By Glorianne L. Vazquez, PsyD
Anxiety is a part of our daily lives, especially during challenging times. It turns out that this emotion has an evolutionary function. Millions of years ago, anxiety was very useful when our ancestors were faced with an imminent threat, such as a charging lion. Their bodies went into fight, flight, or freeze mode and those that took action survived.
Today, anxiety is still helpful to us as it alerts us when there's something going on in our lives that we need to address. But what if your anxiety never turns off even when there isn’t a threat? What if your worries about potential threats become uncontrollable? Let’s explore this and talk about Generalized Anxiety Disorder (GAD).
What is Generalized Anxiety Disorder (GAD)?
GAD is an anxiety disorder that is defined by persistent and uncontrollable worry. When you have GAD you worry excessively about daily events, relationships, health, finances, occupation, and more even when there is little to no reason to worry. Worrying can be so intrusive and distressing that it interferes with your daily responsibilities and activities.
With GAD, you may expect the worst and live in a state of constant dread that skews your perception of the world. As a result, people with GAD tend to perceive neutral or vague situations as threatening. They may have difficulty tolerating uncertainty, worry about worrying, hyperfocus on problems, and judge themselves for feeling anxiety. Coping with life’s uncertainty and everyday problems can wear you out and get in the way of your full potential. Constant worrying is also mentally and physically taxing. When you worry excessively, there’s an increase in muscle tension which in the long run might lead to headaches, soreness, teeth grinding, jaw clenching, digestive issues, and insomnia. Due to these issues, it may be difficult to relax or calm down. The interaction between worrying and muscle tension creates a cycle of hyperarousal that may keep you on high alert for potential danger or threats.
Symptoms and signs of Generalized Anxiety Disorder
- Excessive anxiety and worry about several events or activities
- Difficulty controlling worry
- Anxiety and worry that occurs on most days for at least six months
- Anxiety and worry leads to some of the following physical symptoms:
○ Restlessness, feeling on edge
○ Being easily fatigued
○ Concentration problems or mind going blank
○ Muscle tension
○ Difficulty falling or staying asleep
- Anxiety or physical symptoms cause significant distress or impairment in social, occupational, or other important areas of daily life
Treatment for Generalized Anxiety Disorder
Let’s examine one of the most effective treatments for GAD, Cognitive Behavior Therapy (CBT). CBT for GAD is considered a reliable, first line of treatment. CBT is a time-limited structured approach in which the therapist will collaborate with you to address your current worry and anxiety so you can meet goals to reach your full potential. CBT teaches you that when you have GAD you overestimate the probability of risk and underestimate your resources to cope with risk. Therefore, one of the main focuses of treatment is to examine the way you view your world and your abilities to cope.
Let’s discuss the interventions commonly used in CBT for GAD.
Psychoeducation: In CBT, the therapist is actively and continually teaching you about the strategies used in the session. Your therapist will educate you about the four major components of the cognitive model of GAD. You will learn about how your beliefs fuel the worry process in GAD. You will also learn about the relationship between the way you interpret your thoughts and your emotions, behaviors, and physical responses that result from your thoughts.
Cognitive restructuring: With this intervention, you first learn to become aware of your worry by tracking your anxious thoughts and your responses to those thoughts. You’ll learn to identify these thoughts by asking yourself questions like: “What went through my mind?” or “What did I anticipate?” or “What was I afraid could happen?” Then you will examine these unhelpful thoughts and learn to think more effectively about situations in your life.
GAD can lead to negative predictions about the future and negative beliefs about your ability to cope with challenging situations. Therefore, you're going to be examining and challenging these negative predictions and beliefs by asking questions such as “What’s the likelihood of the worst-case scenario coming true?” or “What’s the most likely outcome?” and “What could I do then?” As you practice challenging your thoughts, you will realize that there are often other ways to look at things that are less anxiety-provoking, and this in turn will decrease your anxiety.
Mindfulness: Mindfulness practices help you bring your attention to the present moment using a non-judgmental stance. Mindfulness helps create new neural pathways as we are able to notice and acknowledge our automatic thoughts and interpretations and let them go without judging or reacting to them. You can disengage with your anxious thoughts by practicing mindfulness and bringing your attention to the present moment over and over without judging yourself.
Problem-solving: Learning conflict-resolution skills and interpersonal effectiveness strategies can help you address anxious thoughts that are true. Your therapist will teach you effective strategies to address your current stressors. When you have GAD, it’s harder to cope effectively with challenging situations so your therapist will help you become more aware of how to do so. You will learn to recognize your current problems and break these down in order to come up with the most effective solutions.
“Worry time”: Your therapist may encourage you to schedule a specific time to worry and problem-solve around your worries. In “worry time,” you’re setting aside time to explore what is making you anxious and concerned. The three components of “worry time” are:
- Worry awareness: Identify your anxious thoughts throughout the day. Mindfulness can help.
- Worry delay: Recognize your worry thoughts and postpone their exploration for your scheduled “worry time”.
- “Worry time”: Explore the anxious thoughts at the scheduled time and problem-solve each of them.
Exposure: As you reduce your worry and anxiety, you can begin to engage in exposure exercises. The main factor influencing GAD is an intolerance of uncertainty. Therefore, the exposure exercises are geared towards situations that induce uncertainty. Your therapist will help you create a list of situations that trigger worry so you can overcome them. The point of exposure is for you to gradually face your fears. Emotion exposure exercises can help you evaluate your unhealthy beliefs about emotions and teach you to allow yourself to experience and accept your emotions.
Relaxation strategies: Relaxation exercises help you reduce muscle tension associated with anxiety and worry. Progressive muscle relaxation and controlled breathing exercises teach you to calm your mind and body. Relaxation exercises can help you engage more effectively when you use other CBT interventions.
Online Cognitive Behavioral Therapy for GAD
Are you wondering if your worries are taking control of your mind? Do you want to know if your level of anxiety is typical given your stressors? Connecting online with a licensed mental health professional can help you address these questions.
Online therapy at Amwell is a convenient way to begin as it gives you access to licensed therapists and their profiles so you can select a provider that is right for you. With online therapy, you can have sessions from the privacy of your own home. This gives you the opportunity to examine your worries and learn coping skills in a comfortable environment. Even if your anxiety is not severe, it can be beneficial to treat it early.