Generalised Anxiety Disorder - More than just being a "worrier"
By Sharon Clifford
What is it like to suffer from Generalised Anxiety Disorder?
The prevalence of anxiety disorders in the general population is greater than that of any other psychological condition, including depression and substance abuse. Generalised Anxiety Disorder (GAD) is one of the most common anxiety disorders, yet sufferers often don't seek help until years after developing symptoms, possibly because Generalised Anxiety Disorder is seen by sufferers and their family and friends as just a part of their 'chronic worrier' personality, rather than a clinical disorder.
The main feature of Generalised Anxiety Disorder is excessive anxiety and worry about a number of events or activities, occurring most days. Other aspects of this anxiety disorder include difficulty controlling the worry and symptoms such as restlessness, fatigue, insomnia, muscle tension, irritability and difficulty concentrating. Generalised Anxiety Disorder sufferers' worry is often focused on losing control, being rejected, physical injury, illness and death of self and others, mental illness, failure to cope, being controlled by others, interpersonal confrontation, personal competence and acceptance by others.
Generalised Anxiety Disorder sufferers experience more muscle tension compared to non-sufferers and often feel they are 'unable to relax'. They frequently feel they cannot control their worrying and can have difficulty 'living in the present', worrying about future and past events instead. They have a tendency to view the world as a dangerous place and feel a need to control events in their life.
Generalised Anxiety Disorder sufferers often show intolerance for uncertainty, which can generate and exacerbate the 'what if.?' questions they frequently ask themselves. They may also have difficulty solving their problems, due to a perceived lack of control over, and confidence in, their problem-solving abilities. In reality, however, it has been found that Generalised Anxiety Disorder sufferers actually have superior knowledge of problem-solving skills.
Traditionally, Generalised Anxiety Disorder has been considered to cause only minor impairments in functioning, but it is now seen as a serious disorder causing significant interference in sufferers' lives. It has been found that the effects on quality of life of untreated anxiety are similar to that of diabetes, congestive heart failure and depression. Generalised Anxiety Disorder often co-occurs with other disorders such as panic attacks, phobias, Post Traumatic Stress Disorder, depression and social anxiety, and is twice as common in women as men.
Cognitive-Behavioural Therapy treatment of Generalised Anxiety Disorder
The worry in Generalised Anxiety Disorder has previously been thought of as 'free-floating', i.e. not having a specific trigger. But this theory has recently been disputed by psychologists who believe that errors in thinking are always present when a person is suffering from an anxiety disorder. Cognitive Behavioural Therapy (CBT) has been shown to be an effective treatment of Generalised Anxiety Disorder. CBT reduces anxiety by targeting these thinking errors and teaching people how to identify, evaluate, control and modify their negative thoughts and associated behaviours.
In CBT, the sufferer and therapist investigate, reality-test and problem-solve. Sufferers' irrational beliefs, 'musts' and 'shoulds' about events are challenged and replaced. Cognitive-behavioural treatments usually include relaxation, anxiety management and assisting the sufferer to identify their unhelpful thoughts which often emphasise loss of control. Consequently CBT helps sufferers to feel more in control of their thoughts.
People suffering from Generalised Anxiety Disorder often catastrophise, (e.g. "My husband is late home from work - I'm sure he's been killed in a car accident!"), think in black and white terms (e.g. "If I don't get an A for this assignment, I'm a failure"), minimise their strengths and coping abilities (e.g. "There is no way I can cope with this situation!"), selectively focus on the negative aspects of situations (e.g. "I bet I won't enjoy this party") and experience intrusive negative thoughts. CBT helps the sufferer to question the accuracy of these types of thinking and replace them with more helpful thoughts.
It is important that beliefs about worrying are targeted as well as the worrying itself. Beliefs about worries can be positive or negative. For example, positive beliefs include, "I should worry if there is a possibility that something bad might happen. Not worrying is irresponsible" and "If I worry I will be prepared", whereas negative beliefs include, "I could go crazy with worry" and "Worrying is harmful".
Relaxation training has been a long-standing and popular treatment for Generalised Anxiety Disorder sufferers to combat the common muscle tension they experience. It has been found that relaxation works best in combination with CBT.
Strategies to manage Generalised Anxiety Disorder
- Try to remain in the present, rather than worrying about what has happened in the past or what may happen in the future, by continuing to re-focus on the task at hand.
- When a worry won't go away, try writing your thoughts down and then test them with the following questions:
- "What's the evidence/likelihood that what I'm worrying about will occur?"
- "What are the possible alternatives to the outcomes I am worrying about?"
- "What is the effect of thinking this way? Is it helping me?"
- "What would a friend/family member tell me if I told them my worry?"
- Become aware of 'doom and gloom' type thinking, expecting the worst and unrealistic thoughts, and try replacing them with realistic thoughts.
- Use problem-solving strategies to work out ways to handle the worst case scenario if it did occur.
- Tell yourself that if the worst case scenario did occur, that "I'll handle it!"
- Learn a relaxation technique, such as meditation, isometric exercises or progressive muscle relaxation, and practice regularly.
- See a counsellor who practises CBT.
Sharon is a psychologist who has previously suffered from panic attacks and agoraphobia and would like to use her experiences on both sides of the couch to assist others with anxiety disorders.
By Sharon Clifford, PsychologistDecember 2003
