What to Expect CBT Treatment Series: Generalized Anxiety Disorder (GAD)
Written By: Dr. Hillary Gorin, PhD
What to Expect and Why:
This blog series will help you understand what to expect in Cognitive Behavioral Treatment (CBT) for a variety of different anxiety disorders, OCD, and PTSD. No matter what you are seeking help for, it can be very scary to start treatment. I assume most of my patients enter their first appointment with me with anxiety. I assume this for several reasons. 1. You are taking a big first step in your life to change something that may feel impossible to change; 2. Most of my patients experience an abundance of anxiety on a daily basis and new experiences make us all feel anxiety.
My hope is that this blog series helps you to have a better sense of what to expect in your treatment if you choose exposure-based CBT interventions. First and foremost, the first appointment will be a lot of data collection. In order to determine how I can be helpful, I must determine what your problem looks like. You can plan on me asking you a ton of questions. My goal is to determine what diagnoses you meet criteria for (to ensure I can treat those diagnoses) and to instill some hope in you that I can help you. Just like we would hope our doctors would evaluate what is broken before treating a broken bone and then tell us how they can be helpful, I want to use a scientific approach in my practice and give you some hope that the science works. Although a one size fits all approach does not work for everyone, I apply all evidence-based techniques or techniques that have been supported by ongoing research. In this series, you will find the general what’s and why’s of treatment with me. Also, if you are struggling with the motivation to get started, I include some information on why it may be worth it to take a chance on this treatment.
Generalized Anxiety Disorder Treatment
What is it?
Essentially, Generalized Anxiety Disorder (GAD) is chronic worry (American Psychiatric Association, 2013). I often describe it as the tendency to get on the hamster wheel of worry. Worries spin around and around, continuing to fuel anxiety. If you are diagnosed with this, you will also be experiencing the physical impact of this anxiety, such as sleep difficulties or muscle tension.
What will we work on?
1. Exposure work: Exposure therapy entails learning to “sit with” anxiety as opposed to avoiding it (Zinbarg et al., 2006). Avoidance fuels the worry cycle. For instance, many times, chronic worriers will think about something frightening, such as “what if I lose my job?” or “what if a loved one gets sick?” and then they try to push that thought out of their head. In GAD treatment, instead of pushing the thought out of your head, we are going to learn to both tolerate the worry and to tolerate related uncertainty. Sitting with worry requires seeing the worry through to the end. You can expect me to ask you “what happens then?” and “what happens after that” if the worry comes true. We will work to see your worry through to the end by developing what are called worst case scenario scripts. When we watch scary movies over and over again, we eventually become desensitized to them. That is the goal of your treatment. Tire out worry brain so that you can return to the present moment.
2. Cognitive Strategies: I will ask you to become a scientist (Zinbarg et al., 2006). What evidence do you have for and against the worry? If the worry may come true, how bad would it be? How would you cope? These are questions we will process. We will cope with everything that comes our way, even hardships and tragedy. My goal for you is to start to accept and learn that. My goal is for you to develop more faith in your abilities to manage whatever comes your way.
3. General Coping Strategies: Relaxation is good for all of us (Zinbarg et al., 2006). However, it does not typically put an end to worry brain alone. We will discuss the practice of healthy relaxation habits to incorporate into your daily practice but I will not encourage relaxation during anxious moments. Instead, I will ask you to take a look at your anxiety, sit with it, and move on.
Why Engage in this treatment?
Consider the ways your life has been negatively impacted by worry. Consider the time you have lost to worrying (Grayson, 2014). Does your worry solve problems or cause more? Does it impact your relationships? Does it impact your ability to enjoy the present moment? If so, you may want to give treatment a try.
Why this treatment works?
Reassuring yourself has not worked, thus far. So maybe it’s time for a new approach. Sometimes, we just need to accept that bad things might happen. This treatment aims to give you tools to cut off the worry cycle, to tire out worry brain, and to re-activate rational thinking brain.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.
Zinbarg, R. E., Craske, M. G., & Barlow, D. H. (2006). Mastery of Your Anxiety and Worry:
Therapist Guide (2nd ed.). Oxford University Press.