What does Generalized Anxiety Disorder feel like? How can therapy help?
Worry is a normal, even useful part of being human. It helps us anticipate problems, plan ahead, and protect ourselves and the people we care about. But if you have Generalized Anxiety Disorder, it doesn’t work like that. It doesn’t result in problem solving and reaching a state of resolution. It’s more like circling around the same problem over and over and never getting anywhere and then, even if it happens to get resolved, your anxiety moves on to something else.
GAD is one of the most underdiagnosed conditions, because it can look a lot like being a conscientious, responsible person who just happens to worry more than most. Many people live with it for years before learning that what they’re experiencing has a name.
How is GAD different from “normal” worrying?
It is characterized by persistent, excessive worry about a wide range of everyday concerns such as your work, health, finances, relationships, world events, etc. It is difficult to control and causes distress in daily life.
Unlike social anxiety disorder, which centers on fear of social situations, or panic disorder, which involves discrete panic attacks, GAD is diffuse. The worry can attach to almost anything. It’s not about specific triggers so much as a general orientation toward the world as a place full of things that could go wrong.
GAD can also have a physical component. It can lead to muscle tension, headaches, GI issues, and insomnia. Many people with GAD have seen multiple doctors for physical symptoms before anyone suggests that anxiety might be at the root. The mind-body connection in GAD is significant.
Treatment for Generalized Anxiety Disorder
GAD responds to psychotherapy. The evidence base is strong and consistent. People with GAD improve with treatment. Here’s how the main approaches work.
Cognitive Behavioral Therapy (CBT)
CBT is the most extensively researched treatment for GAD and is considered a first-line approach. It works by targeting the thought patterns and behavioral responses that maintain anxiety.
Using CBT for GAD, we will work on several things:
Identifying the specific worry patterns and “what if” thoughts that keep your anxiety running.
Cognitive restructuring: learning to evaluate anxious thoughts more realistically, distinguishing between productive problem-solving and unproductive rumination
Tolerating uncertainty: much of GAD is driven by intolerance of not-knowing. CBT helps build a more flexible relationship with uncertainty, which is essential because most of life is uncertain.
Addressing avoidance: gently confronting the situations and experiences that anxiety has been keeping you away from at a pace that works for you.
Acceptance and Commitment Therapy (ACT)
ACT offers a different but complementary approach. Rather than trying to change or reduce anxious thoughts, ACT focuses on changing your relationship to them — so they have less power to dictate your choices and consume your attention.
Some of the ACT skills that are useful when dealing with anxiety include values-based action: clarifying what actually matters to you and taking steps toward it, even in the presence of anxiety and defusion which involves learning to observe anxious thoughts as mental events rather than facts.
Psychodynamic therapy
For some people, especially those whose anxiety feels deeply rooted in their history or sense of self, psychodynamic therapy can offer greater insights into the origin of your anxiety.
GAD can have roots in early experiences of unpredictability such as childhood environments that did not feel consistent or safe. Psychodynamic therapy doesn’t delve into the past for its own sake, but to help you understand how early experiences shaped the nervous system you’re living with now. You want to be able to respond to situations objectively as opposed to reacting as if you were still living in an environment that is far behind you.
Getting Treatment for Generalized Anxiety Disorder
If what you’ve read here feels familiar, and you’ve been living with persistent worry that feels hard to control, therapy can definitely help. You don’t have to be in crisis to reach out.
I offer individual therapy for adults with generalized anxiety disorder in New York, both in-person in Manhattan and virtually across New York State. A free 15-minute phone consultation is a good place to start.
Compassionate and effective psychotherapy for adults with anxiety in New York via telehealth