Generalized Anxiety Disorder (GAD) is the single most common anxiety disorder. Its symptoms are what most people mean when they describe themselves as 'always being anxious'.
Generalized anxiety disorder is more than just worrying about something. It's worrying about many things and worrying most of the time. No doubt, you know someone who could be described this way.
Despite this, many people with generalized anxiety deny that they have a real problem that really should be treated. Some have had it for most of their adult lives. They're resigned to it, describing themselves as 'worriers', as if it were an unchangeable characteristic of their personalities. Treatment seems futile.
However, generalized anxiety is usually treatable, even when it has been a lifelong problem.
Other people with GAD see no point to treatment, pointing to the very real sources for their worries: business problems, family problems, health problems, national politics, the economy, global warming, etc. And in reality, there is a lot for people to be worried about in the world.
In other cases, people develop generalized anxiety while coping with an extremely stressful situation, or multiple stressful situations, for a prolonged period of time. But generalized anxiety can be diagnosed and treated even when someone's nervous tension and worrying is prompted by significant personal stress.
I diagnose patients with generalized anxiety disorder when their tension, nervousness, or worrying has itself become a problem in their lives.
The exact diagnosis of generalized anxiety disorder depends on someone feeling anxious or worried most of the time for at least six months, despite trying to control their worrying. In addition, they must have three or more of the following symptoms at least part of the time:
If you feel that you have been anxious, tense, or 'a worrier' your entire life, you probably have generalized anxiety disorder. If you have notable periods of severe anxiety, anxiety attacks, or panic attacks, you might also want to look at my page on Panic Disorder & Agoraphobia. In addition, many patients with generalized anxiety disorder also suffer from Major Depression and Dysthymia.
Generalized anxiety disorder tends to be one of the more chronic problems that people experience. It often begins in childhood or the early teenage years. People come in for treatment when it has become significantly worse as a result of the demands of adult life.
Short-term therapy for generalized anxiety disorder usually involves three major components. The first component is made up of relaxation techniques that give the person a feeling of well being. Relaxation techniques involve daily use of imagery or meditative breathing. Once these have been mastered, the person learns to monitor their tension in order to relax whenever they feel especially anxious.
The second part of the process involves retraining the thinking process, so that irrational, exaggerated, or unrealistic worries are recognized and addressed. We identify key worries and develop realistic, rational responses to them. These are used to answer the worries whenever they occur. Through repetition, patients learn to regard their worries as brief annoyances rather than realistic problems.
Finally, we look at systematic biases in the way people look at the world. We all filter our daily experiences to determine what is important and what isn't. People with anxiety problems usually regard negative experiences as much more important than all the positive things that more commonly happen. We use a variety of thinking exercises to alter this unbalanced outlook.
When patients are interested in a long-term approach to change a 'worrier' personality, we look at their core beliefs about themselves and others. We examine how these were learned, and whether what was learned was realistic and in proportion to adult life. Once these are identified, exercises are developed to help substitute more realistic core beliefs.
Schemas are a combination of core beliefs, memories, feelings, and outlook on the world. Schema therapy helps patients identify and change the schemas that are at the root of their anxiety. Schema work is usually begun after the most significant symptoms of generalized anxiety disorder have been reduced or eliminated. It is a longer form of therapy. However, it is both more efficient and effective than older methods of therapy used to treat generalized anxiety disorder.