Overview of Generalized Anxiety Disorder (GAD)
Stress and anxiety are a normal part of life. It’s what helps keep us safe and alive. Too much, however, can also make us sick.
Anxiety is the physiological feelings of tension, nervousness, racing heart, sweating, and feelings of dread that can be triggered by worried thoughts.
Anxiety can be a worry and apprehension about something in the future and anxiety can be experienced in the moment during stressful events.
A buildup of daily stress or stress from life events such as losing a job, death of a loved one, or divorce can cause symptoms of anxiety. Our bodies experience a physiological response to these stresses that could lead to more prolonged anxiety.
Generalized anxiety is experienced by both adults and children.
To overcome and conquer your anxiety you begin by transforming your beliefs, identifying your "What if thinking," create more powerful thoughts, and learn to manage the physical symptoms of anxiety.
Generalized Anxiety Disorder is excessive anxiety and worry about multiple events and activities.
Persistent worry and apprehension that is out of proportion to what would actually happen
Difficulty controlling worried thoughts
Worries over routine daily activities and experiences (Job, health, finances, family, household chores, being late)
Difficulty making decisions
The worry and apprehension goes well beyond normal daily worries and is associated with significant physical symptoms of:
Restlessness or feeling on edge
Difficulty concentrating or mind going blank
Muscle tension or muscle soreness
Frequent urination and/or diarrhea
Children typically experience worry about their competence or performance with school or sports.
Children’s worries usually shift from one concern to another. They may seek more reassurance and approval from parents.
Children may also conform more and lack confidence. Children will usually have more physical complaints such as stomach aches or feeling ill and may avoid going to school.
Who’s at Risk?
Females are 2 times more likely than males to experience generalized anxiety disorder. 2.9% of adults and 0.9% of adolescents experience generalized anxiety disorder
Temperament: People with personalities that are shy, negative, behaviorally inhibited, and avoidant may be at risk.
Environmental: Having a difficult childhood and over-protective parents could be associated with generalized anxiety disorder.
Genetic and physical factors: Genetics accounts for approximately one-third of the risk for developing generalized anxiety disorder and is shared with depression and other anxiety disorders.
Worrying takes up a lot of time and energy. It interferes with sleep and feeling well physically.
Generalized anxiety disorder will have an affect on:
Social and interpersonal relationships
Following through with other daily activities and events
Physical health (High blood pressure etc.)
Generalized Anxiety Disorder occurs with other anxiety disorders
People who experience generalized anxiety have beliefs about themselves and the world that cause them to interpret a range of situations as threatening and dangerous.
Within your family environment, you may have learned negative beliefs from your parents that you apply to yourself, other people, and the world.
These subconsciously programmed beliefs influence how you think, how you behave, and how you feel.
If you believe that the world is basically a dangerous place, then your thoughts, behavior, and feelings will follow and lead you to fear and avoid those places that you believe are dangerous.
Common core beliefs include:
I must always be competent
I am responsible for other people’s feelings and actions
I must be in control at all times
I must have certainty at all times
You may have also learned ineffective ways of dealing with worries and stressful situations. You may feel inadequate at solving life’s problems or accomplishing your goals.
Early stressful life experiences such as being bullied in school, for example, could have instilled a sense of uncertainty and helplessness.
These experiences contribute to the development of your beliefs and attitudes about the world and your ability deal with stressful circumstances.
Our beliefs and attitudes directly affect how we perceive and interpret events and situations.
Our beliefs influence how we think and deal with life events.
Negative beliefs and attitudes are reflected in our thoughts and lead us to misinterpret situations. Some thoughts are deliberate and within our awareness, and some of our thoughts are automatic.
Thoughts can be so automatic that we are not fully aware of their impact on our emotions. This can leave us feeling out of control over events and our emotions.
David Burns, MD identified that thinking can be irrational and cause us to make errors. These errors are often called Cognitive Distortions.
All or Nothing Thinking: Also called “black and white thinking.” This is when you see only extremes and don’t appreciate that most things fall somewhere in between or the “grey areas.” Things are either all bad or all good. Examples include, “Either I cope with anxiety right or not at all” and “If I don’t do it perfectly, I’ve failed.” This type of thinking causes feelings of disappointment, frustration, and fear.
