How the problem presents
Some clients describe a mind that moves continuously from one possible problem to another. Health concerns give way to money, work, relationships, and the possibility of having overlooked something. The question “What is the worst memory?” can feel irrelevant when the person's difficulty is an exhausting stream of future-oriented thought.
Listen for the function of worry without deciding it in advance. The client may use it to prepare, maintain responsibility, avoid surprise, or postpone a painful decision. Worry may also accompany genuine instability. A family facing eviction needs practical help as well as thoughtful psychological assessment. Intolerance of uncertainty can be a useful formulation concept; it is not itself proof of a trauma-derived belief.
Assessment and treatment context
Map when worry occurs, how controllable it feels, its physical and functional consequences, and the actions that follow. Distinguish solvable current problems from repeated attempts to secure certainty about hypothetical events. Ask about reassurance seeking, reviewing messages, procrastination, overpreparation, and the cost of these strategies. Explore depression, obsessive-compulsive symptoms, trauma symptoms, substance effects, sleep disruption, and medical contributors where indicated.
NICE uses stepped care for generalized anxiety disorder and recommends CBT or applied relaxation when a high-intensity psychological treatment is chosen; medication is another option within shared planning. [21] EMDR research in generalized anxiety is preliminary, as described below. A practical EMDR plan identifies the experiences or cues that make a particular worry compelling and tests whether processing changes checking, decisions, and daily functioning.
Agree what improvement would look like: completing a decision, sleeping with less checking, or tolerating an unanswered message. “Never worrying again” is a poor shared endpoint.
Candidate targets conditional on the history
A discrete event that still intrudes. A frightening telephone call or abrupt reversal may recur as a sensory memory within broader worry. Assess that experience on its own terms.
An event linked to a current rule. If the client spontaneously connects a remembered criticism with “If I do not check everything, I am irresponsible,” examine the link without assuming the criticism created the disorder.
A distressing consequence of worry. A specific conflict or lost opportunity can become a separate focus when the client considers it central. Do not turn every regret into a target.
No memory target. The current maintaining process may be the best focus of care. Documenting that conclusion is a legitimate outcome of assessment, not a failure to reach a deeper layer.
Assessment Script
“Could we follow one recent worry episode? What started it, and where did your mind go next? Which part was a problem you could take action on? Which part kept returning even after you had done what was reasonably possible?”
“What do you hope worrying or checking will accomplish? What do you fear would happen if you did less of it? Are there situations in which uncertainty feels more manageable?”
“Does this bring up a particular experience you remember, or does it feel mainly like a prediction? Either answer is useful. If an experience comes to mind, how does it relate to the work you want us to do? What would you prefer we address first?”
Avoid questions such as “Who taught you that the world was unsafe?” They presume both an explanation and a teacher before the client has described either.
A fictional past present and future map
Presenting situation. Daniel, a fictional client, repeatedly checks his team's work after hours. He worries across several areas of life and is beginning a condition-specific CBT program. He reports a particular memory of a manager announcing a serious error in front of colleagues.
Past candidate. The remembered moment is the manager turning a screen toward the room. Daniel recalls shame and the meaning “One mistake makes me incompetent.” He also reports that worrying preceded this job. The formulation therefore treats the event as a possible amplifier of present checking, not the origin of all anxiety.
Present cues. Sending a report and receiving a short message from a supervisor prompt both the old image and hours of hypothetical review. The clinician records the memory response separately from present-day checking and legitimate quality-control duties.
Future aim. Daniel wants to submit a report after an agreed, proportionate review and spend the evening with his family, while allowing some uncertainty to remain.
Rationale. The memory is a candidate because Daniel identifies a specific connection and wants to address it. His broader worry still requires its own treatment plan. If memory-focused work is undertaken, the clinician monitors whether it improves the task Daniel values rather than assuming that less shame will generalize across all domains.
From generalized worry to a workable EMDR target
EMDR has been investigated for generalized anxiety as well as PTSD. Gauvreau and Bouchard's four-person multiple-baseline study targeted contributing experiences alongside current and anticipated worry situations and reported improvement maintained at two months. These are encouraging preliminary findings, not the evidential strength of a large randomized trial. They support a focused clinical hypothesis that can be tested through treatment and everyday outcomes. Gauvreau and Bouchard, 2008
Rather than targeting “all my anxiety,” find the point where a worry loop takes on emotional certainty. A terse supervisor message might activate the expectation of being publicly blamed. A small discrepancy in a spreadsheet might reactivate an error with serious consequences. A quiet evening might evoke the moment unexpected news arrived. Ask, “What makes not checking feel dangerous or irresponsible right now?” Then clarify whether the answer is a remembered scene, a current practical problem, or an imagined catastrophe.
