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).
Learn and implement relapse prevention strategies for preventing or managing possible setbacks. (38, 39, 40, 41, 42)
Discuss with the client the distinction between a lapse and relapse, associating a lapse with an initial, potentially temporary, and reversible return of worry, anxiety symptoms, or urges to avoid, and relapse with the decision to return to previous fearful and avoidant patterns in a more sustained manner.
Identify and rehearse with the client the management of future situations or circumstances in which lapses could occur (i.e. high-risk times).
Instruct the client to continue using his/her/their new and effective therapeutic skills (e.g. relaxation, cognitive restructuring, exposure, and problem solving) in daily life to address emergent worries, anxiety, and avoidant tendencies.
Develop a “coping card” or other reminder on which new and effective worry management skills and other important information (e.g. “Breathe deeply and relax,” “Challenge unrealistic worries,” “Use problem solving”) are available to the client for later use.
Schedule periodic “maintenance” sessions to help the client maintain therapeutic gains.
Identify the fears that were learned in the family of origin and relate these fears to current anxiety levels. (43, 44)
Probe the client's family-of-origin experiences for fear-producing situations; help him/her/them relate these past events to current anxious thoughts, feelings, and behaviors; encourage and support the client's verbal expression and clarification of his/her/their feelings that are associated with past rejection experiences, harsh criticism, abandonment, or trauma.
Assign the client to read books on resolving painful early family experiences (e.g. Healing the Shame That Binds You by Bradshaw or Facing Shame by Fossum & Mason); process key concepts