Generalised Anxiety Disorder

“I’ve always been a worrywart, always an overthinker”. Thomas had come to treatment at the strong urging of his wife. He had been made redundant several months earlier and she was working from home. “She can’t stand to be around me, but the truth is, I can’t stand to be around myself”.

Eminent Clinical Psychologist, David H. Barlow, has called Generalised Anxiety Disorder “the Basic Anxiety Disorder”. Other anxiety disorders have a specific target. Panic Disorder is focussed on the fear of panic attacks and of losing control or dying from them. Agoraphobia is the fear of open spaces. Social phobia is… well, you get the picture. The target in Generalised Anxiety Disorder (GAD) is anything that might make us worry. Anything at all.

GAD is the 6th most common psychological disorder in Australia. A pattern of chronic anxiety lasting for at least 6 months could indicate the presence of GAD. This anxiety has to cause impairment and be associated with other symptoms like muscle tension, sleep disturbance, fatigue, edginess or cognitive difficulties. And of course, ever present habitual worry thoughts.

Typical worry thoughts might include:

“what is this feeling in my chest? It could be cancer!”

“Things at work are getting bad right now, I can’t afford to lose my job”

“My wife hasn’t called me yet; she’s had a car accident!”

And worrying is part of life and is the gift and curse of being human. Worry helps us both control for negative outcomes (by anticipating threats and taking premeditative action against them) and also gives us the feeling of control. This foresight is a human superpower.

And this alluring feeling of control is the trap that GAD sets for us.

“I always tend to map the day out beforehand. I worry that something will come up that I haven’t expected so I’ve made a habit of expecting everything”. Thomas was happy with a certain level of worry; he saw himself as sensible. “It’s better to be prepared for the worst, than be hit unexpected”.

Research has shown that people who are asked to worry before a stressful task show less autonomic arousal (the body’s fight or flight response), than people who do a relaxation exercise before the task. Less. Although we think of worry thoughts as the cause of anxiety, worry thoughts may also represent our minds method of taming anxiety. Escaping from the physical sensations of anxiety and pre-empting the worst.

And this alluring, addictive relief that worry thoughts bring keeps people with GAD stuck in a loop.

Treatment

Treatment of this disorder is often more difficult than for other anxiety disorders. Other anxiety disorders, those with specific targets, have treatments which involve exposure to the target of worry and challenging negative thoughts. Grappling with negative thoughts can be more harmful than good, however. Remember: Engaging in worry is an escape and control mechanism. This hole was dug by overthinking and overthinking more won’t dig you out of it.

Acceptance-based treatments, such as ACT (Acceptance and Commitment Therapy) have been shown to have good effectiveness for GAD. These treatments typically involve learning to live with anxiety (acceptance). Acceptance is fostered though mindfulness meditation, and through defusion – seeing thoughts as just thoughts and nothing else.

Disciplining worry, by stopping worry thoughts when they occur, and revisiting them during a set time, can also be helpful. This can be especially useful if the thoughts occur during sleeping hours. Performing some type of structured problem solving, or coping ahead, can be useful to do during Worry-time.

“I’m definitely worrying less and that’s great” Thomas was happy with his change. “The anxiety hasn’t gone away, not by a long shot”. “But I know I’ll always be a bit of an anxious guy, and that’s ok, it no longer controls my life”.

 

 

 

* names and key details changed to protect anonymity

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