Likely targets behind overchecking and overresponsibility
Consider a remembered punishment for an ordinary mistake; being left responsible for something beyond one's capacity; sudden loss that made vigilance feel necessary; blame after a preventable error; or a humiliating appraisal. Current triggers might be clicking Send, delegating a task, leaving work unfinished at the agreed stopping time, or receiving “Can we talk?” The client's rule—“If I relax, I will miss something”—helps organize the map but is not itself an event.
Choose one relevant target and one observable goal. For Daniel, that could be processing the manager turning the screen toward the room while monitoring whether an agreed quality-control review is followed by submission rather than hours of rechecking.
Daniel's treatment sequence
Fictional continuation. Phase 3 focuses on the screen-turning image, his self-belief “I am incompetent,” his preferred alternative “I can be responsible without being perfect,” and the associated emotion, disturbance, cognition-validity rating, and body response. These are individualized formulations, not beliefs supplied as mandatory answers.
In Phase 4, the clinician uses the agreed bilateral stimulation and follows Daniel's responses with brief prompts. If he shifts into analyzing possible explanations, first assess whether this is moving processing forward or represents a block. If it is a block, briefly ask what he notices in the selected experience now rather than inviting a debate about every future error. If distinct relevant material emerges, assess its place in the plan. Complete installation and body scan when indicated; use closure even when further processing is needed. The sequence belongs to EMDR's structured phases, not to reassurance or problem-solving alone. Hase, 2021
Reevaluate uncertainty in action
Return to the processed memory and the actual report submission. Is shame lower? Does a supervisor's message still trigger the same response? How much time went into checking? Address a residual trigger before repeatedly revisiting a resolved past event.
The future template involves reviewing to an agreed standard, sending, noticing uncertainty, and shifting attention to the next valued activity. It includes handling a correction if one becomes necessary. Separately teach any missing delegation or planning skills. If the team is understaffed or the employer assigns contradictory responsibilities, negotiate the real workload problem as well: EMDR can reduce the historical burden without making an impossible job reasonable.
When to reconsider the formulation
Pause the historical search if the client produces increasingly speculative stories to meet the therapist's expectations. Repeated “I suppose it could have been…” responses are not strong evidence of a target link. Clarify that no origin memory is required.
Reconsider when work on one event becomes another form of certainty seeking: “If we find every memory, nothing bad will happen.” Also review current demands. An abusive manager, unclear work standards, or overwhelming caregiving load cannot be reformulated solely as intolerance of uncertainty. The client may need advocacy, boundaries, practical assistance, or a change in treatment focus.
Preparation and pacing
Explain the difference between investigating a useful clinical hypothesis and establishing an exhaustive explanation. A formulation can be provisional without being careless. Set limits on between-session logging if detailed tracking increases rumination. A few representative examples may be more useful than an inventory of every anxious thought.
Preparation should include permission to disagree with the therapist's proposed connection. Ask how the client experiences not knowing whether memory work will help. Address that uncertainty honestly rather than offering reassurance beyond the evidence. Coordinate with other clinicians so that one treatment is not inadvertently strengthening rituals another is trying to reduce.
Future Planning Script
“Choose a decision you expect to face this week. What information is reasonably needed, and what would count as enough? Imagine taking the next step without knowing every outcome. What thoughts might show up? How would you respond without restarting the entire review? If the result were disappointing, what support or repair would be available? What will we observe afterward: the amount of checking, the action you took, or time returned to something you value?”
This rehearsal makes room for uncertainty and error. It should not create a new mental sequence the client must complete perfectly before acting.
Common errors
Treating a future catastrophe as a recovered memory. Label predictions and actual recollections separately.
Making worry evidence of hidden trauma. Generalized anxiety does not require such a history.
Inviting endless target lists. Use relevance and functional impact to narrow assessment.
Promising that processing will provide certainty. Explain that effective action may still involve doubt.
Neglecting external problems. Include material conditions and realistic demands in the plan.
Consultation and companion connection
Consult when checking may reflect obsessive-compulsive processes, when current threat dominates, or when memory work is displacing an established anxiety treatment without a clear rationale. Review whether the intervention is reducing or accommodating the client's need for certainty.
Use Metaphors That Open Doors, Book Two, to support the client's own language for worry, responsibility, or uncertainty after the formulation is established. A metaphor can open discussion; it cannot demonstrate that a particular past event caused the present pattern.