering, relaxation, and mindful action toward expanding present-moment awareness; encourage acceptance rather than judgment and avoidance of internal experiences; and promote action in areas of importance to the individual (see An Acceptance-Based Behavioral Therapy for Generalized Anxiety Disorder by Roemer & Orsillo; and/or supplement by asking the client to read The Mindful Way Through Anxiety by Orsillo & Roemer as an adjunct to the therapy).
