As a clinical psychologist in the Washington-metropolitan area and an adjunct professor at Georgetown University, excessive worry is one of the most pressing psychological problems I see.
My patients worry about work, relationships, children, health and money. When worrying becomes persistent, long-lasting and difficult to control, it can seriously affect daily life. And if the unrelenting worry is accompanied by anxiety symptoms such as irritability, difficulty concentrating, muscle tension, fatigue and poor sleep, that person may be suffering from something called generalized anxiety disorder (GAD).
GAD is one of the newer anxiety diagnoses, appearing in the American Psychiatric Association’s manual of mental disorders for the first time in 1980. Research and recognition of excessive worry and GAD have lagged behind other disorders that have been acknowledged longer, such as depression, or have captured the public’s attention more, such as obsessive-compulsive disorder and post-traumatic stress disorder.
Worriers often suffer in silence. Melisa Robichaud, co-founder of the Vancouver CBT (Cognitive Behavior Therapy) Centre and co-author of “The Generalized Anxiety Disorder Workbook,” said many of her patients are concerned that seeking help for GAD is self-indulgent because they’ve been told that worry is just a part of life.
And many people suffer for a long time.
“I often see people who have struggled with it for 10, 20, 30 years,” said Robert L. Leahy, founding director of the American Institute for Cognitive Therapy in New York and author of “The Worry Cure.”
How does it feel to have GAD? One of my patients told me: “I am frustrated by my mind always moving 100 miles per hour and going down a rabbit hole. I feel constantly on edge and unable to relax.” Another said, “I am exhausted and unable to enjoy life.”
Studies show that between 5.7 percent and 11.9 percent of U.S. adults experience GAD at some point, yet less than half get treatment. Many people with GAD also have other anxiety disorders and depression, as well as significant work and interpersonal problems. GAD also represents a significant risk factor for cardiovascular problems.
Recent decades have brought new understanding about the factors that make worry turn into GAD and those that perpetuate GAD.
Targeting these negative factors directly can help people who worry too much.
Holding erroneous views
People with GAD hold more positive beliefs about the usefulness of worry than the general population. They frequently view worry as motivating, as helpful in preparing them for bad outcomes. They even see it as a positive personality trait. Some believe that worry shows to others how much they care.
White said she and her bosses loved that she worried about every detail when organizing work events, and always had a Plan B — and C and D. Two frequent manifestations of GAD, perfectionism and workaholism, often are rewarded in our culture.
But research shows that worrying does not help people better prepare for the future, nor does it inoculate them from feeling bad when negative events come to pass.
Moreover, worriers are often not good problem-solvers. They frequently procrastinate, and that, as well as having perfectionistic tendencies, has been linked to worse performance. When tackling excessive worry, it is important to acknowledge a person’s positive beliefs about it and a possible ambivalence toward change.
By modifying those beliefs, a path toward less worrying often can be cleared.
Worriers tend to predict that things will turn out worse than they actually do.
A recent study found that 91 percent of worries held by people with GAD did not come true. Psychologists Daniel Gilbert from Harvard and Timothy Wilson from the University of Virginia have found that humans generally are bad at predicting how we will be affected by future events. Their research shows that people tend to overestimate the emotional effect of bad events and underestimate their ability to cope with those events.
“When negative outcomes materialize, most people — at least 70 percent — handle it okay,” Leahy said.
One way to minimize catastrophizing is by distinguishing between worrying and problem-solving — and then improving the latter.
Everything that you have control over calls for problem-solving. Worriers often view problems as threatening, doubt their ability to solve them and distrust potential solutions. Being aware of potential problems allows for early detection, which allows worriers to tackle those problems before procrastination sets in. Basic problem-solving steps, laid out in many worry self-help books and cognitive behavior training protocols, include defining a problem, generating multiple solutions, choosing the best one, implementing it and assessing the result.
Not being 'mindful'
Worry is by definition a cognitive activity, meaning it’s happening in the mind. When we are preoccupied by worry, we are unable to focus on what is in front of us. Habitual worriers have a hard time being mindful of what is happening in their present moment and shifting attention away from recurrent thoughts.
Extensive research suggests mindfulness training can help reduce problematic worry. In a small study of 40 worriers presented at a recent conference, University of Pittsburgh professor Lauren Hallion and colleagues investigated the usefulness of various mindfulness approaches. They found that the “focused attention” approach, in which the participants redirected attention from their worries to an external sound, decreased worrying the most. In comparison, accepting thoughts without trying to change them helped less.
Engaging in regular guided mindfulness mediations more informally or practicing a mindful way of being can also be beneficial.
'Choosing the devil you know'
Intolerance of uncertainty has been shown to be one of the most powerful drivers of worry. Worriers have an extreme dislike and fear of uncertainty, and the act of worrying is an attempt to reduce it. They also tend to avoid uncertain situations whenever possible — even when it means missing out on life.
Douglas Mennin, a professor at Teachers College, Columbia University who has researched worry, said people with GAD are more fearful of and distressed by negative emotions. Consequently, he said, “they tend to organize their lives in very predictable, routinized and structured ways, effectively choosing the devil they know [worry] over opening up to new possibilities.”
Taking chances on new possibilities might bring about more anxiety in the short run. But joy and vitality are also likely to increase as someone engages in a richer, more meaningful existence. Eventually, worry and anxiety will decrease, as well.
Robichaud said intolerance of uncertainty is like a psychological allergy, and that just as gradual exposure to a small amount of allergen can cure an allergy, gradual and small exposure to uncertain situations can significantly reduce the fear of uncertainty and consequent worry.
Sticking with bad behaviors
Safety behaviors are actions that help us feel better in the moment, but exacerbate worry and can even lead to GAD.
One type consists of “approach strategies,” which include excessive information- and reassurance-seeking, double-checking, hypervigilance and failing to delegate. Another type includes “avoidance strategies,” attempts to stop worry through procrastination, evading uncertain, novel or worry-provoking situations, and failing to commit to people or events.
Instead of checking your teenager’s location for the seventh time, for example, try abstaining and see what happens. Try the same technique the next time you feel an urge to ask your partner to ease your worries. If that sounds like a tall order, at least delay the behavior.
When sensing an urge to procrastinate on a hard project at work, take a first step as soon as possible. Or push yourself gently to do what your irrational worries tell you not to.
You might be surprised to discover that, although you feel quite anxious, you can avoid relying on safety behaviors, Mennin said.
The more you are willing to reduce safety behaviors, the more likely you will become worry-free.
So, don’t worry: The factors that turn worry into GAD and the strategies that can help alleviate them are part of a standard cognitive behavioral therapy approach. Following self-help books, videos, and apps can be beneficial.
For those who need or prefer professional guidance and help, cognitive behavior therapists are recommended. The Association for Behavioral and Cognitive Therapies (abct.org) is a good place to start.