Why Can’t I Stop Worrying?

What is generalized anxiety disorder?

Why Can’t I Sop Worrying? Generalized anxiety disorder, or GAD, is characterized by chronic anxiety that persists for at least six months. People with GAD focus their worry on two or more stressful life circumstances (finances, relationships, health, school performance, etc.) most days during at least a six month period. It is common to have a large number of worries and to spend a lot of time worrying. People with GAD have great difficulty controlling their worrying, and the intensity and frequency of the worry is disproportionate to the actual likelihood of the feared events happening. In addition to frequent worry, people with GAD can feel restless, easily fatigued, and irritable. They may have trouble with concentration, tense muscles, and disturbed sleep. Many of these symptoms are also symptoms of major depression, and a competent therapist can help determine whether these symptoms are due to GAD, major depression, or both. Normal anxiety occurs in everyone from time to time. The difference is that normal anxiety is usually perceived as more controllable and can be put off until later, while GAD is more pervasive, pronounced, distressing, and long-lasting. GAD is distinguished from obsessive-compulsive disorder (OCD). OCD sufferers have obsessions (recurring ideas, thoughts, images, or impulses that seem senseless but are nonetheless persistent and intrusive) and/or compulsions (behaviors or rituals that are performed to dispel the anxiety brought up by obsessions). GAD is different from panic disorder, which is characterized by recurrent panic attacks and the persistent concern about when the next one will occur. A panic attack is an abrupt, discrete period of intense fear or discomfort, accompanied by symptoms such as heart palpitations, sweats, trembling, shortness of breath, choking sensations, chest pain, nausea, dizziness, numbness, chills or hot flashes, feelings of unreality, fear of going crazy, and fear of dying.

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What are the causes?

Anxiety problems are brought on by a variety of causes, including heredity, biology, family background and upbringing, conditioning, recent stressors, self-talk, personal beliefs, and difficulty expressing feelings. Four traits that perpetuate anxiety are perfectionism, excessive need for approval, excessive need for control, and a tendency to ignore physical and psychological signs of stress. People who are raised in families where abuse, neglect, deprivation and shaming were common feel less self-confident and more vulnerable to GAD.

Do I need psychotherapy?

If you suffer from GAD, you can do a number of things on your own first to reduce anxiety and make it more manageable. Increased exercise, good nutritional habits, and the practice of deep relaxation or meditation can all help relieve the physical and emotional tension associated with GAD. Learning to identify your feelings, recognizing when these feelings are being suppressed, and communicating these feelings to others can keep your anxiety from building. Identifying and countering critical things you say to yourself and mistaken beliefs about yourself with positive and supportive statements can increase self-esteem and self-acceptance. If your efforts to reduce anxiety through self-help are insufficient, psychotherapy can help you in a variety of ways. Short-term psychotherapy (usually six to twenty sessions) can help you develop a plan for reducing anxiety that fits you best, and help you identify some of the historical and psychological contributors to anxiety. Long-term therapy (a year or more) can help you discover the deeper emotional issues underlying anxiety and help you build more lasting protective barriers against it. Both individual and group therapy are effective methods for dealing with anxiety. Individual therapy provides the opportunity to gain insights and changes in the context of a one-to-one relationship. Group therapy helps people experience the ways their interpersonal relationships contribute to, and can potentially relieve, anxiety.

Should I take medication?

Many people with generalized anxiety disorder find they can avoid drugs through psychotherapy, improved nutrition, daily exercise, daily meditation or deep relaxation, changes in self-talk, and support of family and friends. However, when panic attacks, obsessions and compulsions, or depressive symptoms are significant enough to prevent you from functioning in most of your usual activities, medication can be a valuable component of treatment. Although medication will not fix the underlying psychological causes of anxiety, it can help you gain sufficient control and emotional stability to employ other non-medical strategies.

Further Reading

Bourne, E. J. The Anxiety and Phobia Workbook, 4th Edition. New Harbinger Publications, 2005.

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