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How to Handle Uncertainty Without Spiraling: A Guide to Mental Resilience

Control seems like the best cure for anxiety, but managing how your nervous system interprets ambiguity helps break the mental spiral of uncertainty.

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September 18, 2026
Stress Management & Mental Resilience

Uncertainty is the condition of having incomplete information about an outcome, a probability, a timeline, or an appropriate response. It is not an emotional flaw, a cognitive failure, or a medical disorder. Instead, it is an unavoidable baseline condition of daily work, health, relationships, and long-term planning.

Mental resilience when facing the unknown is often misunderstood. It is not an unshakeable sense of calm, nor is it the ability to predict the future with total accuracy. True resilience is the capacity to stay present, think clearly, and take sensible action while incomplete information remains unresolved.

When the brain cannot tolerate missing data, it often creates worst-case scenarios to fill the void. This guide examines why the mind prefers a painful explanation over no explanation at all. It outlines evidence-based strategies from cognitive science to help you break mental spirals, regulate nervous system arousal, and make sound decisions under pressure.

  • Ambiguous Event or Unanswered Question
  • Negative Threat Interpretation
  • Heightened Autonomic & Emotional Arousal
  • Urgent Control Reaction: Checking / Rehearsing
  • Temporary Sense of Relief
  • Reinforced Belief: "Uncertainty is Dangerous"

What Does the Science Say About Uncertainty and Stress?

Research from clinical psychology and neuroscience shows that the distress people experience during periods of ambiguity is rarely caused by the missing facts alone. Instead, the distress stems from a trait known as intolerance of uncertainty. This trait reflects a tendency to view ambiguous situations as inherently threatening, distressing, unfair, and paralyzing.

Psychological research demonstrates that intolerance of uncertainty is a core vulnerability factor across several anxiety conditions. When researchers developed the Intolerance of Uncertainty Scale, they found that people who struggle with the unknown often believe that ambiguity prevents effective action. These individuals frequently believe that unexpected events are negative and should be avoided at all costs.

  • Intolerance of Uncertainty Patterns
  • 1. Information Gathering: Checking updates repeatedly
  • 2. Action Paralysis: Postponing choices until certainty
  • 3. Cognitive Rehearsal: Looping hypothetical outcomes
  • 4. Meaning Imposition: Treating "unknown" as "bad news"

The evidence supporting this relationship is strong and consistent across clinical and non-clinical populations. In cognitive-behavioral treatment studies, reductions in intolerance of uncertainty directly mediated reductions in worry. In fact, research published in cognitive therapy journals suggests that lowering this intolerance accounted for nearly sixty percent of the reduction in worry during treatment. When people learn to tolerate open-ended scenarios, their chronic worry drops significantly.

Understanding this dynamic is critical for your daily health. When you treat every open question as a personal crisis, your nervous system remains in sustained sympathetic activation. This ongoing arousal elevates daytime fatigue and disrupts the quality of your nightly rest. If you want to understand how chronic cognitive tension drains your daily physical capacity, reading about how invisible cognitive demands drain biological energy can provide valuable biological context.

  • Long-Term Impact on Daily Functioning
  • Sustained sympathetic nervous system tone
  • Heightened baseline muscle tension
  • Fragmented slow-wave sleep
  • Executive fatigue and decision paralysis

Why Does the Brain Prefer a Bad Story to Not Knowing?

The human brain operates as an advanced prediction engine. It constantly compares incoming sensory signals with internal models of the world to forecast what will happen next. From this predictive perspective, an open question represents an unresolved prediction error. The brain feels compelled to resolve that error to restore a sense of predictability.

  • Prediction Error Loop
  • Incoming Stimulus
  • Internal Prediction Model
  • (Mismatch Detected)
  • Aversive Information Gap
  • Constructed Premature Conclusion

The Information-Gap Account

Information-gap theory explains that when a question feels personally important but remains unanswered, the gap itself becomes emotionally painful. People naturally prefer clarity and definitive beliefs over sustained ambiguity. As a result, the mind will often accept a premature explanation just to close the painful gap.

A flawed or negative conclusion feels more manageable than a vacuum. A conclusion gives the brain a definite landscape to react against. If you conclude that a silent colleague is upset with you, your mind instantly constructs a narrative. You can mentally prepare an apology, plan a defense, or look for alternative support. If the reality is simply that you do not know why they have not replied, your mind feels paralyzed without a defined problem to solve.

