Generalized Anxiety Disorder (GAD) ...

"Even when things are okay, it's almost like I look for something to worry about."

Generalized Anxiety Disorder is known as the “worry-disease.” In GAD, anxiety is free-floating, and is not attached to any specific concern. Rather, it moves from issue to issue and rarely settles down. People suffering from GAD tend to worry a great deal, and never feel at ease or at peace, no matter how much comforting and reassurance they get. GAD is defined as:

1. Excessive anxiety and worry, about a number of events or activities (such as work or school performance) This occurs more days than not.

2. The person finds it difficult to control the worry.

3. The anxiety and worry are associated with three or more of the following symptoms:

Restlessness or feeling keyed up or on edge

Being easily fatigued

Difficulty concentrating or mind going blank

Irritability

Muscle tension

Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep).

4. The anxiety, worry, or physical symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning

Cognitive-behavioral model of GAD:

Cognitive-behavior therapists view worry as the result of the worrier's effort to avoid intense emotional experience. In addition to worry behavior, worriers show other types of related problematic behavior, such as being on time at all costs, cleaning their home thoroughly every day in case someone visits unexpectedly, or insisting their partners call immediately when they arrive at work. These behaviors are also viewed as efforts to avoid emotional experiencing.

Cognitive-behavior therapy for GAD:

Education: Therapy teaches the worrier about the cognitive, physical, and behavioral components of worry, and teaches the distinction between helpful and unhelpful worry.

Monitoring: Learning the specifics of worry episodes (triggers, content, frequency, intensity, duration) provides much-needed perspective as well as information to guide other aspects of treatment.

Physical control strategies: Diaphragmatic breathing and progressive muscle relaxation, mindfulness meditation, help decrease the persistent physical over-arousal that contributes to the maintenance of the worry process, as well as many of the symptoms the person with GAD worries about (gastrointestinal distress, sleeplessness, and fatigue).

Cognitive control strategies: Certain patterns of thinking contribute to feeling keyed up and on edge. Clients are taught to evaluate situations more realistically and alter their thinking patterns so that they can decrease anxiety and more effectively solve day-to-day problems. In addition, cognitive therapists help clients test the assumptions or beliefs they have about worry itself -- that worry leads to greater certainty and control, that worry itself is uncontrollable, and that worry decreases the likelihood of bad events.

Behavioral strategies: To address the worrier's fear of emotional experiencing, cognitive-behavior therapy teaches the worrier to confront (in imagination) the things he most fears, as a way of learning to be less afraid of it and (paradoxically) gaining more control over it. Learning how to focus on one particular worry thought or image without avoiding or escaping from it will, over time, help decrease the worrier's anxiety. Other behavioral strategies include teaching time management or problem-solving skills.