About Worry & Generalised Anxiety

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Generalised anxiety tends to be associated with prolonged worry about a range of possible future catastrophes or lots of minor daily problems.  “Worry” involves over-thinking, sometimes for hours, and people may describe it as trying mentally to solve problems or prepare themselves for anticipated crises.  However, these concerns often relate to hypothetical setbacks that don’t occur in reality.  Worry often involves dwelling on “What if?” questions, (“What is something goes wrong?”) and questioning “How will I cope?”, styles of thinking that tend to be closely-associated with feelings of anxiety, and sometimes frustration, irritability or annoyance, or a sense of inadequacy or vulnerability.  Worry is often associated with physical symptoms of anxiety such as muscular tension, fatigue, poor concentration, or problems getting to sleep at night.

When particularly chronic and severe it can lead to the diagnosis of ”Generalised Anxiety Disorder” (GAD).  Research suggests that about 5.7% of people will have experienced GAD at some point in life (NCS-R) and that rates are about 50% higher in women than men (Roth & Fonagy, 2005, p. 152).  Research has proven full-blown GAD slightly harder to treat than most other anxiety disorders, with average success rates of around 50-65% for traditional CBT (Roth & Fonagy, 2005, p. 173).  However, recent innovations in cognitive therapy appear to have led to an improved success rate, with one recent study showing 77% of clients no longer meeting diagnosis following a revised CBT approach (Clark & Beck, 2010, p. 438-440).

Whether or not your anxiety is severe enough to meet the diagnosis of GAD, you may find it helpful to know more about it because milder worry and anxiety often takes a similar form and is associated with similar problems.  GAD refers to severe anxiety and difficult-to-control episodes of worry (apprehension) about multiple topics, occurring most days, for at least six months.  In addition, the worry and anxiety must be associated with at least three of the following symptoms, some of which must occur most days:

1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

In particular if you have been feeling nervous, anxious or on edge most days and unable to stop or control worrying, those are typical indications of Generalised Anxiety Disorder or a milder (“subclinical”) version of the same problem.

People with severe worry and generalised anxiety are often particularly concerned about “failure” and may report a sense of “inadequacy” or feeling “unable to cope” with stressful situations.  They often describe a sense of urgency about having to solve problems, which psychologists call the “looming cognitive style.”  That might mean, e.g., lying in bed at night worrying about problems that you would be better tackling at another time, during the day.  People often resort to trying to suppress their worry or distract themselves from it, particularly when it is very severe, but this tends to be an unhelpful way of coping in the longer-term.  CBT offers alternative, evidence-based, ways of learning to respond to anxious thoughts without becoming too absorbed in them.

Recommended Reading

The Worry Cure by Prof. Robert Leahy

This is probably the best self-help CBT book about worry and generalised anxiety.  It contains may useful pieces of information and practical techniques.  My only caveat is that clients with generalised anxiety often feel overwhelmed by too many techniques and may prefer a simpler approach.  However, using some of the strategies in this book will usually be of benefit.

Blog Articles About Worry & Generalised Anxiety

• How Fragile is Worry? October 31, 2012
  This short article lists a wide variety of brief cognitive-behavioural experiments that can be used to change your experience of worrying and to alter unhelpful attitudes toward it.The post How Fragile is Worry? appeared first on Cognitive-Behavioural Therapy in London. […]
  Solutions: London Cognitive-Behavioural Therapy (CBT)
• What’s the point checking things? August 22, 2012
  What’s the point checking things? Copyright © Donald Robertson, 2012.  All rights reserved. One of the most common problems people report in relation to anxiety is the compulsion to check things excessively, e.g., checking that lights are turned off, emails … Continue reading →The post What’s the point checking things? appeared first on Cognitive-Behavioural […]
  Solutions: London Cognitive-Behavioural Therapy (CBT)
• CBT for Intolerance of Uncertainty and Chronic Worry June 18, 2012
  Recent advances in the cognitive therapy of generalised anxiety disorder have focused on the role "intolerance of uncertainty" plays in triggering and maintaining chronic worry, this article provides a brief outline of the approach.The post CBT for Intolerance of Uncertainty and Chronic Worry appeared first on Cognitive-Behavioural Therapy in Londo […]
  Solutions: London Cognitive-Behavioural Therapy (CBT)
• Decatastrophising in Cognitive Therapy April 7, 2012
  This short article describes the "decatastrophising" strategy used in Beck's cognitive therapy as a self-help technique for severe anxiety.The post Decatastrophising in Cognitive Therapy appeared first on Cognitive-Behavioural Therapy in London. […]
  Solutions: London Cognitive-Behavioural Therapy (CBT)
• CBT Self-Help for Managing Worry November 14, 2011
  This short article provides a basic "three-stage" self-help guide to one of the simplest CBT techniques for managing worry, the "stimulus control" method, which is the basis of more complex therapy approaches.The post CBT Self-Help for Managing Worry appeared first on Cognitive-Behavioural Therapy in London. […]
  Solutions: London Cognitive-Behavioural Therapy (CBT)
• Stages in Applied Relaxation Training September 25, 2011
  Stages in Applied Relaxation Training Copyright © Donald Robertson, 2011.  All rights reserved. This short article provides an overview of different stages and components in Progressive Relaxation (PR) and Applied Relaxation (AR) training.  The assumption is that each stage of … Continue reading →The post Stages in Applied Relaxation Training appeared first […]
  Solutions: London Cognitive-Behavioural Therapy (CBT)
• Detached Mindfulness (DM) August 11, 2011
  This brief article outlines the technique of Detached Mindfulness used in Metacognitive Therapy (MCT) with some basic definitions and guidance on using this approach.The post Detached Mindfulness (DM) appeared first on Cognitive-Behavioural Therapy in London. […]
  Solutions: London Cognitive-Behavioural Therapy (CBT)
• Worry Postponement and Exposure March 5, 2011
  This short article describes how to use worry spotting, postponement, and exposure to reduce chronic worry and generalised anxiety.The post Worry Postponement and Exposure appeared first on Cognitive-Behavioural Therapy in London. […]
  Solutions: London Cognitive-Behavioural Therapy (CBT)
• Appraising your Sense of Safety February 17, 2011
  This short form is used in conjunction with cognitive therapy to help modify beliefs about personal safety and address the sense of vulnerability common in stress and anxiety-related problems.The post Appraising your Sense of Safety appeared first on Cognitive-Behavioural Therapy in London. […]
  Solutions: London Cognitive-Behavioural Therapy (CBT)
• Problem-Domain Analysis Form (Revised) January 23, 2011
  This is a short assessment form used to provide an overview of problems in different domains of life and focus on goals, obstacles, coping, and worry, in the most problematic areas.The post Problem-Domain Analysis Form (Revised) appeared first on Cognitive-Behavioural Therapy in London. […]
  Solutions: London Cognitive-Behavioural Therapy (CBT)