Overgeneralization: We overgeneralize when we conclude that one single event is evidence of all future events. We use a lot of “Always” and “Never” statements. This causes feelings of helplessness and feeling overwhelmed.
Labeling: You assign a label to yourself or other people that uses both all or nothing thinking and overgeneralization. “I made a mistake, so I’m a defective person.” This creates feelings of hopelessness and an inability to change.
Jumping to Conclusions: Mind Reading - we imagine we know what others are thinking and Catastrophizing - we know what will happen in the future without sufficient evidence. We make assumptions that create anxiety, anger, and depression.
Mental Filtering: You minimize positives and only pay attention to negative information, causing you to magnify and exaggerate your fear and negative outcomes.
Discounting the Positives: You reject positive qualities and experiences and conclude that they don’t count.
Magnification and Minimization: You exaggerate the importance of your failures (or someone else’s success) and minimize any evidence personal achievement.
Personalization: You assume and take on all the responsibility for a situation or another person’s behavior causing you to feel guilty and shameful.
Should and Must Statements: These are a ridged set of rules that when not followed also create feelings of guilt and fear of failure.
Emotional Reasoning: You assume that because you feel this way something must be true. “I’m anxious, so there must be danger.” Emotional reasoning creates a self-fulfilling prophecy and you end up worrying more and feeling anxious even though there really is no danger.
If you believe you could have Generalized Anxiety Disorder it will be helpful and important to seek consultation with a mental health professional to first verify the diagnosis and then receive appropriate treatment.
Generalized Anxiety Disorder (GAD) can be successfully treated with psychotherapy, and in some cases, a combination of psychotherapy and medication.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is a well-researched and highly effective form of talk therapy that focuses on learning more helpful ways of thinking and behaving.
You learn ways of improving your communication skills and different ways of responding to social situations and to your feelings of anxiety.
CBT helps challenge and change your unhelpful beliefs that cause the anxiety.
After you learn to master the anxiety, you will be encouraged to approach more social situations that trigger the anxiety. This is where you apply your new CBT skills within a feared situation and have the experience of feeling less anxious and more confident.
This is when your beliefs really begin to change and the social anxiety becomes non-existent.
Please consult with your primary care physician or a psychiatrist regarding the use of medication.
Medication can help reduce the physical symptoms of anxiety. Commonly prescribe medications include benzodiazepines, anti-depressants, and beta blockers.
Benzodiazepines are quick acting sedatives that are generally safe and effective for short term use. However, the long term use of benzodiazepines is associated with the risk of developing tolerance, dependence, and possible other adverse effects.
Commonly prescribed benzodiazepines are:
Anti-depressant medications are also effective at reducing symptoms of anxiety on a daily basis. This helps dampen the physical and emotional effects of anxiety and increases a person’s capacity to cope with stressful situations.
Commonly prescribed anti-depressants are:
Beta Blockers are used to treat high blood pressure, heart arrhythmias, and migraines. They are also prescribed for off-label use by physicians to help reduce the physical symptoms of anxiety.
Beta blockers have the ability to control rapid heartbeat, shaking, trembling, and blushing in response to anxiety.
Commonly prescribed Beta Blockers:
Metoprolol (Lopressor, Toprol-XL)
How to Overcome Generalized Anxiety Disorder
Transforming Your Beliefs
Profound and lasting changes happen when there is a shift in your beliefs.
Just because you believe something, it doesn’t make it true. Think about beliefs that people have that are not true such as “All men are good drivers and all women are bad drivers.” These beliefs are not accurate or true. These inaccurate beliefs are called stereotypes. Think about the stereotypes that you have about yourself and other people.
Your unhelpful beliefs and attitudes need to be identified and the truthfulness or accuracy of these beliefs need to be disputed.
After disputing these beliefs, you can replace them with more sensible ones.
Albert Ellis, Ph.D., the founder of Rational Emotive Behavior Therapy (a form of CBT), identified an irrational belief that applies to anxiety:
“I absolutely must under all conditions do important tasks well and be approved by significant others or else I am an inadequate and unlovable person!”
Identify your beliefs about yourself and other people
1. “At my core I am a person.”
2. “If other people are upset with me, then that means I
3. “I absolutely must always or I am an
inadequate and unlovable person.”
