SAMPLE TREATMENT PLAN

ANXIETY

Definitions: Excessive and/or unrealistic worry that is difficult to control

occurring more days than not for at least 6 months about
a number of events or activities.
Motor tension (e.g., restlessness, tiredness, shakiness, muscle
tension).
Autonomic hyperactivity (e.g., palpitations, shortness of
breath, dry mouth, trouble swallowing, nausea, diarrhea).
Hypervigilance (e.g., feeling constantly on edge, experiencing
concentration difficulties, having trouble falling or staying
asleep, exhibiting a general state of irritability).
Goals: Reduce overall frequency, intensity, and duration of the
anxiety so that daily functioning is not impaired.
Learn and implement coping skills that result in a reduction
of anxiety and worry, and improved daily functioning.

OBJECTIVES INTERVENTIONS

1. Describe situations, thoughts, 1. Focus on developing a level of

feelings, and actions associated trust with the client; provide
with anxieties and worries, their support and empathy to
impact on functioning, and encourage the client to feel safe
attempts to resolve them. in expressing his/her GAD
symptoms.
2. Ask the client to describe his/her
past experiences of anxiety and
their impact on functioning;
assess the focus, excessiveness,
and uncontrollability of the
worry and the type, frequency,
intensity, and duration of his/her
anxiety symptoms (consider using
a structured interview such as
The Anxiety Disorders Interview
Schedule–Adult Version).
2. Verbalize an understanding of 1. Discuss how generalized anxiety
the cognitive, physiological, and typically involves excessive
behavioral components of worry about unrealistic threats,
anxiety and its treatment. various bodily expressions of
 tension, overarousal, and
hypervigilance, and avoidance of
what is threatening that interact
to maintain the problem (see
Mastery of Your Anxiety and
Worry—Therapist Guide by
Zinbarg, Craske, and Barlow;
Treating GAD by Rygh and
Sanderson).
2. Discuss how treatment targets
worry, anxiety symptoms, and
avoidance to help the client
manage worry effectively, reduce
overarousal, and eliminate
unnecessary avoidance.
3. Assign the client to read
psychoeducational sections of
books or treatment manuals on
worry and generalized anxiety
(e.g., Mastery of Your Anxiety
and Worry—Workbook by
Craske and Barlow; Overcoming
Generalized Anxiety Disorder by
White).
3. Learn and implement calming 1. Teach the client calming/
skills to reduce overall anxiety relaxation skills (e.g., applied
and manage anxiety symptoms. relaxation, progressive muscle
relaxation, cue controlled
relaxation; mindful breathing;
biofeedback) and how to
discriminate better between
relaxation and tension; teach the
client how to apply these skills to
his/her daily life (e.g., New
Directions in Progressive Muscle
Relaxation by Bernstein,
Borkovec, and Hazlett-Stevens;
Treating GAD by Rygh and
Sanderson).
2. Assign the client homework each
session in which he/she practices
relaxation exercises daily,
gradually applying them
 progressively from non-anxiety-
provoking to anxiety-provoking
situations; review and reinforce
success while providing
corrective feedback toward
improvement.
4. Learn and implement a strategy 1. Explain the rationale for using a
to limit the association between worry time as well as how it is to
various environmental settings be used; agree upon a worry time
and worry, delaying the worry with the client and implement.
until a designated “worry time.”
2. Teach the client how to
recognize, stop, and postpone
worry to the agreed-upon worry
time using skills such as thought
stopping, relaxation, and
redirecting attention (or assign
“Making Use of the Thought-
Stopping Technique” and/or
“Worry Time” in the Adult
Psychotherapy Homework
Planner by Jongsma to assist
skill development); encourage
use in daily life; review and
reinforce success while providing
corrective feedback toward
improvement.
5. Verbalize an understanding of 1. Assist the client in analyzing
the role that cognitive biases play his/her worries by examining
in excessive irrational worry and potential biases such as the
persistent anxiety symptoms. probability of the negative
expectation occurring, the real
consequences of it occurring,
his/her ability to control the
outcome, the worst possible
outcome, and his/her ability to
accept it (see “Analyze the
Probability of a Feared Event”
in the Adult Psychotherapy
Homework Planner by Jongsma;
Cognitive Therapy of Anxiety
Disorders by Clark and Beck).
 6. Identify, challenge, and replace 1. Explore the client’s schema and
biased, fearful self-talk with self-talk that mediate his/her fear
positive, realistic, and response; assist him/her in
empowering self-talk. challenging the biases; replacing
the distorted messages with
reality-based alternatives and
positive, realistic self-talk that
will increase his/her self-
confidence in coping with
irrational fears (see Cognitive
Therapy of Anxiety Disorders by
Clark and Beck).
2. Assign the client a homework
exercise in which he/she identifies
fearful self-talk, identifies biases
in the self-talk, generates
alternatives, and tests through
behavioral experiments (or
assign “Negative Thoughts
Trigger Negative Feelings” in the
Adult Psychotherapy Homework
Planner by Jongsma); review and
reinforce success, providing
corrective feedback toward
improvement.

DIAGNOSIS

300.02 (F41.1)* Generalized Anxiety Disorder

*ICD-9-CM Code (ICD-10-CM Code)