Generalised Anxiety Disorder

A key feature of generalised anxiety disorder (GAD) is exaggerated worry about a number of everyday events. The worry is uncontrollable and it lasts for months and years rather than hours or days. Common worries include family, work, health, money, disasters and worry about worry.  In GAD people also experience physical symptoms of anxiety such as muscle aches, tension headaches, butterflies, diarrhea, irritablity, difficulty sleeping and feeling restless and and on edge. 

One of the hallmarks of generalized anxiety is worry about worry.  For example, people often worry that worry could cause them harm or become uncontrollable. 

Common worries about worry include ideas such as: worrying is uncontrollable, worrying is harmful, worrying could make me go crazy, I could enter a state of worry and never get out, worrying could take over and control me, worrying could harm my body, and I cannot tolerate worry and I could go mad. 

To cope with these worries about worries people often engage in number of behaviours that are designed to stop worry and any harm that worry could cause.  

Common behaviours to stop worry include: trying to distract yourself from worry, trying too hard to reason out the worry, looking for evidence for and against the worry, planning how to cope if the worry were true, asking others for reassurance about the worry, staying close to people who can reassure you about your worries, pushing worries out of your mind, and avoiding situations that trigger worries.

Although these behaviours might seem like a good idea and may reduce worry in the short-term, they accidentally keep worry going in the long term because they stop people from finding out that worrying is not as dangerous as it may seem.

We know from research that it is normal to worry.  About 80% of the population admit to worrying.  If the problem in generalized anxiety disorder is “worry” then 80% of the population should have generalized anxiety disorder.  But they don’t.  This means that there must be something else in addition to worry that causes generalized anxiety disorder.  The research suggests that this something else is “worry about worry”.  CBT focuses on helping people to worry less about worry by changing unhelpful thinking and behaviours.

The goods news is that CBT for worry can be very effective. CBT helps people to recognise the processes that keep worry going.  In therapy you discuss only one or two worries from the week and try to identity processes that kept the worry going.  Therapy helps a person disengage from these processes.  It also tests out feared beliefs, practices exercises to reduce physical tension, and addresses beliefs related to perfectionism, control and the need to be 'on duty' all the time.