Generalized anxiety disorder (GAD) has often been thought of as anxiety about a range of topics. This may lead clinicians to think of generalized anxiety as being “anxiety about anything” (e.g., work/school, errands, family life, etc) or about “more than one specific thing”. But research has increasingly found that unique and specific characteristics make up GAD and worry.
Worry can occur as part of many different disorders (e.g., social anxiety, OCD, depression, etc.). But worry and its corresponding experiences and behaviors appear to be the key feature to characterize GAD. Throw in physical symptoms (e.g., heart rate increases, feeling on edge, etc) and you’ve got a tough recipe to cope with.
Worry is similar to anxiety, but also has distinct differences. Anxiety tends to involve distinct thoughts of some threat or catastrophe occurring. These thoughts interact with acute uncomfortable physical reactions and feeling state. Worry tends to characterize more continuous “what if” thoughts with a less intense but longer-term “nagging” physical reaction and feeling state.
Those with GAD will often live in the “what ifs?”. This rumination may manifest internally as a question, but it often entails the assumption that something will indeed go wrong. The individual then often engages in extra and extensive action steps to ensure that catastrophe does not occur. For example, they may spend 23 total hours researching a car mechanic because they worry their car will be repaired poorly and still breakdown.
Research has uncovered multiple reasons this pattern can begin to occur. One theory posits that worry and those extensive efforts to stave off catastrophe actually help an individual avoid contacting the experience of anxiety. Another well supported theory points to the possibility that those with GAD experience an intolerance of uncertainty. In that case, those extensive efforts to prepare for any possible catastrophe function to lead the individual to believe they have acted effectively to seize control. They then gain a short-term sense of certainty.
Either way, key difficulties with managing or regulating that anxiety and worry appear to be a key underlying factor for GAD. Worry and belief about the need to be vigilant and prepared are strongly reinforced by the short-term certainty provided. “If I don’t heavily prepare, something bad will happen.” or “When I prepare so much, I am ready for anything.” But the downsides continue: constant anxiety and feeling overwhelmed at “having to” prepare so much. Not to mention impacts of continued worry and preparation on relationships, work life, and physical health.
The nice thing about these newer theories is that they help shed light on the nature of GAD. They make a nebulous and complex process (how people develop and maintain overwhelming worry) seem more straightforward. This helps us choose clear and specific approaches to more easily help those with GAD!
More good news is that treatments we already have appear to be highly effective for those processes. Key beliefs about catastrophe, rumination about everything that will go wrong, the experience of uncertainty, hyperpreparedness behaviors, and avoidance of experiences are all targets of existing therapy approaches. Cognitive-behavioral and exposure/experiential approaches can hit these nails on the head!
Generalized anxiety is a unique condition, as opposed to a catch-all. And that condition can be extremely overwhelming for individuals. Luckily for clinicians, newer understandings make generalized anxiety much less overwhelming to identify and treat. Not to mention that there are a lot of therapist resources available for how to address specific aspects of the condition. That’s a relief for us to help those who have trouble finding their own relief.
