CBT for Generalised Anxiety Disorder

If to worry is to be human, to worry excessively is to try to be superhuman, that is, to be able to anticipate, prevent and deal with anything and everything that could possibly go wrong at anytime. However worry gets false credit for being helpful, and many previous believers can attest to the liberation that comes from learning to reject its hold over them using a talking therapy such as CBT.

Worry appears to have been around for as long as modern humans. The Roman poet Ovid (43BC – AD17), told us that “happy is the man who has broken the chains which hurt the mind, and has given up worrying once and for all”. Everyone knows what it’s like to worry, often about things like health, money or family, as occasional anxiety is a normal part of life and people experiencing Generalised Anxiety Disorder (GAD) tend to worry about the same things as people without GAD.  However, the worry experienced is persistent and excessive. Worrying about one thing leads quickly and easily to worrying about something quite different. As a result, worriers can get caught up in a whirlwind of thoughts about catastrophes that might happen, meaning GAD is characterised by a crushing sense that disaster is just over the horizon.

Once worriers are caught in this whirlwind, they often feel as if they can’t stop. The worries come at them thick and fast, and seem uncontrollable; sometimes circulating at the back of their minds, coming into sharper focus every now and then.

Seeing a qualified professional to determine an accurate diagnosis is key, here’s what professionals look for to help determine if someone’s worry and anxiety are related to GAD:

  1. The presence of excessive anxiety and worry about a variety of topics, events, or activities. Excessive worry means worrying even when there is no specific threat present or in a manner that is disproportionate to the actual risk. Worry occurs more often than not for at least six months.
  2. The worry is experienced as very challenging to control, and may easily shift from one topic to another.
  3. The anxiety and worry are accompanied by at least three of the following physical or cognitive symptoms (in children, only one of these symptoms is necessary for a diagnosis):
    – Restlessness or feeling keyed up or on edge
    – Being easily fatigued
    – Difficulty concentrating or mind going blank
    – Irritability
    – Muscle tension
    – Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
  4. The anxiety, worry, and other associated symptoms make it hard to carry out day-to-day activities and responsibilities. They may cause problems in relationships, at work or in other important areas of life.
  5. In order to give a diagnosis of GAD, the symptoms also must be unrelated to any other medical condition, and cannot be explained by a different mental health issue or by the effect of a substance such as prescription medication, alcohol or drugs.

Of course, you may not have full-blown GAD, but you may still worry a lot. Although the formal diagnostic criteria are helpful, they are essentially a guide. Many people with disabling and distressing experiences of worry fall outside the diagnostic framework. When deciding to seek help, think honestly about how difficult it is to feel any sense of calm, comfort, and reassurance around your worry. Untreated, GAD often get worse with age as weighed down by the stresses of life over a long period, it takes less and less stress to trigger acute bouts of anxiety. Worriers may simply just get used to carrying the burden, but the impact on their lives is immense.

GAD is characterised by a crushing sense that disaster is just over the horizon.

How CBT Can Help

The good news is that GAD can be successfully treated using CBT, focusing on the factors that keep worry going:

  • Cognitive distortions such as catastrophisation
  • Positive beliefs about worry such as, “worry means I’m prepared”
  • Negative beliefs about worry lead to worry about worry, such as, “my worry will drive me crazy”
  • Intolerance of uncertainty leading to a demand for certainty, “I must know for sure”
  • Challenging problematic behaviours such as avoidance, procrastination and reassurance-seeking.
  • As with other anxiety disorders, behavioural experiments give the chance to do things differently and experience new learning.

Worry is how many of us respond to uncertainty, and it can be changed. Don’t be a habitual worrier all your life, take the first step to free yourself from excess worry and make an appointment for an initial conversation with me, to see if CBT for GAD could help you.