  • Information Gap Responses
  • Open Ambiguity: Unclear meaning - Indefinite waiting - Perceived paralysis
  • Negative Story: Defined problem - Action script generated - Illusion of agency

The Illusion of Agency and False Certainty

A negative explanation creates a temporary illusion of agency. Anxious thinking frequently biases this process toward worst-case scenarios. The mind selects the interpretation that accounts for the greatest potential loss, rejection, or failure.

This mechanism creates an interesting cognitive paradox:

> The mind often prefers to know that something terrible is happening rather than remain unsure whether anything is wrong at all.

This manufactured state is known as false certainty. False certainty offers brief emotional relief from the discomfort of the unknown. Unfortunately, this relief comes at the expense of factual accuracy.

Under sustained stress, the brain regularly confuses coherence with truth. A story that is vivid, detailed, and emotionally intense feels true to a stressed nervous system. In reality, a vivid story is merely a mental forecast built from incomplete observations.

  • Common Cognitive Confusions Under Stress
  • Vividness is mistaken for high probability
  • Emotional intensity is mistaken for factual truth
  • Mental repetition is mistaken for practical problem-solving

What Factors Shape How Strongly We React to the Unknown?

The intensity of your reaction to unresolved situations is shaped by internal and external variables. These factors alter how threat appraisal networks process ambiguous cues.

  • Factors Influencing Arousal
  • Physiological State
  • Predictive Capacity
  • Contextual Realities
  • Sleep deprivation - Chronic health issues - Financial insecurity
  • Autonomic tone - Competing life demands - Discrimination

Autonomic Baseline and Sleep Deprivation

Your underlying autonomic state plays a powerful role. When you are sleep-deprived, the prefrontal networks responsible for emotional regulation and cognitive flexibility show reduced functional connectivity. At the same time, deeper threat-monitoring systems become hyper-reactive.

In this state, ambiguous messages or minor delays are instantly flagged as immediate dangers. If your brain is constantly racing before sleep, learning practical ways to reduce bedtime mental overload can help settle physiological arousal before it distorts your daytime thinking.

  • Physiological Cascade
  • Poor Sleep Reduced Prefrontal Control Heightened Threat Bias Low Uncertainty Tolerance

Chronic Health Status and Life Demands

Your overall health status also changes how your brain processes missing information. Research examining people with long-term medical conditions shows that higher intolerance of uncertainty correlates with lower psychological well-being. When you must manage unpredictable symptoms, your baseline cognitive load is already elevated.

Adding workplace or relational ambiguity to this existing load quickly exhausts your coping capacity. Similarly, adults juggling complex professional duties alongside family caregiving have fewer mental reserves available to process ambiguous feedback.

  • Compounding Vulnerabilities
  • Baseline symptom unpredictability
  • Constant physical monitoring
  • Depleted cognitive reserves
  • Amplified threat appraisal

Social and Structural Realities

Real-world conditions shape your baseline vigilance. A person dealing with unstable housing, financial strain, or systemic discrimination has concrete reasons to remain alert. In these environments, ambiguity often carries real risks.

Vigilance in these contexts is an understandable adaptation to an unstable environment rather than an internal cognitive error. It is vital to separate practical environmental vigilance from unproductive mental loops that drain personal energy without providing safety.

  • Vigilance Assessment
  • Structural Vigilance: Protects against measurable, recurring environmental hazards
  • Internal Rumination: Loops over hypothetical, uncontrollable possibilities

How Does the Uncertainty Spiral Develop in Daily Life?

The path from an ambiguous trigger to an exhausting mental spiral follows a predictable seven-step cycle. Recognizing these individual stages allows you to intervene before the loop gains momentum.

  • THE UNCERTAINTY SPIRAL
  • 1. Ambiguous Trigger
  • 2. Threat Interpretation
  • 3. Cognitive Amplification
  • 4. Urgent Control Action
  • 5. Fleeting Relief
  • 6. Negative Reinforcement
  • 7. Sensitized Baseline

Stage 1: The Ambiguous Trigger

The cycle begins with an unresolved observation. Common examples include an unread email, an unexpected bodily sensation, vague feedback from a manager, or shifting economic headlines. At this starting point, the event contains missing information but no confirmed harm.

