Assessment & Research

The Effects of Worry and Relaxation on Flexibility During Cognitive Restructuring.

Stevens et al. (2018) · Behavior modification 2018
★ The Verdict

Run a brief relaxation exercise before cognitive restructuring for GAD clients—worry first makes their alternative predictions more negative and abstract.

✓ Read this if BCBAs doing cognitive work with anxious adults in clinic or telehealth.
✗ Skip if Practitioners who only treat young children or non-verbal clients.

01Research in Context

01

What this study did

The team asked adults with GAD symptoms to think in three different ways before doing cognitive restructuring.

One group worried for five minutes. One group relaxed. One group thought neutral thoughts.

Then everyone wrote new predictions for bad events. The researchers counted and rated these predictions.

02

What they found

Worry did not change how many new predictions people wrote. It did not change how likely they thought the events were.

It did make the predictions more negative and more vague. Relaxation kept the predictions balanced and concrete.

03

How this fits with other research

Ladouceur et al. (1997) showed that high worriers ask for extra facts when tasks are only partly clear. The new study adds that worry also twists the facts people already have.

Eggleston et al. (2018) found that problem-solving only helps when stress is controllable. Here, relaxation helped no matter the topic, so it may be the safer first step.

Brosnan et al. (2025) link intolerance of uncertainty to long deliberation in autism. Our GAD sample showed a faster bias, hinting that different diagnoses may need different timing fixes.

04

Why it matters

You can spare two minutes to run a brief relaxation script before you ask anxious clients to reframe thoughts. This tiny step keeps their new predictions concrete and less doom-filled. No extra forms, no tech, just a quieter mind ready to do the real work.

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→ Action — try this Monday

Open your next GAD session with two minutes of paced breathing, then move to thought logs.

02At a glance

Intervention
not applicable
Design
randomized controlled trial
Sample size
189
Population
anxiety disorder
Finding
mixed

03Original abstract

Worry is associated with inflexibility in cognitive, emotional, and physiological functioning. In addition, worry's negative valence and abstract level of construal are rigid characteristics that contribute to its nonadaptive consequences. Relaxation and cognitive therapy aim to increase flexibility in chronic worriers, and may have greater efficacy when administered in combination. We examined the extent to which relaxation enhances and/or worry inhibits cognitive flexibility during a cognitive restructuring exercise in which participants generated alternative predictions for their worries. Participants ( n = 189) were randomly assigned to engage in relaxation, worry, or neutral thinking prior to cognitive restructuring. We measured the number and perceived likelihood of alternative predictions generated by participants, and coded those alternative predictions for their degree of positive valence, negative valence, and level of construal (abstractness to concreteness). Worry and relaxation did not lead to different numbers or perceived likelihood of alternative predictions. However, compared with participants with minimal symptoms of generalized anxiety disorder (GAD), those with elevated symptoms of GAD who engaged in prior worry generated alternative predictions characterized by greater negative valence and more abstractness (i.e., less concreteness). We also found that greater negative valence of alternative predictions was associated with more abstractness, whereas greater positive valence of alternative predictions was associated with more concreteness. These findings suggest that after engaging in worry, individuals with GAD may be less able to flexibly shift from the use of nonadaptive characteristics (negative valence, abstractness) associated with feared outcomes to the use of more adaptive characteristics (positive valence, concreteness) when considering alternative predictions.

Behavior modification, 2018 · doi:10.1177/0145445517732272