General Anxiety

What is worry?

Most people worry. When we see a potential problem in the future we might spend a lot of time thinking about it … what will happen? … what could we do about it? … how might we cope? Much of our worry is focussed on everyday events - paying the bills, dealing with difficult people at work, or trying to decide what to buy or where to send the kids to school. Another type of worry concerns the sorts of things that might happen in the future, such as illness, accidents, or any other event that might affect our safety or wellbeing, or that of our families or others we care about. In scientific terms worry is described as "a predominantly verbal thought activity concerned with negative views of future events".

See also www.crufadclinic.org for a patient education package for generalized anxiety disorder that your doctor can arrange for you for $10. It contains elements of the cognitive behaviour therapy in an illustrated story line to show you just what to do to recover. Pictures are much better than words.

When worry becomes a problem

As most of us worry, it is useful to recognise when that worry becomes a problem. It is generally true that all people tend to worry about the same sorts of things, so it is not the content of the worry that is the problem. Instead, worry becomes a problem when it is excessive and/or difficult to control.

Worry is excessive when it is too intense, happens too often, or takes up too much time than is warranted by the realistic importance of the event or the actual likelihood of the event occurring. For example, worrying about being fired from a job which most people think you do well, worrying about the devastating consequences of contracting an illness for which you have few risk factors, or worrying about people you don't know disliking you is probably excessive. This excessiveness becomes all the more so if the worry happens most days, and occupies much of your waking hours!
Your worry is difficult to control if you are unable to dismiss it easily from your mind or often find it difficult to sleep because of worry.

Strategies for controlling problem worry

When you find yourself worrying, ask yourself the following questions:

Is your worry reasonable?

Is the thing you fear really likely to happen? How can you be sure? Is there another possible explanation or outcome? Are you trying to predict things in the distant future that you can't possibly know anything about? If it does happen, how much will it really matter? How would someone else see this worry?

Is there a true problem to be solved?

If there is a realistic problem, then you may need to focus on finding solutions for it. Good problem solving can be thought of as helpful or adaptive worry.

Try the six-step structured problem solving technique

write down exactly what you believe the main problem to be
write down all possible solutions, even bad ones
think about each solution in practical terms
choose the most practical solution
plan how you will carry that solution out
do it.

Now did you solve the problem? If no... Have you learnt a better way of defining it? if so, write down the new problem and do the six steps again. It is as good as pills for many people.

What is the effect of thinking the way you do?

If your worry has some basis, but there is nothing you can do about it right now, then see if you can accept the worry and let it go. This can seem difficult for expert worriers, but try to say "There's nothing I can do to change this right now, thinking about it will only make me more upset. I'll accept the worry and get busy with something else for now". And then really do try to get busy with something else.

Worry and Generalized Anxiety Disorder (GAD)

Worry is the central feature of a common anxiety disorder called Generalized Anxiety Disorder (GAD). People are said to have GAD when they have had excessive worry that is difficult to control that has lasted for more days than not over six months or more. In addition people with GAD experience a number of other problems that tend to be associated with the worry.

Problems associated with worry in Generalized Anxiety Disorder:

Feeling restless, keyed up, or on edge
Being easily tired
Having difficulty concentrating, or having your mind go blank
Being irritable
Having tense or sore muscles
Having difficulty falling asleep, staying asleep, or having restless unsatisfying sleep

Many people with GAD will find the strategies outlined above for controlling worry helpful, but some may need to seek professional treatment.

What treatments work for GAD?

Getting better means gaining control over worry and ceasing to experience the problems that are normally associated with excessive worry. A number of psychological treatments have shown to help people with GAD, but cognitive behavioural therapy (CBT) produces the most consistent and long-lasting improvements.

It appears that the following components of treatment are most important:

An approach where people are taught skills to manage their anxiety and to take responsibility for change and control over their thoughts, feelings, and behavior
Actively identifying and challenging worrying thoughts
Relaxation training (usually a form of progressive muscle relaxation) to control physical tension

Medication

Some medications, such as antidepressants, have been shown to reduce worry and associated physical symptoms in people with GAD, but it appears that the improvements only last as long as the medications are taken. Benzodiazepines such as Valium provide temporary relief from symptoms, but are addictive and people end up needing larger doses to get the same effect. These drugs are not recommended for long-term use. Your doctor will be able to provide more information on medication, but used alone this treatment option will not be as good as when combined with CBT.

Where can I get help?

Start by talking to your local doctor. Another option is to contact your local community health centre and speak to a specialist mental health professional. Your local phone book should help you to find you closest centre. Many universities offer treatment for anxiety disorders through their Psychology or Psychiatry departments. Professional bodies for clinical psychologists and psychiatrists may be able to help you find the care you need.