What is generalized anxiety disorder (GAD): Generalized anxiety disorder involves excessive and persistent worry about things that are realistic in life but unlikely to happen. It includes high levels of physical tension. The worries must occur more days than not for six months or more, which is different from being in response to a stressor. These worries are difficult to control and interfere with the quality of life.

Common worry themes include work or school, health, friends and family, finances, and daily life. Although everyone worries and it is normal to do so, individuals with generalized anxiety disorder either overly worry to feel prepared for stressors and in control of their anxiety or avoid worries due to the discomfort.

Those who overly worry often have unrealistic expectations of themselves and will worry to avoid mistakes. They may also hold false beliefs that worrying will prevent outcomes or that it is necessary to worry. Conversely, those who avoid worries believe that worrying will lead to losing control and attempt to shut off the worry. All of these mistaken beliefs related to worry block emotions and only serve to maintain anxiety.

What causes generalized anxiety disorder (GAD): GAD can be caused by genetic factors, such as emotional sensitivity in the family, life experiences including parental modeling and exposure to dangerous situations, and life stressors like relationships, work, and finances.

Who is affected by generalized anxiety disorder (GAD): GAD can develop at any age, but the most common onset is between childhood and middle age, around 20 years old. It can come on gradually across the life cycle. GAD affects 6 million adults or 3% of the population, with women being twice as likely to develop symptoms as men. Only 40% of sufferers receive treatment. GAD is highly treatable with a trained professional!

The treatment for GAD: Cognitive behavior therapy (CBT) is the leading treatment for anxiety.

The components of CBT for GAD: Although CBT is the broadly researched treatment for all anxiety disorders, it includes therapy strategies specific to each type of anxiety. To treat GAD, the following components are used:

• Psychoeducation on symptoms of general anxiety disorder and understanding how it presents for the person.
• Relaxation techniques: To decrease the chronic tension associated with general anxiety. It includes breathing and muscle relaxation.
• Thinking skills: To assess realistic likelihoods of worries occurring, as well as the probability in one’s ability to cope. Anxiety convinces one that the worry thought is highly likely and the person’s ability to cope is low
• Exposure therapy: Approaching fear based situations to elicit the anxiety and allow opportunities to manage the symptoms. The goal is to generalize the skills used during exposures to real life situations and to gain mastery over the emotions. Emotional mastery may include a decrease in the emotion (habituation), as well as an ability to ride the wave of the the emotion. The types of exposure used are imaginal exposure (deliberately focusing on negative images and stories associated with the worry) and in-vivo exposure (approaching real life avoided situations).

Complementary treatments to CBT for GAD: Additional treatments can be added to support individuals during CBT. Mindfulness and self-compassion skills can teach people to come to the present moment and notice worry thoughts and anxious feelings without worsening them. The skills encourage a kindness and understanding to urges to avoid or control worries while holding oneself accountable to change. Acceptance and commitment therapy includes structuring exposures in line with one’s goals and values to return to living life fully.

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