We all experience anxiety as it is, unfortunately, an integral part of life. When we feel anxious, the body detects threat and prepares us for the fight/flight or freeze response by releasing adrenalin. Modern day stress is still detected as danger to the automatic response portion of our brain (the hypothalamus and amygdala). These parts of the brain receive the same signal whether we are confronted by debt, a marital affair, technological distress or with a life-or-death situation. The effect on the body is the same. As a result, ongoing anxiety can be extremely debilitating to the body.
The difference between anxiety and Generalised Anxiety Disorder (GAD) lies in the focus of the anxiety. People with GAD worry about everything. They might worry about flying as they fear the plane crashing even though the likelihood is small or they may worry about how they will afford to pay for their baby’s university fees. They tend to owrry about many different things in many areas – for instance, they will worry abut work, family, health etc instead of a worry on one of these areas.
Normal anxiety is healthy as we need it to keep us safe but people with GAD spend excessive amounts of time worrying and they tend to live in the future. They find it very hard to live in the present moment.
The future orientation of individuals with GAD is often apparent right from the first therapy session. For example, the client might ask “Will this therapy work for me?” or “How long will it take before I feel better?” It may even be difficult for the clinician to obtain information about the client’s current state because of this tendency to discuss the future.
Research has shown that individuals with GAD tend to have thoughts beginning with “What if…?” Clearly, it is difficult to enjoy the present moment when one is thinking thoughts such as, “What if I can’t meet my deadline at work?”; “What if my child gets terribly sick?”; and “What if my husband decides to leave me?”
At the heart of GAD is the intolerance of uncertainty. No ones likes uncertainty but people with GAD believe that the more they worry, the safer they will be from harm in the future. These positive beliefs about worry do more harm than good in that they encourage the individual to keep worrying thereby maintaining the anxiety.
Worrying does not provide safety, this is a myth.
GAD has four main features: intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance.
Intolerance of uncertainty
Individuals who are intolerant of uncertainty believe that uncertainty is stressful and upsetting, that being uncertain about the future is unfair, that unexpected events are negative and should be avoided, and that uncertainty interferes with one’s ability to function.
Positive beliefs about worry
If a person notices that the act of worrying is followed by the attainment of desired outcomes (positive reinforcement) or the avoidance of undesirable outcomes (negative reinforcement), that person would be likely to develop positive beliefs about worry (and continue to worry).
Negative problem orientation
The problem-solving process can be broken down into two major constituents: problem orientation and problem-solving skills. Problem orientation refers to an individual’s general cognitive set when faced with a problem. It appears that although individuals with GAD generally know how to solve their problems, they have difficulty successfully doing so because they have a negative cognitive set when faced with a problem. That is, they tend to view problems as threatening, to doubt their problem-solving ability, and to be pessimistic about problem-solving outcomes.
This refers to a variety of strategies that lead to the avoidance of threatening cognitive and emotional content. Since the late 1980s, Thomas Borkovec, a researcher at Penn State University, has studied the avoidant nature of worry. His work has shown that individuals use implicit avoidance strategies that allow them to avoid threatening cognitive content and dampen unpleasant physiological arousal.
Self assessment of GAD
The Penn State Worry Questionnaire:
Instructions: Rate each of the following statements on a scale of 1 (“not at all typical of me”) to 5 (“very typical of me”). Please do not leave any items blank.
Not at all typical of me 0 – 5 Very typical of me
1. If I do not have enough time to do everything,
I do not worry about it. 1 2 3 4 5
2. My worries overwhelm me. 1 2 3 4 5
3. I do not tend to worry about things. 1 2 3 4 5
4. Many situations make me worry. 1 2 3 4 5
5. I know I should not worry about things, but
I just cannot help it. 1 2 3 4 5
6. When I am under pressure I worry a lot. 1 2 3 4 5
7. I am always worrying about something. 1 2 3 4 5
8. I find it easy to dismiss worrisome thoughts. 1 2 3 4 5
9. As soon as I finish one task, I start to worry
about everything else I have to do. 1 2 3 4 5
10. I never worry about anything. 1 2 3 4 5
11. When there is nothing more I can do about a
concern, I do not worry about it any more. 1 2 3 4 5
12. I have been a worrier all my life. 1 2 3 4 5
13. I notice that I have been worrying about
things. 1 2 3 4 5
14. Once I start worrying, I cannot stop. 1 2 3 4 5
15. I worry all the time. 1 2 3 4 5
16. I worry about projects until they are all done. 1 2 3 4 5
Scoring the PSWQ
In scoring the PSWQ, a value of 1, 2, 3, 4, and 5 is assigned to a response depending upon whether the item is worded positively or negatively. The total score of the scale ranges from 16 to 80.
Items 1, 3, 8, 10, 11 are reverse scored as follows:
• Very typical of me = 1 (circled 5 on the sheet)
• Circled 4 on the sheet = 2
• Circled 3 on the sheet = 3
• Circled 2 on the sheet = 4
• Not at all typical of me = 5 (circled 1 on the sheet)
For items 2, 4, 5, 6, 7, 9, 12, 13, 14, 15, 16 the scoring is:
• Not at all typical of me = 1
• Ratings of 2, 3, and 4 are not transformed
• Very typical of me = 5
16-39Low Worry, 40-59 Moderate Worry, and 60-80 High Worry.
Scores Above 45 suggests GAD.
Cognitive Behavioural Therapy is great antidote for GAD. GAD does not have to be the burden it becomes if left or denied for too long.