Worry & Indecisiveness: Tackling Decision Making Worries in the Context of GAD

Workshop Outline

The primary feature of generalized anxiety disorder (GAD) is excessive worry about daily life events, with the content of worry tending to be dynamic and regularly shifting according to the day. As a consequence, CBT for GAD is typically most effective when targeting processes that underlie excessive worry, rather than the specific worries themselves. Despite this, there are certain common worry themes that do emerge for many GAD clients, and can be more directly addressed within a larger CBT protocol for GAD. Among these is worries related to indecisiveness. Daily life decisions, such as what to wear on a given day or which colour to paint one’s walls, are inherently uncertain as there is no clear “right” answer. Within the CBT for GAD protocol targeting intolerance of uncertainty (CBT-IU), uncertain situations are a trigger for worry, such that daily life decisions can become a significant catalyst for worries.  

This workshop will discuss the clinical application of CBT-IU for GAD, with a particular focus on targeting the worry theme of indecisiveness in daily life situations. Although the role of intolerance of uncertainty in the development and maintenance of worry will be highlighted, its specific impact on decision-making worries and associated safety behaviours will be emphasized. This presentation will include a discussion of the following: 1) presentation of the CBT-IU model for GAD; 2) review of behavioural experiments targeting intolerance of uncertainty 3) presentation of maximizer and satisficer decision-making styles, and their influence on how people approach daily life decisions and evaluate their choices; 4) the impact of cognitive dissonance with respect to the relationship of effort and value; 5) safety behaviours for decisional worries, and the unique goals of “straddling the line” and “controlled spontaneity” when developing behavioural experiments involving decision-making. Specific examples of decision-making worries and how to target them will be provided, and case vignettes will be presented throughout.