The treatment of generalised anxiety disorder. A biopsychosocial approach across therapeutic schools

The coronavirus pandemic has led many people to experience an existential threat and triggered different forms of coping with this persistent stress situation. The risk for development of a generalised anxiety disorder has increased significantly. As established cognitive behavioural therapy (CBT) concepts are only moderately effective, a comprehensive therapy concept has been developed with reference to the biopsychosocial approach of Rief and Strauss (2018), in which reference to early imprints in the primary family (insecure-ambivalent attachment, suppression of curiosity behaviour) is conveyed in the context of psychoeducation as the cause of permanent worrying and intolerance of the uncertainty behind it. Against this background, the initial focus is on establishing a sustainable therapeutic relationship («alliance »), in which the patient’s autonomy and self-efficacy are promoted. Central to therapeutic progress is the promotion of self-efficacy-enhancing experiences and the reduction of avoidance behaviours through exposure and behavioural experimental techniques. The reduction of maladaptive coping through worry chains and reassurance behaviours occurs through the development of an increasingly greater tolerance of uncertainty in current daily life. Essential for prognosis are consideration of metacognitions and dysfunctional relationship patterns with the partner, as well as relaxation, aerobic exercise and the treatment of insomnia. Finally, this approach involves the treatment of dysfunctional coping strategies, which promote chronification