What is generalised anxiety disorder?
General Anxiety Disorder is long-term and intense worry about a variety of events and situations. If you have GAD you have a lot of anxiety (feeling fearful, worried and tense) on most days. Your anxiety tends to be about various stresses at home or work, often about quite minor things. Sometimes you do not know why you are anxious.
As a rule, symptoms of GAD cause you distress and affect your day-to-day activities. In addition, you will usually have some of the following symptoms:
- Feeling restless, on edge, irritable, muscle tension, or keyed up a lot of the time.
- Tiring easily.
- Difficulty concentrating and your mind going blank quite often.
- Poor sleep (insomnia). Usually it is difficulty in getting off to sleep.
Cognitive Behavioural Therapy
Cognitive behavioural therapy (CBT) is probably the most effective treatment. It works for over half of people with GAD to reduce symptoms and improve quality of life.
It is not uncommon for people with GAD to report that they are worrying or almost all of their waking hours. They often find it extremely difficult to concentrate or “live in the moment” because of all of the worries swirling around in their heads. People with GAD also find that their worry is difficult to control – once they have started worrying about something, they find it difficult to let go and turn their attention to other tasks. Worry in GAD tends to be “exaggerated”, or out of proportion to the actual situation – that is, people with GAD worry more than other people would in the same situation.
The goal of cognitive-behavioral therapy (CBT) is to regain control of reactions to stress and stimuli, thus reducing the feeling of helplessness that often accompanies anxiety disorders.
CBT works on the principle that the thoughts that produce and maintain anxiety can be recognized and altered using various techniques that change behavioral responses and eliminate the anxiety reaction.
People with GAD imagine the worst happening (and worry about all the possible worst case scenarios). They also believe they won’t be able to cope when these possible imagined terrible things ‘do’ happen. However, as in all anxiety, we tend to over-estimate the danger, and under-estimate our ability to cope.
There are specific aspects to the anxiety that occur with GAD:
Worries are classified into worries about:
- Current problems (things I can do something about – and can therefore learn to problem solve)
- Hypothetical situations (things I can’t do anything about – and can therefore learn to react to differently)
An ‘intolerance of uncertainty’ means that the person with GAD will worry about an imagined feared event as long as there is even the slightest risk of it happening. Examples of thoughts:
- There’s always a risk of something terrible happening
- I have to be 100% sure!
- I can’t tolerate not knowing
- The worst could happen
- Uncertain events are almost always negative
People with GAD worry about the worry – they may have negative beliefs about worry:
- I might lose all control
- The worry will drive me crazy
…and/or positive beliefs about worry:
- Worrying keeps me (and others) safe
- Worrying helps me prepare for all the possible worst case scenarios
- Worrying means I’m a caring person
- Worrying means I’ll cope better when the worst happens
Therapy for GAD therefore focuses on how to deal with worry, learning to increase tolerance of uncertainty and the associated discomfort of anxiety, and challenging the unhelpful beliefs about worry (see the Vicious Cogs of GAD).