Generalized Anxiety Disorder
At any given time, approximately 3 out of every 100 adults in the United States suffers from Generalized Anxiety Disorder (National Institute of Mental Health), with lifetime prevalence rates of approximately 6%.
What is Generalized Anxiety Disorder?
Generalized Anxiety Disorder (GAD), is defined as frequent excessive anxiety and worry. In association with the worry, the individual may experience the following:
GAD is essentially a fear of bad things happening in the future. Individuals with GAD worry about a large variety of fears such as a loved one dying or being in a serious accident, something horrible happening to their children, money/financial security, getting a serious illness or dying, how they are performing in their jobs, losing their job, being evaluated by others, making mistakes, etc.
Individuals with GAD find it very difficult to control their worry and often describe worry as almost compulsive in nature. Long periods of time may go by before the individual realizes that they have been steeped in worry.
Importantly, worry itself is conceptualized as a cognitive avoidance strategy. This may sound confusing, since worrying feels like the opposite. However, worry is thought to be a verbal/linguistic process versus an "imaginistic" process, the former of which distracts and inhibits appropriate appraisals of threat (Borkovec, Sahdick, & Hopkins, 1991). In addition to worry, an individual may engage in other cognitive avoidance strategies such as planning and distraction. Individuals with GAD also frequently engage in overt safety behaviors to reduce their feared consequences from happening (e.g., texting their loved one repeatedly to reassure themselves that their loved one is safe, googling information about feared illnesses or conditions, procrastination, over-preparation, etc.). Unfortunately, all of these avoidance strategies only serve to perpetuate worry and fear and the individual ends up inadvertently maintaining their symptoms. Lastly, individuals with GAD report that, if the thing they were worried about recently has been resolved, they will start scanning for threat to make sure everything is safe, and will inevitably find something else to worry about.
How do you Treat GAD?
Cognitive-Behavioral Therapy (CBT) is the treatment of choice for GAD.
The goals of CBT for GAD are to:
- Evaluate and alter assumptions about the liklihood and cost of feared consequences.
- Evaluate and alter assumptions about their own self-efficacy (their belief in their ability to handle challenges and bad things happening).
- Identify and alter other related beliefs that perpetuate their worry (e.g., beliefs about the function of worry, beliefs about perfectionism).
- Help the individual distinguish between "helpful" and "productive" worry versus "unhelpful," maladaptive, unproductive worry.
- Alter both cognitive and behavioral avoidance strategies and help the individual face their fears to allow for habituation and healthy evaluations of their feared consequences (liklihood and cost estimates).