Generalized Anxiety Disorder (GAD)
What is GAD?
Generalized Anxiety Disorder is characterized by excessive worry and anxiety that is difficult to control. It is accompanied by symptoms like fatigue, restlessness, irritability, muscle tension and possible insomnia. Individuals with GAD often worry about a variety of things, rather than one specific issue (American Psychiatric Association, 2000). GAD is a basic anxiety disorder (Brown, Barlow, & Leibowtiz, 1994), from which other anxiety and mood disorders develop. Many patients with GAD also present with co-morbid disorders like social phobia, panic disorder, and major depression (Heimberg, Turk, & Mennin, 2004). Successful treatment of GAD often results in improvement of these co-morbid disorders (Borkovic, Abel, & Newman, 1995).
Conceptualization in a CBT Framework
The Cognitive Behavioral model of GAD emphasizes how the negative biases in an individual’s thinking contribute to anxiety. In GAD, the predominant bias is the tendency to anticipate the worst and assume that the worst is most likely to happen. The CBT model also emphasizes the tendency of individuals with GAD to underestimate their ability to cope with anticipated problems, which heightens anxiety (Beck, Emery & Greenberg, 1985). Individuals with GAD may use worry as an ineffective form of coping or problem-solving. When we worry, it can create the illusion that we are “on a problem” or addressing it, when in actuality, all we are doing is thinking, and thinking catastrophically. CBT helps to short circuit this cognitive churn and move us more quickly into problem-solving. Worry may also be a way to avoid unwanted emotions or thoughts (Wells, 1997). Unfortunately, avoiding thoughts and feelings only increases fear of them. For this reason, CBT helps clients bring these thoughts and feelings into awareness.
The primary goal of Cognitive Behavioral Therapy for GAD is to decrease excessive worry. In treatment, clients will learn to identify and modify beliefs about worry using cognitive restructuring strategies like questioning evidence and validity of worry, challenging appraisals about the uncontrollability of worry, and normalizing. Further, clients will work to change their tendency to overestimate threat and learn coping skills (Wells, 1997). Because worry thoughts are future focused, people with chronic worry experience decreased contact with the present moment. For this reason, mindfulness, the skill of bringing one’s awareness to the present moment, is an important part of GAD treatment (Borkovec & Sharpless, 2004).