  • Common Everyday Triggers
  • A brief text message lacking customary punctuation
  • A subtle, unfamiliar muscle twitch
  • A calendar invite without a clear agenda

Stage 2: Negative Threat Interpretation

The brain reviews the missing data and applies a threat bias. It interprets the silence, delay, or sensation as an active indicator of danger. The working thought shifts from "I do not know the reason for this delay" to "This delay means something has gone wrong."

Stage 3: Cognitive Threat Amplification

The mind inflates both the probability and the personal cost of the imagined negative outcome. It treats a low-probability event as an imminent reality. You begin to mentally forecast severe consequences, such as professional dismissal, severe illness, or relational abandonment.

Stage 4: The Urgent Control Reaction

To extinguish the rising internal discomfort, the individual executes a rapid control behavior. These actions include:

  • Repeatedly refreshing an inbox or messaging platform
  • Searching symptoms and personal forums online for hours
  • Mentally running through defensive dialogues
  • Seeking immediate, repetitive reassurance from peers or family

Stage 5: Fleeting Emotional Relief

The control behavior momentarily reduces internal anxiety. A reassurance text arrives, an online article seems temporarily soothing, or mental exhaustion forces a brief pause. Autonomic arousal drops slightly.

Stage 6: Neural and Behavioral Reinforcement

Although relief feels welcome, it teaches the brain a dangerous lesson. The nervous system learns that the ambiguous situation was genuinely hazardous. It concludes that the frantic checking behavior was the precise action that prevented catastrophe.

Stage 7: Lowered Baseline Tolerance

Because the brain never discovered that it could endure the discomfort of not knowing, baseline tolerance decreases. The next ambiguous event triggers the threat appraisal system even faster. The threshold for what feels intolerable drops, locking the person into a recurring loop.

  • The Reinforcement Mechanism
  • Uncertainty Feared
  • Compulsive Check
  • Brief Calm
  • Brain Learns: "Checking Saved Me"

How Can You Tell Real Danger Apart From Mental Spirals?

Tolerating uncertainty does not mean ignoring genuine hazards or living recklessly. Resilient decision-making relies on separating sensible caution from unproductive overthinking.

  • Decision Boundaries
  • Sensible Caution Intolerance of Mystery
  • Identifies concrete risks Reacts to vague feelings
  • Gathers bounded data Gathers limitless data
  • Acts despite ambiguity Delays action for calm
  • Sets clear review dates Re-evaluates constantly

The Nature of Sensible Caution

Sensible caution focuses on identifiable risks where objective evidence exists. You collect a bounded amount of practical information to make a proportionate choice. Once you take reasonable precautions, you establish a future review date and continue with your daily responsibilities.

Caution accepts that some degree of unknown outcome always remains. It matches the scale of your preparation to the actual likelihood and impact of the hazard.

The Traps of Uncertainty Intolerance

Intolerance of uncertainty behaves very differently. It demands an absolute emotional guarantee that nothing bad will happen before it allows you to rest. It drives you to collect information that cannot change your underlying choice.

Intolerance treats every hypothetical disaster as an urgent emergency requiring immediate resolution. It regularly confuses emotional discomfort with factual vulnerability.

To clarify your thinking during an active worry spiral, use the systematic comparison below:

Probability Assessment

Ask yourself what concrete evidence supports the negative prediction right now. Separate verifiable facts from mental forecasts. If your only evidence is an uneasy bodily sensation, your actual probability of disaster remains unproven.

  • Evidence Evaluation
  • Observable Facts: Written statements, hard numbers, confirmed dates
  • Mental Projections: Inferred motives, imagined scenarios, catastrophic forecasts

Impact Assessment

Evaluate the realistic impact if the unwanted event occurs. Would it represent an absolute catastrophe, or would it be an inconvenient challenge requiring steady adaptation? Intolerance of uncertainty regularly mistakes manageable discomfort for permanent destruction.

  • Impact Calibration
  • Catastrophic Disaster
  • Manageable Friction

Proportionate Action

Identify the single smallest constructive step available today. If an effective action exists, take it calmly. If no constructive step exists because the outcome depends entirely on future events, any further thinking is rumination rather than problem-solving.

