"Even when things are okay, it's almost like I look for something to worry about."

Generalized anxiety disorder (GAD) is an anxiety disorder that is characterized by excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities (health, money, family, or work). Individuals who have GAD are plagued by worry, fearing, for example, that if they go on vacation their house will burn down while they are away, that fatigue indicates a serious health problem, or that a sour look from the boss means they are about to be fired. When these individuals encounter problems, even small ones, they tend to overestimate their severity, viewing a headache as a sign of a brain tumor, for example, or an argument with their partner as a sign they are headed for divorce. People with GAD find it difficult to control their worry thoughts. They also experience distressing physical symptoms, including fatigue, muscle tension, head and neck pains, and gastrointestinal distress. They feel irritable, keyed up and tense, and have trouble concentrating. They often have trouble falling or staying asleep.

Cognitive-behavioral Model of GAD
The cognitive-behavioral model views the worry of the person with GAD as avoidance behavior. In the cognitive-behavioral model, worry allows the worrier to avoid intense emotional experience. In addition to worry behavior, worriers show other types of related problematic behavior, such as being on time at all costs, cleaning their home thoroughly every day in case someone pops in unexpectedly, or insisting their partners call immediately when they arrive at work so the worrier can feel secure that the partner arrived safely. These behaviors are also viewed in the cognitive-behavioral model as efforts to avoid emotional experiencing.

Cognitive-behavior Therapy for GAD
Cognitive-behavioral treatment of GAD typically includes some or all of the following components:

• Education. Therapy teaches the worrier about the cognitive, physical, and behavioral components of worry, and teaches the distinction between helpful and unhelpful worry.
• Monitoring. Learning the specifics of worry episodes (triggers, content, frequency, intensity, duration) provides much-needed perspective as well as information to guide other aspects of treatment.
• Diaphragmatic breathing and progressive muscle relaxation. These strategies help decrease the persistent physical over-arousal that contributes to the maintenance of the worry process, as well as many of the symptoms the person with GAD worries about (gastrointestinal distress, sleeplessness, and fatigue).
• Cognitive strategies. Certain patterns of thinking contribute to feeling keyed up and on edge. Clients are taught to evaluate situations more realistically and alter their thinking patterns so that they can decrease anxiety and more effectively solve day-to-day problems. In addition, cognitive therapists help clients test the assumptions or beliefs they have about worry itself -- that worry leads to greater certainty and control, that worry itself is uncontrollable, and that worry decreases the likelihood of bad events. Clients learn strategies to tolerate uncertainty and to decrease their use of worry as an effort to control outcomes.
• Behavioral strategies. To address the worrier's fear of emotional experiencing, cognitive-behavior therapy teaches the worrier to confront (in imagination) the events he most fears, as a way of learning to be less afraid of these events and the emotions they elicit and (paradoxically) gaining more control over the events and emotions. Learning how to focus on one particular worry thought or image without avoiding or escaping from it will, over time, help decrease the worrier's anxiety. Other behavioral strategies include teaching time management or problem-solving skills.