Over 3 million adults in the U.S. experience Generalized Anxiety Disorder (GAD) each year. GAD is characterized by persistent, excessive and unrealistic worry about everyday situations. More specifically, it is the worry about the outcome of any number or type of situations, over which one has no, or very little, control. Or persons with GAD may be excessively worried about family, money, career, school, etc. These everyday situations may trigger a sense of danger or disaster, and thus a threat. Our brains react to threats by generating a fight or flight response in the amygdala. But this part of our brain cannot distinguish what is a true or a false threat and so will respond to all perceived threats as if they are real. The fight or flight response boosts our body with a rush of energy to respond to threats. This is often noticeable in the physical symptoms of GAD; rapid breathing, faster heartbeat, muscle tension and excessive perspiring.
We don't know why some people develop GAD and others do not. Some evidence suggests a biological underpinnings. Other evidence points towards family background and stressful or traumatic experiences in life. Most people with GAD experience symptoms gradually over time, with GAD forming in childhood to middle adulthood.
On the main page of this site the mechanism by which anxiety is reinforced in mentioned briefly. To understand it better, one can think of GAD as a cycle. An uncertain situation causes an anxious person to worry about an outcome that undoubtedly (in their mind) be bad or disastrous. They begin worrying about the uncertainty and the outcome for a duration until the outcome happens. The outcome the vast majority of the time is not bad or disastrous leading to the formation of the belief that worry prevents danger (the mechanism of reinforcing anxiety). Hence, the next time a similar uncertain situation presents itself, the person worries, and the bad outcome does not happen. This is sometimes referred to as "Magical Thinking."
Magical thinking, however, is not preventative of bad things happening. Magical thinking is often an unconscious or semi-conscious belief that can be exposed when asked to think what it would mean to "let go" of anxiety in mental imagery exercises. Resistance to reducing anxiety revolves around letting go of such "magical" thoughts that a person believes protects them from feared outcomes. On some level many people with GAD realize their worry is disproportionate to a situation, but are at a loss to control the anxiety. Therapy aims to help those trying to manage GAD that had they not engaged in anxious worry, the outcome would have been the same or similar.
GAD is diagnosed in adults when they experience at least three of the symptoms below on more days than not for at least six months; only one symptom is required in children.
Symptoms of GAD include the following:
(Source: DSM-5)
Like most mental health disorders, GAD can be thought of being on a spectrum of mild to severe distress. Those who have mild to moderate GAD symptoms are often able to experience full lives and feel their lives are lived meaningfully. Those with moderate to severe GAD may need some type of treatment to help them experience this fulfillment in life.
Cognitive Behavioral Therapy (CBT) is a very effective treatment for General Anxiety Disorder. Within the context of treating Generalized Anxiety Disorder, CBT counselors look at patterns of thought and behaviors that sustain or maintain GAD and behaviors an individual engages in to remain "safe" in uncertain situations. The client and therapist will talk about the mechanism of how GAD is reinforced by "safety behaviors" (relief from avoiding triggering situations) and consider ways to restructure anxious thoughts and belief systems around one's fear of negative consequences to ambiguous situations. Clients and their CBT therapists also will make a list of situations that trigger GAD symptoms and clients learn how to face these fears with a new, more realistic narrative. For instance, someone who worries that they will fail a test may catastrophize the situation and worry they will be fail out of Cornish. With treatment, they learn to come up with alternative, more realistic narrative as one means of reducing anxiety symptoms.
To alleviate some of the symptoms that may be triggered by thinking anxious thoughts breathing exercises are often taught to clients to use when they initially notice symptoms of anxiety. Someone who is anxious about their academic success that they never socialize may be encouraged to spend a certain number of hours each week engaged in non-academic socializing. In each circumstance the client will be encouraged to attend to the process and outcome of the assigned experience and compare that to their initial worries.
In Mindfulness Based Therapies (MBTs) a person is taught how to change their relationship to anxious feelings. Rather than trying to push such feelings away, a person seeking MBT treatment is taught to "lean into" these feelings and fully experience the anxiety. Instead of avoiding distressing thoughts, the client is encouraged to explore them as a means of realizing that these thoughts are not fact or true. Clients learn to respond to anxiety stimuli in such away that they are able to reduce their fight/flight response by realizing their symptom reactions are based on perceived threats that are not factual. In other words "As anxiety reveals itself to be a misperception, symptoms will dissipate." (Psych Central Website)
With Biofeedback therapies clients are taught ways to respond to and change their physiological symptoms of anxiety. Depending on the response the clinician determines is best for a client, some type of measuring apparatus will be used and some training will be provided to help the client change their physiological responses such that a change is measured on the apparatus. For example, a clinician may use an electromyograph which measures muscle tension (a common symptom of anxiety) in one part of your body and have you use techniques taught to relax those muscles. Usually these apparatus provide immediate feedback that reinforces the use of these techniques, thus leading to symptom reduction when symptom onset is noticed.
These are not the only therapies for GAD. If you are interested in learning about other types of therapies, or wish to know more about the ones mentioned, please feel free to contact one of the Cornish Counseling Services staff for more information.