  • Action Checklist
  • 1. Is there an action I can complete in under twenty minutes?
  • 2. Will this action alter the objective outcome?
  • 3. If yes: Execute the step and stop.
  • 4. If no: Acknowledge the hypothetical nature and redirect attention.

What Concrete Steps Build Real Resilience Under Pressure?

Building tolerance for the unknown is a practical skill that develops through structured daily practice. The following evidence-informed methods will help you navigate ambiguous situations without spiraling.

  • PRACTICAL RESILIENCE PROTOCOL
  • 1. Regulate Physiology
  • 2. Name the Process
  • 3. Sort Facts & Fiction
  • 4. Apply Stopping Rules
  • 5. Structured Exposure

1. Regulate Physiology Before Reasoning

When your autonomic nervous system is in high sympathetic arousal, your prefrontal cortex cannot balance complex probabilities effectively. Trying to out-think a panic spiral while your heart is racing usually produces more catastrophic narratives.

Begin by steadying your physical baseline:

  • Place both feet flat on the floor and release tension in your jaw and shoulders.
  • Lengthen your exhalations so they are noticeably longer than your inhalations.
  • Name five specific sensory objects in your immediate physical environment.
  • Wait several minutes before typing a message, searching the web, or making a decision.

This quick physiological reset signals safety to subcortical threat centers. It allows your executive networks to re-engage before you interpret the situation.

  • Autonomic Reset Steps
  • Physical Grounding
  • Extended Exhale
  • Sensory Labeling
  • Paused Action

2. Name the Internal Process

Use cognitive labeling to create distance between your observing awareness and your anxious predictions. Unhook yourself from automatic thoughts by changing your internal language:

  • Instead of saying "I am going to lose my job," try "I am having the thought that this delayed reply means my job is unsafe."
  • Instead of saying "Something is wrong with my health," try "My brain is trying to close an information gap with a catastrophic forecast."
  • Say to yourself: "This is the discomfort of an open question, not proof of an immediate threat."

This linguistic shift prevents you from mistaking internal cognitive noise for external objective reality.

  • Cognitive Labeling Formula
  • Outcome X
  • Ambiguous Cue Y

3. Use the Known, Unknown, and Influenceable Framework

When an unresolved issue consumes your focus, divide your notes into three distinct categories:

  • 1. What is Known?
  • (List only confirmed facts, direct quotes, and data)
  • 2. What is Unknown?
  • (List missing details, future timing, and motives)
  • 3. What is Influenceable?
  • (List the single action step within your direct control)

Consider a workplace scenario where your supervisor cancels a regular catch-up meeting:

  • Known: The meeting was cancelled fifteen minutes prior with a brief calendar notification.
  • Unknown: The reason for the cancellation, the supervisor's schedule, and their view of your work.
  • Influenceable: Continue your current project tasks and ask a brief scheduling question tomorrow morning if necessary.

This practice stops unverified assumptions from masquerading as settled facts. If you frequently take work stress to bed, using structured tools like external next-action plans to reduce cognitive interference can help you set aside unfinished tasks until morning.

4. Apply Minimum Sufficient Information and Stopping Rules

Uncontrolled information-gathering is one of the most common ways people feed an uncertainty spiral. Before you open a search engine or ask for advice, establish clear stopping rules:

  • Stopping Rule Architecture
  • Define the exact decision being made.
  • Select a maximum of two credible reference sources.
  • Set a strict fifteen-minute time limit for review.
  • Commit to a choice based on available data, then close all tabs.

Gathering facts helps when it changes your immediate choice. It becomes harmful when it transforms into an endless loop that fuels distress. Setting boundaries on information gathering protects your mental clarity.

  • Information Gathering Boundary
  • Define Question
  • Check 2 Sources
  • 15-Min Timer
  • Select Action & Close

5. Practice Structured Uncertainty Exposures

Cognitive-behavioral protocols use behavioral experiments to help individuals learn that ambiguity is safe. You can systematically build tolerance through purposeful, low-stakes exposures:

  • Delay asking for reassurance from a friend or partner for twenty minutes.
  • Send an ordinary email without re-reading it multiple times.
  • Make a low-stakes restaurant or menu selection without reading online reviews.
  • Leave an ambiguous, non-urgent message unread until a designated afternoon check-in.

Record what you expected to happen, the discomfort you experienced, and what actually occurred. Over time, your nervous system learns that the feeling of not knowing is uncomfortable, but fundamentally safe.

