Effect of Cognitive Restructuring, Worry Exposure, and Contrast Exposure on Worry

Numerous clinical trials have supported the efficacy of cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD). Despite this, psychological treatment of GAD continues to be unsatisfactory, with research suggesting that CBT is less efficacious for GAD compared to other anxiety disorders. Few studies have directly investigated the mechanisms underlying improvement within CBT. Research on the mechanisms of therapeutic change may help improve cognitive-behavioral treatments of GAD. This research investigated the direct impact of cognitive restructuring, worry exposure, and contrast exposure when they are utilized to address pathological worry. Six adults identified as meeting diagnostic criteria for GAD were recruited from the Anxiety and Depression Clinic at Hofstra University. Participants took part in a 15-week treatment study utilizing a single-case, alternating, counterbalanced treatment design. All participants received one psychoeducation session, three sessions of cognitive restructuring, three sessions of worry exposure, and three sessions of contrast exposure. It was hypothesized that all treatments would be effective, however the relative efficacy of each treatment strategy was unknown. Results indicated that five out of six participants experienced a reduction in worry from pre to post treatment. Worry exposure and cognitive restructuring appeared to have a greater effect on worry compared to contrast exposure. Individual characteristics appeared to play a crucial role in levels of state anxiety and worry. Results indicated that there might be a particular benefit for implementing cognitive based techniques prior to exposure therapy. Future research is needed on the relative contributions of cognitive-behavioral strategies in the treatment of GAD.