Generalised Anxiety Disorder
Generalised anxiety disorder, or GAD, is a condition where the person is anxious most of the time. A person with GAD may feel like they worry all the time. It isn’t so much that they have a particular problem that they worry about; rather they keep finding lots of things to worry about. But the biggest problem is that they have the problem of worrying. Generalized anxiety disorder is worrying about worrying. Or being anxious about being anxious.
People with GAD end up fighting with their own thoughts. They take their worries very seriously, and fret about them. For instance, you might have the worry “what if I lose my job?” Then you spend a lot of time wondering what your boss thinks about you; how to find out if you’re going to be fired; how your spouse will react if you are fired; where you could look for another job; how you will pay the children’s school fees; what will happen to your mortgage and so on. You’re thinking about it a lot in an effort to reassure yourself, but you just find more worries.
Alternatively you might stop thinking about the idea of getting fired, and focus instead on how all this worry is likely to affect you. You would worry that the worry will lead to a stroke, or a nervous breakdown. In this case you’d be worrying about worry.
There are other symptoms of GAD – aches and pains, restlessness, sleep disturbances – these other symptoms are caused by the excessive worrying and appear to result from long-term activation of the fight-flight response.
What if…? and the self-fulfilling prophecy of anxiety
There are two words which, more than any others, accompany anxiety. These are the words “what if…?”.
The person with GAD imagines something terrible, eg “what if I get too anxious to work?” regardless of how likely or unlikely it is, and imagines the consequences should this event occur. Then they try to figure out how they can make sure that this terrible thing will never become a reality. They try to eliminate all doubt. But since it’s impossible to prove, beyond a shadow of a doubt, that something could never happen, this opens the door to unending worry. This constant worrying means you have less time and energy for engaging with the real world, and you end up tired and irritable, unable to concentrate and less productive at work. This may in fact become a self-fulfilling prophecy.
A person with GAD gets tricked into trying to stop the unwanted “what if?” thoughts, rather than accepting them and taking care of present business as thoughts come and go. So the first step to overcoming GAD is to accept the worrying thoughts and then move onto something else. This particular trick is made easier when you practise mindfulness meditation, so perhaps the first step is to start meditating.
Why do I suffer from GAD?
There is some evidence that there is a genetic basis to GAD: the children of parents with GAD are six times more likely to have it themselves compared to those whose parents do not have GAD. It seems that these people are generally more sensitive.
Increased sensitivity in the central nervous system (brain and spinal cord) may be at least partly responsible for the anxiety and symptoms of GAD. The anxiety is triggered more easily, and then the brain thinking that there is some kind of threat, triggers the sympathetic nervous system, which is responsible for the fight/flight response, and all the symptoms which come with it (increased heart rate, sweating, and so forth).
However there is another mechanism which perpetuates the anxiety. Claire Weekes, an Australian GP, identified this as a combination of fear and bewilderment: fear of the anxiety and bewilderment (or confusion) about what is going on. So in order to break the cycle, the patient needs to understand what is happening and become comfortable with the anxiety. This sounds strange, because anxiety is very uncomfortable. But we can use self-talk to make the anxiety less frightening, by saying for instance “Oh I’m getting anxious again. Well that’s ok, it’ll pass soon and in the meantime I can take some deep breaths and focus on what I’m doing right now.”
Anxiety First Aid: Change Your Behaviour, Rather than Your Thoughts
The problem is this: if you have a thought in your mind and try to remove it, the very act of trying to remove the thought practically guarantees that you will have the thought again. If I tell you not to think of a sheep with a golden saddle, with a monkey riding on its back, you will find it impossible not to think of it.
Since you can’t simply “turn your thoughts off”, progress with GAD (and with worry in general) comes when a person becomes more accepting of his thoughts – the good, the bad, and the unlikely – rather than trying to get rid of them. Effective treatment will help you change your relationship with your thoughts. It will help you respond to them as nothing more than symptoms of anxiety, rather than viewing them as true representations of reality or important signals about the future.
There are three things you can start doing right now to help deal with worrying thoughts.
- Mindfulness meditation: mindfulness consists in paying attention to the present moment and accepting whatever you find there. The usual instruction is to attend to your breath (or perhaps your feet or the sounds in your environment). You may then find that your mind has wandered off into thoughts. This is normal – it is what minds naturally do. So your response then is to notice what you are thinking about (or worrying about), and then gently guide your mind back to the breath (or your feet or the sounds). This process is one of accepting things as they are so that you can then move on.
- Stop fighting and learn to float: anxiety (and panic attacks) are maintained by the struggle we put up against them. If you“stop holding tensely onto yourself, trying to control your fear, trying ‘to do something about it’ while subjecting yourself to constant self-analysis…“The average person, tense with battling, has an innate aversion to …letting go. He vaguely thinks that were he to do this, he would lose control over the last vestige of his will power and his house of cards would tumble.” In fact if you let go and allow yourself to float through the anxiety or panic attack, it will pass more quickly. The idea of floating through anxiety comes from Claire Weekes, the Australian GP mentioned above, whose insight into the nature of anxiety has formed the basis of much current thinking.
- The use of worry appointments. A worry appointment is a time you set aside (about 10 minutes) which is devoted to your worrying thoughts. If you like you can make a note of any worrying thoughts on a worries to-do list, which you can then bring to the worry appointment. But don’t just worry; do your worrying out loud, in front of a full length mirror. When you say the worries out loud like this, you hear them. When you worry in front of a mirror, you see yourself doing the worrying. You’re not just worrying in the back of your mind. You’re hearing, and watching yourself as you worry. The worry is no longer subliminal, and that should help you get a better perspective on it. The rest of the day when worrying thoughts arise you give yourself a choice to either: a) take ten minutes now to worry very deliberately about this issue, or b) postpone it to your next worry appointment.
Further information & resources
Further information about anxiety