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

What is generalized anxiety disorder (GAD)?
Generalized anxiety disorder (GAD) is characterized by

• excessive anxiety and worry,
• occcuring 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
Cognitive-behavior therapists view worry as the result of the worrier's effort 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. These behaviors are also viewed as efforts to avoid emotional experiencing.

Cognitive-behavior therapy for GAD

• 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.
• Physical control strategies. Diaphragmatic breathing and progressive muscle relaxation 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 control 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.
• Behavioral strategies. To address the worrier's fear of emotional experiencing, cognitive-behavior therapy teaches the worrier to confront (in imagination) the things he most fears, as a way of learning to be less afraid of it and (paradoxically) gaining more control over it. 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.

Additional resources

Web links:
The Anxiety Disorders Association of America
The Association for Behavioral and Cognitive Therapies
Freedom from Fear

Books:
For links to purchase these books and others, please go to Self-Help Books for Adults

Bourne, E. J. (2005). The anxiety and phobia workbook (4th ed.). Oakland, CA: New Harbinger Publications.

Craske, M. G., & Barlow, D. H. (2000). Mastery of your anxiety and panic (3rd ed.). New York, NY: Oxford University Press (copyright by Graywind Publications).

Leahy, R. L. (2005). The worry cure: Seven steps to stop worry from stopping you. New York: Harmony.

White, J. R. (1999). Overcoming generalized anxiety disorder “ client manual: A relaxation, cognitive restructuring, and exposure-based protocol for the treatment of GAD. Oakland, CA: New Harbinger Publications.