Generalised Anxiety Disorder
Everyone worries but some people struggle with an excessive amount of anxiety and worry and report the following symptoms;
- Chronic worries running through their mind – no matter how hard you try not to worry or not think about things these thoughts keep popping into the mind against your will
- Worries about what we value – we usually worry about whatever is important to us in that time in our life and may change as we go through life. For instance; someone may be excessively worried during school about performance, then relationships, then work, then home/security in the family
- Uncontrollable anxiety – having a strong desire to be in control of emotions yet feeling as though anxiety and worry has taken control over them and there is nothing that can stop it
- Physical effect – anxiety causes nervousness, nausea, dry throat, tension, restlessness, heart racing, headaches
- Hating uncertainty – wanting to know what is going to happen in the future, predicting things that may or may not happen, finding the experience of “not knowing” very difficult indeed
- Sleep disturbance – having trouble falling asleep, maintaining sleep because their mind is constantly ticking over. In addition to sleep deprivation, anxiety can make us exhausted and so have a need to take naps during the day.
How does it present itself?
Typically there will be a pattern of how you respond in certain situations when you find yourself worrying. Situation / Trigger
Anxiety, Unhelpful Attempts to Prevent Worry and finally exhaustion
You receive news that your child is taking part in a play at school (trigger). You then notice a stream of thoughts triggered by an initial worry – “what if it all goes wrong?”, “what if he needs a costume, what about his lines, I must make sure that he learns everything so he isn’t embarrassed, where will the play be at, how do we get there, what if we are late and he misses the show, what if the other children are better than him?”.
These thoughts will all naturally cause us to become anxious. In order for us to feel better or to try and prepare for the event we can get caught up in “unhelpful attempts to prevent worry”. These attempts are usually in the form of an approach or avoidance strategy.
Approach strategies include; talking to the other mums to see how much they have prepared, practising the route from home to the location of the play to prevent being late, ensuring I sit with the child to ensure he learns his lines, talk to teachers about the event and seek reassurance or find out as much information as I can, checking and then re-checking the date of the play or alternatively avoidance – make excuses not to go to the play and avoid this stress altogether. As you can imagine this process of worrying followed by all this extra work we do causes a huge amount of anxiety until eventually we reach exhaustion, sadness, depression.
Take some time to think about a few examples of when you last worried and whether you can recognise any pattern in your worry?
Why does this keep happening?
Research into GAD has found there are specific maintaining factors involved, we can use this when we begin thinking about how to treat GAD and to learn how to break the cycle.
1. Real vs Hypothetical Worries
As discussed everyone will worry in their lives, it’s normal to worry. However, if you struggle with excessive worry it is often found that you are worrying about things that may or may not happen, future events, or things that may go wrong. These are known as hypothetical worries.
Real or practical worries – things that are happening right now that we can do something about by some problem solving.
Hypothetical worries – thoughts about what may happen and usually are worst case scenario.
E.g – there’s a clunky noise on the car.
Real worry “oh theres a problem with the car, I will have to take it to the garage to get checked out”
Hypothetical worry – “my car is going to break down, I’ll be stranded, I’ll have to miss work, when I take it to the garage they will tell me there’s something seriously wrong and it will cost me a fortune, I will have to put this all on my credit card, I’ll never pay it off”.
In order to begin to overcome worry the first step is to learn how to recognise when we worry is it real or hypothetical. Simply labelling these thoughts as “oh there’s all my hypothetical worries again, off I go!” will help interrupt the stream of thoughts and allow you distance yourself from the anxiety a little. Once you can do this, we can learn how to rationalise things a little better. We tend to go into Worst case scenario, but I wonder do these worst case scenarios ever really happen? A good question to ask yourself then is;
2. What’s the most likely thing to happen?
The second key area is to recognise all the unhelpful attempts you use when you are worried, all the approach vs avoidance strategies. These may feel like they are helping at the moment however we have found that this actually makes us more exhausted in addition to keeping the problem going as we gradually reduce our tolerance of anxiety so smaller and smaller things will cause us an extreme anxiety response.
Therefore it’s a good idea to start recognising “what is it that I want to do to feel better” and if you can slowly reduce the amount of excessive behaviours you carry out. For instance, using the child at a play example, it may be a good start to reduce asking other people ie other mums and teachers for advice and information. Try and reassure yourself rather than relying on other people.
Make a list
Make a list of all the things you tend to do and see what things you can start to reduce a little. See it as an experiment over the next few weeks to keep it more fun and engaging. For instance “I will deliberately not check and re-check my emails before sending”
“I will deliberately not ask my partner if I’ve made the right decision”
The way this will help is it will start to build your tolerance of uncertainty; a key maintaining factor involved in GAD.
Allergy metaphor – if you were allergic to pollen and suffered hay fever it would take the smallest amount of pollen to set off a bad reaction – sneezing, stinging eyes etc. The same is true for GAD sufferers, that it only takes a small amount of uncertainty in our lives to set off our worry allergy. So for example, someone with GAD will worry a great deal about their plane crashing as there is a small possibility that it “may” happen.
To help stop worry and anxiety then we could either a) increase our certainty of situations i.e know 100% all the time what will happen, or b) increase our ability to tolerate uncertainty. All the behaviours you do when you are anxious is an attempt to increase certainty, by reducing this down you will allow yourself to build your tolerance of uncertainty.
3. Your beliefs about worry
The final part involves looking at another maintaining factor which is your beliefs about worry. People who worry tend to have a belief about worry for instance “worry helps me prepare for the worst” or “worry helps me to get things done”. For this, we just need to spend some time questioning the usefulness of worry and whether we can learn to live a life where we can have a more acceptable level of worry rather than excessive worry.
Problem solving is great but worry doesn’t help – it only makes you feel worse. Problem-solve, take action and then let go and get back to living in the moment, not worrying about the future that isn’t here yet.