Hébert & Dugas (2019) · Generalised anxiety disorder
Hébert & Dugas (2019)
Trigger
A situation involving novelty, ambiguity or unpredictability — anything where the outcome is not yet known.
Uncertainty
Uncertainty: not knowing how things will turn out. People who are intolerant of uncertainty notice and react to it more readily than others.
Catastrophic Misinterpretation of Uncertainty
Catastrophic beliefs about uncertainty — e.g. 'Uncertainty is unbearable and unfair', 'If I'm unsure, I shouldn't act', 'Not knowing means something bad will happen'. Intolerance of uncertainty runs in the background and colours the whole cycle.
Worry
Worry: repeated 'What if...?' chains, trying to think the uncertainty away. Worry itself generates further possibilities — and so more uncertainty.
Anxiety
Anxiety: apprehension and physical arousal — restlessness, muscle tension, irritability, poor concentration and disturbed sleep.
Safety Behaviours
Safety behaviours: reassurance-seeking, over-preparation, checking, list-making, doing things oneself, or avoiding uncertain situations. They lower anxiety briefly but prevent the person from learning that uncertainty can be tolerated.
The published model, shown for reference. Switch to “Blank” to see the empty template you complete with a client.
Some people find not knowing how things will turn out especially hard to bear. This model describes a pattern that can keep generalised anxiety going.
It begins with a situation that is new, ambiguous, or unpredictable — anything where the outcome is not yet certain. For someone who finds uncertainty very uncomfortable, that not-knowing gets read as a sign that something bad is likely, or as simply unbearable or unfair.
That reading sparks worry — long chains of 'What if...?' — as the mind tries to think its way to certainty. Worry brings anxiety: feeling on edge, restless, tense, and finding it hard to switch off. To feel safer, people often seek reassurance, over-prepare, double-check, or avoid uncertain situations altogether.
These responses ease the discomfort for a moment, but they get in the way of discovering that uncertainty can be lived with. So the pattern repeats — and worrying, by throwing up ever more possibilities, can actually add to the very sense of uncertainty it was meant to settle.
How to introduce the model, guided-discovery questions, treatment targets and a behavioural experiment are available to signed-in therapists.
This diagram is a reconstruction of the published model for clinical and educational use, grounded in the sources above.
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
Sign up free to open the interactive formulation builder, complete this model collaboratively, and export it as a PDF or share it with your client.