Generalized Anxiety Disorder/ Chronic, Uncontrollable Worrying

Generalized Anxiety Disorder (GAD), or chronic worrying, is based on repetitive, persistent, uncontrollable thinking about uncertainties associated with future negative possibilities. GAD is associated with anxious feelings of dread and various problem- solving solutions that fail to reduce this heightened sense of uncertainty.

Those with GAD often suffer from physical symptoms associated with stress such as restlessness, fatigue, irritability, difficulty concentrating, muscle tension, headaches, and sleep and sexual problems. This experience of worry is compared to the wringing of a towel as compared to the startled fear response associated with panic.

Worries associated with GAD are often across various life domains that concern most people at some time:

• Health (self/family/friends)
• Safety concerns (self, children, family, loved ones)
• Work or school
• Finances
• Relationships (partner, family, friendships, colleagues)
• Minor matters (e.g., making appointments, completing daily chores)
• Community, world affairs (e.g., global warming, terrorist attacks, crime)
• Spiritual/Existential Matters (e.g., meaning and purpose, death, religious concerns)

Many people cope with chronic worrying by trying to suppress their worries, seeking reassurance from others, looking up information, or checking for safety. Unfortunately, these coping behaviors that were meant to ease worry are often what is adding to the distressing experience of worry.

Productive worrying is associated with effective and efficient preparation and problem solving and comes with our ability to think about our futures. Worrying is an adaptive response meant to propel us into action and planning that will protect us from danger. With a sufficient plan in place, we are expected to return to our lives. In this scenario, the worry is a “signal” to take action.

The problem is that worrying can become unproductive when it focuses on situations in the distant future that are largely outside of one’s control. These hypothetical “what if” worries are often based on problems that are a repetition of well-known, familiar concerns that cycle through one’s mind without leading to any satisfying resolution. In this scenario, worrying is “noise” in that there is no sufficient action to be taken towards a specific problem.

Unproductive worrying can become overwhelming, paralyzing, preoccupying, and toxic when it is driven by attempts to seek perfect solutions with a 100% guarantee of success, a relentless pursuit of certainty, narrow focus on imagined worst case scenarios, feelings of helplessness, high anxiety, and barriers to your greater life goals and values.

Everybody can relate to engaging in some unproductive worrying from time to time, but for some people this style of thinking begins to dominate their lives. This can happen when there are beliefs that:  

• any uncertainty or discomfort are signs of danger
• worrying is helping one prepare or prevent bad events, giving a sense of control
• worrying is a way of showing care towards oneself, others, the world
• worrying can help distract from more painful issues

Unproductive worrying also becomes problematic when coping strategies are based on attempts to control, distract, suppress, or stop the worrying as these strategies have the paradoxical effect of making worries worse. Problem solving or planning also do not work well when used to find solutions to hypothetical situations in the far future because they are usually met with the infinite possibilities of, “Yeah, but what if…” for each of your potential solutions.

The challenge though is that these coping strategies DO work…in the short run. The feelings of relief are often transient so that the content of the worry continues to pop up over and over again. After a period of time, an increase in anxiety, an increase in worrying, along with an increase in the attempts to control these emotions, can lead to the feeling that your worries are spiraling out of control. This can then trigger “worry about worry,” where you become concerned about the negative impact of excessive worrying.  

Treatment Strategies:

The goal in therapy is to find a way to resist the usual attempts to control the worry and instead learning to sit with the uncomfortable feelings of uncertainty and discomfort. Various strategies can be implemented to help with this process and can include:

• Psychoeducation regarding the function and process of worry
• Scheduling worry time to give your worries the attention they are clamoring for and to build tolerance for uncertainty and discomfort
• Changing your relationship to worry by becoming more accepting of the risks associated with stepping back from the worries and increasing your faith in your ability to cope  
• Mindfulness training
• Relaxation training
• Developing effective problem-solving skills (e.g., learning to see all possibilities, creative problem solving)