Which elements are typically included in a CBT case formulation for a generalized anxiety disorder presentation?

• A. Identify physiological arousal and sleep patterns only
• B. Identify genetic risk factors and family history
• C. Identify triggers, worry processes, cognitive distortions (catastrophizing, magnification), safety behaviors, avoidance; and propose interventions: cognitive restructuring, worry exposure, and thought monitoring
• D. Use ERP as sole intervention

Answer: (C)

In CBT, a case formulation for generalized anxiety disorder centers on how triggers activate worry, how worry processes are maintained, and how cognitive distortions and safety behaviors keep the anxiety going, then links those insights to targeted interventions. You map out triggers and the worry pattern, noting cognitive distortions like catastrophizing and magnification, and identify safety behaviors and avoidance that help the person temporarily feel safer but overall sustain the worry cycle. This map then guides treatment choices: cognitive restructuring to challenge and reframe distorted thoughts; worry exposure to practice maintaining worry in a controlled, nonthreatening way and reduce avoidance; and thought monitoring to increase awareness of automatic thoughts and develop more adaptive responses. This combination directly targets the core CBT mechanisms in GAD—uncontrollable worry, intolerance of uncertainty, and avoidance—so it provides a coherent plan for both understanding and treating the presentation. Other options don’t fit as well because they either focus only on physical symptoms, which misses the cognitive-behavioral drivers; emphasize genetic risk, which informs risk but not treatment planning; or propose a single intervention like ERP, which is not typically the sole or primary approach for GAD.