Generalized Anxiety Disorder

I seem to spend so much of my time feeling
anxious and worrying. Usually it's day-to-day
stuff, you know, the family, our health, or just
getting it all done the way it should be. My
body just stays so tense. Of course, things
usually turn out just fine, but... I just can't
seem to turn it off. I am worn out.

At the core of generalized anxiety are two central features. The first is excessive worry about things that are unlikely to happen or that are much more manageable than you might think if they do occur. For the worrier, the thought "what if..." is a frequent companion. Usually such thoughts are about events that could, in fact, happen. Things may not get done on time, your child may get sick. Yet, you may also be someone who handles things quite capably when the unlikely does occur. In addition, it is common in Generalized Anxiety Disorder (GAD) to worry about your tendency to worry. That is, your worry may seem excessive to you or out of control. Unsuccessful attempts to stop the worry process can make things worse.

The second primary feature of GAD is a high level of physical tension or other bodily experiences such as difficulty sleeping, being easily fatigued, or feeling high strung. It is easy for excessive worry and physical tension to feed off each other and spiral upwards. If this description fits you, and you often find yourself feeling exhausted with a nervous stomach or headache, then you are one of the roughly 4% of the population with GAD. Generalized anxiety is very common and often occurs along with another anxiety disorder or with an alcohol or drug problem.

Of course, much of what I have just described would be expected to occur if you had just gone through a major life crisis. In fact, a defining feature of GAD is that worrying occurs when nothing unusual is going on, yet you often feel irritable and unhappy. Things may continue that way month after month, really detracting from your quality of life.

Is it really possible to learn to be less anxious?

Research and clinical experience would suggest that the answer to that question is yes. In my work with generalized anxiety, I try especially hard to individualize how I apply the cognitive and behavioral strategies of CBT and some of the newer research-based approaches in the field, especially what is known as Acceptance and Commitment Therapy (ACT). The following are some of the procedures that often seem quite helpful with GAD:

  • Exploring and understanding which habitual strategies for controlling anxiety have not worked
  • Discovering which thoughts about and interpretations of common life events contribute to your anxiety
  • Looking for an older, wiser, more empathic part of you that already recognizes the unreasonableness of some of your thoughts
  • Determining whether actively analyzing and challenging what you recognize to be an unreasonable thought is as helpful as being clear that there is a difference between having a thought and buying a thought
  • Practicing a form of mindfulness meditation that is focused NOT on stopping worrisome thoughts but on allowing them to be there while another part of you just watches them
  • Clarifying important life values and determining whether anxiety-based avoidance is detracting from satisfaction with life

Is medication helpful with GAD?

Yes, as with all of the anxiety disorders, medication is often helpful, especially during the first phase of treatment. About half the people that I see take it at some point.

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