4. “Other people are/will always and that is
cause for me to be very anxious all the time.”
Dispute your irrational beliefs by answering these questions
1. What is the evidence for this belief? What facts suggest this
belief is 100% true all the time?
2. What evidence does not support this Belief? What facts or
experiences suggest that this belief is not true all the time?
Are there contradictory experiences?
3. How does this belief help me?
4. What would I tell a friend who had this belief?
Develop more accurate and helpful beliefs
Your new belief will be more accurate and realistic. It will not just be a positive or wishful belief.
For example: “It’s not fair to expect myself to be a perfect person for everyone all the time.”
“Even though I sometimes make mistakes, there are people who still care about me.”
Your more helpful beliefs will be solidified when you test them out and actually have a positive experience while holding onto those beliefs.
Identify your negative “What If” Thinking
Identifying your “What If” thinking can reveal the underlying beliefs that cause excessive worry and anxiety.
Are you catastrophizing or jumping to conclusions?
Are you discounting the potential positive outcome and only focusing on the negative outcome?
If your “What If” thinking is focused on negative outcomes, then you will experience worry and anxiety.
If your “What If” thinking is focused on a desired outcome or what you want, then you will feel less anxious and be able to more effectively problem-solve.
Example: “What if I don’t do well on the test, then I will get a bad grade and prove to everyone that I’m a failure.” This is all or none thinking and is related to the belief of “I must always be competent.”
If you constantly focus on the possibility of danger, then your brain and body will prepare you for that danger. That means experiencing anxiety.
Begin to create more balanced thoughts by identifying the positive outcomes and experiences you want to have.
Create Powerful “If Then” Thoughts
“If Then” thoughts and statements set intentions or goals with the power to create feelings of certainty. This will help reduce doubt and uncertainty.
These are logical statements that the human brain is very good at encoding.
This is the language of your brain. Your brain is more capable of processing, “If X happens, then Y will happen.”
Example: Instead of focusing on the negative outcome “What if I don’t do well on the test, then I will prove to everyone that I’m a failure,” identify the positive outcome of “If I study well, then I will do well on the test.”
If you continue to define yourself and situations based on negative outcomes that haven’t happened yet, then you will have a very unpleasant life.
If you define yourself and situations based on what you want, then your brain will work toward that goal.
You are telling your sympathetic nervous system that there is no danger. This will reduce the symptoms of anxiety.
You are instructing your sympathetic nervous system how to respond appropriately instead of reacting with anxiety.
How to Manage Physical Anxiety
Feeling confident in your ability to manage the symptoms of anxiety will help with your fear of embarrassment and fear of panic attacks in public places.
Turn on Your Parasympathetic Nervous System
The parasympathetic nervous system is also called the “Rest and Digest” system. It produces a calm and relaxed feeling by:
Decreasing the heart rate
Dilating the blood vessels
Stimulating tear production
Stimulating the digestive system
Increasing a feeling of calm
Improves sexual arousal
The parasympathetic nervous system is activated by stimulating something called the vagus nerve. This nerve is very long and it runs from the hypothalamus in the brain to the chest, diaphragm, and intestines.
The vagus nerve can therefore be stimulated through diaphragmatic breathing, humming, and singing.
You can also turn on your parasympathetic nervous system with progressive muscle relaxation and by exposing yourself to cold temperatures.
Diaphragmatic Breathing Exercise
1. Inhale through your nose slowly by expanding from
your belly first then fill your upper lungs for a count
2. Hold your breath for a count of 2
3. Exhale slowly and forcefully through pursed lips for a
count of 10
4. Repeat this 5 to 10 times or do it for at least 1 minute
Progressive Muscle Relaxation
1. From a seated position begin by tensing your legs and
buttocks for a count of 5, then relax
2. Tense your abdomen for a count of 5, then relax for a
count of 5
3. Tense your arms for a count of 5, then relax for a
count of 5
4. Shrug your shoulders to your ears and tense for a
count of 5, then relax for a count of 5
5. Press your tongue to the roof of your mount for a
count of 5, then relax for a count of 5
Tips: Let all of the tension release and flow out or your muscles. Exhale as you release the tension and relax. You should feel the muscles become loose and limp.
Focus on the difference between the tension and relaxation as this is the most important part of the exercise.