Generalized Anxiety

Anxiety is something we all experience and some of us are more prone to it than others.

It is not always easy to distinguish anxiety from stress, but one way to look it at it is that if there is a bear standing in front of you, it is a stressor, and you are experiencing stress. If the bear is in your thoughts, it is anxiety! Anxiety is worrying about things that may or may not happen.

Thinking about things that may or may not happen, and then taking action can be useful, and it is often a question of the extent of the thinking and the accompanying emotion that makes the difference. Thinking of having two payment methods when planning a trip, in case one fails, may be smart, but thinking about every possible problem to the extent that you can no longer enjoy the planning process or that you are too afraid to go on the trip is, of course, not desirable.

There are thinking habits that put one at risk for anxiety, like:

Excessive need for approval

Perfectionism

Excessive need for control

Do I have Anxiety, or do I have Generalized Anxiety Disorder (GAD)?

As the name implies, Generalized Anxiety Disorder is anxiety that is generalized to a multitude of situations or facets of a situation, it is the “What if?” disorder: What if I get lost going there? What if I can’t find parking? What if I get in an accident?”, etc. GAD usually begins at a young age and leads people to believe “this is who I am, I am a worrier”, as if part of a set identity as opposed to being a thinking habit. But in reality, it is a thinking habit related to a fear of uncertainty whereby one tries very hard to avoid uncertainty through thinking about everything in an effort to gain more certainty and prevent, or be prepared for, “bad things”. The issue is that all this only makes one feel more uncertain and worry more! Above all, it also often interferes with spontaneity, being in the moment, and enjoying life.

GAD is defined by the following Symptoms:

Excessive anxiety and worry, more days than not, for at least six months, about a number of events or activities.

Finding it hard to control the worry.

The anxiety or worry is associated with at least 3 of the following:

Restlessness
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep disturbance

These cause significant distress or impairment at work, at home, socially or in other ways.

Statistics

If you have GAD, you are not alone! Almost one in 10 people will suffer from generalized anxiety disorder at some point in their life.

If you experience anxiety or GAD and want help, please contact us.

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Treatment

CBT has been shown through decades of research to be effective in the treatment of GAD.

Changing thoughts: If you have generalized anxiety disorder, you tend to focus on the worst-case scenarios and all their possible ramifications, so that you can be ready for it all should it happen. You don’t like uncertainty and try to problem-solve for every possible eventuality.

You may, in those anxiety-provoking situations, overestimate the danger and underestimate your ability to cope. Cognitive re-structuring is used to correct these biases (overestimation and underestimation). Through therapy, you will also learn to accept uncertainty as the stuff reality is made of: Very few things in life are certain, unchanging, and forever. Life is instead full of opportunities and new experiences, which allow for new beginnings, growth and excitement!

Changing behaviors: Those with generalized anxiety disorder tend to procrastinate on making decisions or taking action; they don’t want to make a move until they know for sure it is the right one. They seek reassurance from others or reassuring information.  Treatment includes changing these behavior patterns by learning to effectively approach and solve problems (e.g., by writing and doing), trying to reframe them as challenges and not threats, and through action and exposure to situations outside of one’s comfort zone, developing the self-confidence that allows for the attitude of “whatever comes my way, I can handle it!”.

A move towards a “whatever comes my way, I can handle it!” attitude is wiser, because even with all of the overthinking possible, one cannot predict the future. How many times have you worried about something, only for something different to then happen instead?

Optional additional treatment strategies

Relaxation and proper breathing

Mindfulness and Acceptance: Learning to be in the here and now, and to suspend judgment. Instead of labeling experiences as “good” or “bad”, accepting them the way they are can be powerful. We can be quick to think of something as a “bad event” (e.g., losing a job, an unexpected divorce), but 5 or 20 years later, end up being thankful that it happened as it led to something better that we would otherwise not have known.

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Selected Book References

Selected Book References

Dr. Michel Dugas is a Quebec researcher who has advanced our understanding of GAD significantly over the past decades. You can look for some of his work, with Dr. Melisa Robichaud.

Below are some good books on anxiety, worry and GAD:

Best CBT Books in General:

Book: Change your thinking, third edition (2013). By Sarah Edelman.

Workbook: Mind over Mood, second edition (2016). ByDennis Greenberger and Christine Padesky.

Books on Anxiety, Worry and GAD:

Pleasant easy read:

Feel the fear…and do it anyway (2006). By Susan Jeffers.

10 simple solutions to worry (2006). By Kevin Gyoerkoe and Pamela Wiegartz.

Women who worry too much: How to stop worry and anxiety from ruining relationships, work and fun (2005). By Holly Hazlett-Stevens.

The worry cure: Seven steps to stop worry from stopping you (2005). By Robert Leahy.
Three Rivers Press. ISBN 1-4000-9766-5

More serious read or workbook:

The Generalized Anxiety Disorder Workbook: A Comprehensive CBT Guide for Coping with Uncertainty, Worry, and Fear (2015). By Melisa Robichaud, Michel Dugas and Anthony Martin.

Cognitive Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice (2019). By Melisa Robichaud, Naomi Koerner and Michel Dugas.

The Anxiety and Worry Workbook: The Cognitive Behavioral Solution (2023). By David Clark and Aaron Beck.

The Anxiety and Phobia Workbook (2020). By Edmund J. Bourne.

Generalized Anxiety Disorder Workbook: CBT Activities to Manage Anxiety, Cope with Uncertainty, and Overcome Stress (2022). By Lawrence Shapiro.

The mindfulness and acceptance workbook for anxiety (2007). By John Forsyth and Georg Eiffert.

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