Intolerance-of-uncertainty therapy for GAD

Domain II · Behavioural & cognitive · Michel Dugas, Robert Ladouceur · 1990 · Laval University, Quebec

What it is

Format and dose (version followed). In Bouchard et al. (2022), treatment ran for 15 weekly 60-minute individual sessions in six modules. Therapists had to deliver all six modules in order and could not add material, but could vary the pace by one or two sessions. Written home exercises were set…

Format

• Format and dose (version followed). In Bouchard et al. (2022), treatment ran for 15 weekly 60-minute individual sessions in six modules. Therapists had to deliver all six modules in order and could not add material, but could vary the pace by one or two sessions. Written home exercises were set…

Who practises it, and how they are trained or regulated

• First edition (Dugas & Robichaud, 2007): the order is usually given as psychoeducation and worry awareness, uncertainty recognition and behavioural exposure, re-evaluation of the usefulness of worry, problem-solving training, imaginal (cognitive) exposure, then relapse prevention. In this version, cognitive exposure to core fears, problem-solving and re-evaluation of worry beliefs were the named components.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• see non-adherence in Section 5.
• a client seeking certainty that the gains will last. Treat that as one more uncertainty to tolerate.
• clients who have good skills but don't use them. That is an orientation problem, so stay on this step longer.
• formulations that stay at the level of worry topics (health, money, family). Push down to the shared element, which is not knowing.
• beliefs stated as feared outcomes ("the meeting will go badly"). Reframe them as beliefs about uncertainty ("if I'm not sure, I'll fail").

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.