What is Anxiety?

All of us feel anxious at times. We may worry about things that might happen. We may have a restless night of sleep. But people with generalized anxiety disorder (or GAD) have physical symptoms that interfere with their normal lives. These problems may include restlessness, fatigue, problems with concentration, irritability, muscle tension, insomnia and sometimes physical symptoms. In addition, these individuals worry about a variety of events, such as health, financial problems, rejection, and performance, and they find it difficult to control their worry. Many people with GAD feel that their worry is “out of control” and that it will make them sick or make them go insane.

Who Has Generalized Anxiety Disorder?

About 7% of the population will suffer from GAD. Women are twice as likely as men to have this problem. This is a chronic condition, with many people saying that they have been “'worriers” all their lives. Most people with GAD have a variety of other problems, including phobias, depression, irritable bowel syndrome, and relationship problems. Many people who have this problem find that they avoid others because of fear of rejection, or that they become overly dependent on others because of their lack of confidence.

What Are the Causes of Generalized Anxiety Disorder?

Only about 30% of the causes of GAD are inherited. There are certain traits that may make people more likely to develop this problem; these include general nervousness, depression, inability to tolerate frustration, and feeling inhibited. People with GAD also report more recent life stresses (such as conflicts with other people, changes in their work, and additional demands placed on them) than those without GAD do. People with GAD may not be as effective in solving problems in everyday life as they could be, or they may have personal conflicts in which they may not be as assertive or effective as they could be.

How Does Thinking Affect Generalized Anxiety Disorder?

People with GAD seem to be worried that bad things are going to happen most of the time. They predict that “terrible” things will happen, even when there is a very low probability of bad things happening. They think that the fact that they feel anxious means that something bad is going to happen - that is, they use their emotions as evidence that there is danger out there somewhere. Many people who worry believe that their excessive worry may keep them from being surprised, or that worrying may prepare them for the worst possible outcome. If you are a chronic worrier, you probably notice yourself saying, “Yes, but what if . . . ?” This “what-iffing” floods you with a range of possibly bad outcomes that you think you have to prepare yourself for. There seems to be no end to the things that you could worry about. In fact, even when things turn out to be OK, you may say to yourself, “Well, that's no guarantee that it couldn't happen in the future!” In addition to worrying about things that might happen “outside of yourself,” you may think that “worrying will make me crazy” or “worrying will make me sick.” If you have GAD, you may be locked in a conflict between the fear that worry is uncontrollable and the belief that worry protects you.

How Can Cognitive-Behavioral Therapy Help?

Cognitive-behavioral therapy for GAD can help you identify your beliefs about the costs and benefits of worrying, and show you how to recognize the difference between productive and unproductive worrying. Your therapist will help you carry out experiments in “letting go” of worry and postponing worry. In addition, you will learn how to overcome your avoidance of activities or thoughts about which you worry. Your therapist may also use interventions such as muscle relaxation, biofeedback, breathing exercises, time management techniques, and treatment of insomnia in order to reduce your overall levels of anxious arousal.

Other interventions may include addressing your concern that worrying too much may be harmful, assessing your tendency to jump to conclusions that awful things will happen, and helping you learn to distinguish between anxiety and actual facts. Your therapist can teach you to use an extensive self-help form (“Questions to Ask Yourself If You Are Worrying”) that can help you get a better perspective on worrying. Finally, since you are worrying throughout the day, your therapist will assist you in limiting worry to “worry time” and will help you keep track of the different themes of worry.

How Effective Is Cognitive-Behavioral Therapy for Generalized Anxiety Disorder?

Given the apparent long course of GAD, it is promising that new forms of treatment are proving to be effective. In some studies, cognitive-behavioral therapy has proven to be more effective than medications in the treatment of GAD. It leads to a reduction of the need to use medications, and in some cases patients continue to improve even more after therapy is completed. About 50% of patients with GAD show significant improvement.

Are Medications Useful?

Many patients with GAD also benefit from the use of medication, which can decrease the feeling of anxiety and apprehension. The value of medication is that it can make you feel less anxious very rapidly. Medication may be an essential part of your treatment, while you learn - in therapy - how to handle your problems more effectively.

What Is Expected of You as a Client?

Because you may have been a worrier all your life, you may be pessimistic about the chances that anything will help you. It is true that you won't get better overnight, so you will have to work on your worries and anxiety on a regular basis. Your therapist will want you to come to sessions on a weekly basis, to keep track of your worries, to practice relaxation or breathing exercises at home, and to work on managing your schedule so that you are not overburdened. In addition, your therapist will help you identify your worries and help you view things in a more realistic perspective. To do this, you will be asked to write down the things that you are worried about, and to use self-help homework techniques to challenge your negative thinking. You may also be asked to work on solving problems more effectively and on learning how to interact with people more productively.


The information on this page is provided for informational purposes only and does not replace in any way a formal medical or psychiatric evaluation or suggest a diagnosis. If you suspect you may be experiencing any of the above symptoms we would recommend you seek an evaluation by a psychiatrist or medical practitioner. All therapy should begin with seeking any medical reasons for the presenting problem.