  • Behavioral Experiment Log
  • Target Action Feared Outcome Actual Result Lesson Learned
  • Delay check 20m Disaster strikes Nothing changed Discomfort faded

6. Replace Reassurance-Seeking with Grounded Support

Repeatedly asking others if things will be alright provides only temporary comfort. The underlying doubt almost always returns quickly.

Shift your interactions toward genuine support rather than certainty-seeking:

  • Instead of asking: "Are you sure this presentation is completely fine?"
  • Try asking: "I notice I am feeling uneasy about this talk. Would you sit with me for five minutes while I organize my notes?"
  • Instead of asking: "Are you certain you are not upset with me?"
  • Try saying: "My mind is running through worst-case scenarios today. I am practicing sitting with this feeling without asking you for constant reassurance."

This shift breaks the interpersonal checking loop while preserving meaningful emotional connection.

  • Interpersonal Shift
  • Demanding Certainty: "Promise me nothing bad will happen." (Reinforces fragility)
  • Requesting Support: "Help me stay steady while I handle this open question." (Builds resilience)

Where Are the Real-World Boundaries of Uncertainty Research?

While cognitive-behavioral approaches to uncertainty are supported by clinical trials, it is essential to understand the real-world boundaries of this research.

  • RESEARCH BOUNDARIES
  • Methodological Limits
  • Contextual Limits
  • Clinical trial homogeneity - Structural & financial instability
  • Self-report scale reliance - Systemic marginalization
  • Mechanistic complexity - Acute medical risks

Study Populations and Measurement Limits

Much of the foundational literature on intolerance of uncertainty was developed using university student cohorts and adults diagnosed with generalized anxiety disorder. While recent research has evaluated broader populations, findings from clinical trials cannot be applied universally to every individual facing ordinary life strain.

Furthermore, research scales like the Intolerance of Uncertainty Scale measure subjective self-reports. These instruments measure personal attitudes and behavioral tendencies rather than fixed biological traits. A high score on a self-report questionnaire reflects an area for skill development rather than a permanent medical diagnosis.

  • Measurement Realities
  • Self-report tools capture current attitudes, not unalterable neurological wiring.
  • Population cutoffs vary significantly across distinct life stages and medical settings.

The Complexity of Brain Systems

Neuroimaging studies show that processing uncertain choices involves complex interactions between the insula, amygdala, and prefrontal networks. The insula tracks perceived risk, while prefrontal regions regulate emotional appraisals.

However, these findings reflect complex, dynamic networks rather than a simplistic fear switch in the brain. Popular wellness claims that reducing stress is as simple as turning off your amygdala oversimplify human neuroscience. Cognitive and physiological regulation work together over time, not through instant biological switches.

  • Neurobiological Reality
  • Dynamic Neural Networks
  • Single "Fear Switch" Narratives

Contextual and Structural Limits

Uncertainty tolerance techniques are designed to address internal cognitive distortions. They are not a substitute for addressing genuine instability, hazardous environments, or systemic inequality.

If you are navigating an unsafe workplace or unstable housing, your primary need is practical security and community support, not cognitive reframing. Psychological practices must always be applied with an honest understanding of your real-world circumstances.

  • Application Context
  • Appropriate Domain: Internal catastrophic forecasts about ambiguous, uncontrollable events
  • Inappropriate Domain: Demanding acceptance of genuine physical hazard or workplace exploitation

When Is Professional Support the Right Choice?

Navigating ambiguity is an everyday life skill, but there are times when self-directed practices are insufficient. Knowing when to consult a qualified mental health or medical professional is a critical part of personal health literacy.

