UNDERSTANDING THE SPECIFICITY OF THAT LABELED GENERALIZED ANXIETY DISORDER (GAD)
It is a misconception that Generalized Anxiety Disorder (GAD) is, put simply, a cluster of generally anxious symptoms. GAD, in fact, points to a very specific pattern of anxiety that is namely, excessive worry. I think we can all agree that worrying occasionally is “normal.” However, when the worry is all-encompassing and is the only thing you do all day-every day, there is a clinical problem happening and it’s called Generalized Anxiety Disorder (GAD).
As you’ve guessed, the leading symptom of GAD is excessive worry and it’s not GAD unless you are worrying about many different things that fit under many different categories. If you are only worried about your airplane fight to Florida next month, we are not talking GAD (perhaps specific phobia, but not GAD).
To meet the criteria for GAD you must also have catastrophic thoughts about the future. “What if my son doesn’t graduate?” “What if I lose my job?” “What if my parents get sick?” “What if I get into an accident?” All of these questions could easily be the dialogue of an individual with GAD. As a matter of fact, “what-if thinking” is a prominent characteristic of this type of anxiety.
Another pattern I notice with my GAD clients is that they make a lot of medical appointments. When worried about their health, for example, they might make a gazillion appointments with multiple physicians in an attempt to put their worries to bed. However, an individual with significant GAD will never be satisfied and will continue to worry about their health even when they’ve gotten a clean bill. “My doctor says I’m fine but I made an appointment with cardiology to make sure my heart is ok.” I call this “the search and doubt cycle.” They search for professionals to help them but endlessly doubt and worry that the problem was not solved. This is another prominent feature of GAD.
So, how can therapy help? Here are four steps to include in treating GAD.
1) Acknowledge the GAD.
When you notice yourself excessively worrying, recognize the GAD. Just like an alcoholic must, hi-my-name-is-…-and-I’m-an-alcoholic, you must acknowledge your GAD. Admitting to it creates a degree of separation between you and the condition. This enables you to feel more powerful over it; it makes you feel like GAD does not own you.
2) Ask yourself, “What am I really afraid of?”
Worrying gives people a false sense of security. People believe that if they worry, they will save themselves from some catastrophic future outcome. I therefore recommend that GAD clients acknowledge their worst fear. What’s that huge deal they are trying to protect themselves from? After digging deep, probing and podding, I usually uncover these kinds of core fears: “I’m afraid my parents will die.” “I’m afraid I won’t be a good enough mom.” “I’m afraid I won’t be a good provider for my family.”
3) Process the emotions associated with these core fears.
Once you acknowledge your core fear, you must process the emotions associated with it. Thinking about your parents dying is not fun but you must not avoid that potential and sweep those respective emotions under the rug. You must acknowledge that yes it will be extremely sad, and yes you will be in rough shape. You will eventually heal but it will hurt in a very real way at first. You will find a way to cope and deal but your emotions will be high for a certain period of time. Feel the emotions. Do not avoid them. Let them in. As discussed in a previous blog entry, repressed emotions will lead to anxiety…so set them free!
4) Use your thoughts to uncover more rational thinking.
Last but not least, once you’ve acknowledge the GAD, your worst fear, and your emotions, you are ready to use cognitive behavioural tools. Yes, your parents will die one day, but what is that likelihood now? …or what are more balanced ways to think about death? Someone dying is not all good but it may not be all bad either. Process. Think. Rationalize. There are an abundance of cognitive techniques your therapist can help you with at this point but I stress that steps 1-3 must be completed first.
Keep a journal of these four steps and use them with any and all of your most prominent worries. If you try it, let us know how it goes! This technique has seen much success with my clients.