Introduction
On September 22nd 2023, Dr. Melisa Robichaud delivered a half-day workshop on behavioural experiments for excessive worry and GAD, with an emphasis on targeting the fear of uncertainty and its consequences.
Workshop Outline
Excessive worry is a symptom present across most anxiety disorders, and it is also the cardinal feature of generalized anxiety disorder (GAD). Yet despite its omnipresence in anxiety, excessive worry can be challenging to address in treatment, particularly with individuals struggling with GAD. A primary reason for this is that the content of worry can often be varied and shifting in nature, such that traditional CBT strategies that target the worries themselves can often feel like they involve “chasing a moving target”. It can therefore be more helpful to conceptualize excessive worries and GAD according to the processes that underlie them, rather than on the symptom of worry itself. This workshop will focus on the process-driven understanding and treatment of excessive worry and GAD as a cognitive response to the perceived threat of uncertainty and its consequences on outcomes and personal coping due to an overall intolerance to uncertainty.
This workshop will present clinical strategies designed to conceptualize and treat excessive worry seen in GAD and other anxiety disorders through the lens of the construct of intolerance of uncertainty (IU). Specifically, the role of IU as the primary theme of threat in GAD and excessive worry will be introduced, with an emphasis on presenting a cohesive and logical rationale to clients. In addition, the development, application, and debriefing of behavioural experiments designed to specifically challenge negative beliefs about uncertainty will be presented. Specific examples of worry themes will also be reviewed, including worries related to decision-making, perfectionism, and a need for control. Case vignettes, as well as detailed homework handouts and examples, will be included throughout.
Content
Learning Objectives
At the end of the session, attendees will learn to:
Understand and conceptualize excessive worry and GAD within a CBT framework that highlights the role of intolerance of uncertainty
Present a clinical model of excessive worry to clients that uses the fear of uncertainty as the primary theme of threat
Identify worry-specific safety behaviours
Develop behavioural experiments designed to test out negative beliefs about uncertainty and its consequences
Troubleshoot challenging presentations, including worries related to perfectionism, indecisiveness, and need for control
About the Presenter
Dr. Melisa Robichaud is a Founding Director of the Vancouver CBT Centre, where she works as a clinical psychologist specializing in the assessment and treatment of anxiety disorders. She is currently an adjunct faculty member in the University of British Columbia (UBC) Department of Psychology, a clinical instructor in the UBC Department of Psychiatry, and a clinical associate in the Simon Fraser University (SFU) Department of Psychology. She received her Ph.D. in clinical psychology at Concordia University in Montreal, completed her internship training at the UBC Hospital Anxiety Disorders Clinic, and a post-doctoral fellowship in the Department of Psychiatry at UBC Hospital.
Dr. Robichaud is a past President of the Canadian Association of Cognitive and Behavioural Therapies (CACBT) and has been certified as an expert in CBT by the organization. She is also on the Anxiety Canada Scientific Advisory Board, and has served on their Board of Directors from 2006 to 2010.
Her area of clinical specialization is CBT for anxiety disorders, with a special emphasis on generalized anxiety disorder. She has provided workshops internationally and has published numerous scientific articles and book chapters on the subject, as well as co-authoring several books on the cognitive-behavioural treatment of GAD, including Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice (2nd edition), The Generalized Anxiety Disorder Workbook: A Comprehensive CBT Guide for Coping with Uncertainty, Worry, and Fear, and The Worry Workbook: CBT Skills to Overcome Worry and Anxiety by Facing the Fear of Uncertainty.
Training Modalities
The workshop will combine didactic components with case illustrations, and Q&A.
Who should attend
This workshop is most suitable for mental health professionals with some prior exposure to CBT and its application to GAD and to excessive worry across the anxiety spectrum.
Continuing Education (CE) Credits
Bespoke Mental Health Canada is approved by the Canadian Psychological Association to offer continuing education for psychologists. Bespoke Mental Health Canada maintains responsibility for the program.
After viewing this workshop, participants have the option to complete an evaluation form and a workshop knowledge quiz in order to be eligible to receive a certificate confirming the number of credits awarded. This certificate will be sent via email.
Participants who completed this workshop are eligible to receive 3 CE credits
Fees
Professionals: $100 CAD +tax
Students*: $80 CAD +tax
* Proof of student status may be required in order to qualify for a student rate.
Key References
Beesdo-Baum, K., Jenjahn, E., Hofler, M., Lueken, U., Becker, E.S., & Hoyer, J. (2012). Avoidance, safety behavior, and reassurance seeking in generalized anxiety disorder. Depression and Anxiety, 29, 948-957.
Dugas, M.J., Sexton, K.A., Hebert, E.A., Bouchard, S., Gouin, J.-P., & Shafran, R. (2022). Behavioral experiments for intolerance of uncertainty: A randomized clinical trial for adults with generalized anxiety disorder. Behavior Therapy, 53, 1147-1160.
McMillan, D., & Lee, R. (2010). A systematic review of behavioral experiments vs. exposure alone in the treatment of anxiety disorders: A case of exposure while wearing the emperor’s new clothes? Clinical Psychology Review, 30, 467–478.
Robichaud, M., & Dugas, M.J. (2015). The generalized anxiety disorder workbook: A comprehensive CBT guide for coping with uncertainty, worry, and fear. New Harbinger: Oakland
Robichaud, M., Koerner, N., & Dugas, M.J. (2019). Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice (2nd ed.). Routledge: New York.