  • EVALUATION DECISION PATHWAY
  • Are Red Flags Present?
  • YES
  • Seek Clinical Evaluation
  • Are Functional Areas Impaired?
  • Sudden acute symptoms - Work, relationships, sleep
  • Compulsive physical loops
  • Persistent despair
  • Consult Therapist
  • Self-Help Protocols

Recognizing When to Seek Professional Guidance

Consider reaching out to a licensed healthcare provider, such as a psychologist, clinical social worker, or psychiatrist, if you experience:

  • Persistent, uncontrollable worry that severely disrupts your daily work or relationships
  • Chronic sleep disruptions lasting more than a month despite good sleep habits
  • Compulsive checking routines that take up significant time each day
  • Physical panic symptoms, such as sudden tachycardia or shortness of breath, without a clear cause
  • Pervasive feelings of hopelessness or an inability to care for your basic needs
  • Core Areas of Functional Assessment
  • Occupational: Inability to complete tasks due to endless re-checking
  • Interpersonal: Severe relational strain from constant reassurance demands
  • Biological: Persistent insomnia, tension headaches, or digestive distress

Specialized Clinical Support

Evidence-based therapies, including Cognitive Behavioral Therapy for Intolerance of Uncertainty and Metacognitive Therapy, provide structured support for these challenges. These clinical protocols help you safely test underlying beliefs, reduce compulsive loops, and rebuild emotional flexibility.

If you notice that chronic tension is clouding your ability to read your physical needs, learning how to read your energy and fatigue levels accurately can help you decide whether your symptoms require rest, routine changes, or medical care. For wider guidance on maintaining mental stamina under sustained pressure, you can review our stress management and mental resilience resources.

Medical concerns also require clear boundaries. Tolerating uncertainty never means ignoring sudden, severe, or worsening physical symptoms. Acute bodily changes always warrant a proper clinical evaluation to rule out underlying medical issues before applying psychological coping tools.

  • Safety Priority
  • Acute Physical Symptoms
  • Medical Clearance First
  • Psychological Framing

Frequently Asked Questions About Coping With Uncertainty

What is the difference between uncertainty and actual risk?

Risk refers to situations where the potential outcomes and their statistical probabilities can be reasonably estimated, such as the odds of a flight delay during a snowstorm. Uncertainty involves ambiguous situations where the outcomes, probabilities, or underlying meanings are unknown. Resilient decision-making calculates known risks while practicing emotional tolerance for unresolved ambiguity.

  • Risk vs. Uncertainty
  • Risk: Measurable probabilities - Actuarial preparation possible
  • Uncertainty: Unknown probabilities - Requires emotional flexibility and adaptive steps

Can chronic worry about the unknown cause physical fatigue?

Yes. Chronic cognitive worry keeps your autonomic nervous system in a state of continuous low-grade arousal. This sustained sympathetic activation increases muscle tension, alters digestion, and elevates resting heart rate. Over time, this mental strain exhausts your physical energy and interferes with deep, restorative sleep.

  • Fatigue Mechanism
  • Mental Worry
  • Sustained Sympathetic Tone
  • Elevated Cortisol/Tension
  • Somatic Exhaustion

Why does asking for reassurance make my anxiety worse over time?

Reassurance provides an immediate, temporary reduction in autonomic distress, which feels rewarding in the moment. However, this relief reinforces the belief that the situation was dangerous and that certainty was required to feel safe. Because absolute certainty about the future is impossible, your brain demands more frequent reassurance after each brief fix.

  • The Reassurance Loop
  • Doubt
  • Ask Reassurance
  • Temporary Relief
  • Brain Learns Uncertainty is Intolerable

How can I stop checking my phone or email when waiting for important news?

Create clear friction between the urge to check and your physical behavior. Set a specific timer for planned updates, such as once every two hours, and place your device in another room between those intervals. When the urge to check arises, acknowledge the sensation, take three extended breaths, and return your focus to your current task until the timer sounds.

  • Phone Friction Protocol
  • Acknowledge Urge
  • Extended Exhale
  • Check Timer Remaining
  • Return to Physical Task

The Takeaway

Mental resilience is not built by eliminating the unpredictable nature of daily life. It grows from the quiet confidence that you can think clearly, act wisely, and live fully without needing the future to be completely knowable.

Sources

  1. The Intolerance of Uncertainty Scale: psychometric ...
  2. The intolerance of uncertainty scale: psychometric properties of the English version
  3. Psychometric Evaluation of the Intolerance of Uncertainty Scale for Children (IUSC): Findings From Clinical and Community Samples in Iran - Mehdi Zemestani, Reza Didehban, Jonathan S. Comer, Philip C. Kendall, 2022
  4. Validation of the intolerance of uncertainty scale as a ...
  5. The role of uncertainty intolerance in adjusting to long-term ...
  6. An Information-Gap Theory of Feelings About Uncertainty
  7. Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment program for generalized anxiety disorder
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