Generelized Anxiety

What is Anxiety

Anxiety is a normal part of life. At times it is unavoidable, and sometimes even necessary and advantageous. This may seem counter intuitive, but anxiety can often help us motivate or push ourselves to get something done that we know we’ve been putting off. Imagine you have a big presentation coming up at work that could potentially lead to the promotion you’ve been striving for. Without a little anxiety, you might not take your work as seriously or get it done on time. It can also help us recognize danger and keep us safe. Think of your ancient ancestor who had to hunt for food in the wild. If they did not have the fear and anxiety to recognize and run from overpowering predators, they would easily become prey themselves. So having a little anxiety is not such a bad thing. But what happens when you can’t shut that anxiety off?

The difference between necessary anxiety and an anxiety disorder lies mainly in the duration, intensity and impact of the anxiety. Anxiety that is only brought on by occasional stressors throughout life is generally not too problematic, but if you are feeling anxious seemingly all the time, it is going to be difficult for you to live a fully functional and fulfilling life – and this is precisely why it is called a disorder.

The most common anxiety disorder is called Generalized Anxiety Disorder (GAD). The symptoms of this disorder include the following:

Excessive Worrying and 3 of the following:
Restlessness or feeling keyed up or on edge
Feeling easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle Tension
Sleep Disturbance

These are the symptoms listed in the DSM-5, or Diagnostic and Statistical Manual of Mental Disorders, but they are certainly not the only symptoms you may experience. Other common symptoms include body aches, decreased (or increased) appetite, indecisiveness, chest tightness, difficulty breathing, and many others. It’s also important to note that the “worrying” can be about a variety of different topics, including your health, your job, finances or even minor issues. This is why it is referred to as “generalized” anxiety. The anxiety does not seem to have one specific cause or focus, and instead seems to follow you in any or every aspect of your life. You may also notice changes in your behavior. Perhaps you are not sleeping as well as you used to, you find yourself snapping at people more often or are having difficulty completing tasks at work.

People who struggle with anxiety are often called “worry warts” or “overthinkers,” but anxiety is as much physical as it is mental. So, take notice of not just your thoughts and worries, but also what effect this is having on your physical body and behavior. If you notice many of the symptoms listed above and they don’t seem to be going away, it may be an indication you are suffering from an anxiety disorder. Keep in mind, an anxiety disorder can appear at any time in your life but does not necessarily have to stick around forever either.

How do we Treat Generalized Anxiety Disorder

Anxiety looks differently for everyone can have different causes. It’s important we first take a deeper look into the causes of your specific struggles and identify the historical, cognitive and emotional aspects of your inner world and the life circumstances that contribute to your anxiety. There is no cookie-cutter way to treat anxiety, but there are some basic principles that we can utilize to find a solution that fits with your personality.

For some people, anxiety appears, at least on the surface, to be very mental. If you’re one of these people, you may find that you are not necessarily overwhelmed by intense physical sensations, but are instead stuck in your head; obsessing and ruminating to no end. You may find that your anxiety will identify a problem, and you will spend hours trying to solve it or work around it, only to find that no matter how hard you try the worries do not go away. If this sounds familiar to you, then we may focus on finding a way to tap into our physical and emotional sensations. As human beings, we like to believe we are perfectly rational. The reality however is that our nervous system plays a significant, if not, majority role in how we think and behave. You may not even realize that your nervous system is on fire because you spend all your energy in your mind trying to “solve” problems.

As we learn to re-focus on our body and physical sensations, we can begin to recognize that much of our anxiety actually begins in our body and not our mind. With this, we can now learn how to sit with our negative emotions instead of avoiding them. We will practice being with our discomfort and not pushing it away, which, in the long run will help us get more and more comfortable with our discomfort. We learn to sit and be with the anxiety so we can practice accepting the stressors in our life that are not in our control; instead of trying to “solve” or work around them in our mind. We will also practice ways to regulate our nervous system so we can slow our heart rate and nerves down. When we are anxious, our prefrontal cortex (which controls rational thought) is completely shut down. This is why no amount of ruminating can make that anxiety go away! If we can learn to regulate our nervous system, we can turn our thinking part of our brain back on, so we can start see things more clearly and begin to challenge some of those negative thinking patterns.

On the other hand, if your anxiety is less mental and more physical (tightness in chest, sweating, stomach pain, sweating, rapid heart rate), we may begin by trying to identify the specific stressors (internal and external) that may be contributing to your anxiety. If you feel anxiety more physically, you may notice that your brain goes blank when you are anxious, or your thoughts are so jumbled that you can’t make sense of them. Once again, we will work on ways to slow your nervous system down so we can begin to access that rational side of your brain. As we explore this further, we can begin to get a better understanding of why you are so anxious, and begin to formulate a plan of attack.

You may not fit cleanly into either of these buckets and may notice you struggle with a mix of symptoms; that’s ok too! Your symptoms may also fall more in line with another form of anxiety, such as obsessive-compulsive disorder, social anxiety or one of the many phobias that plague humanity. This is why doing a thorough assessment of the causes and symptoms is so important.

But regardless of the exact form of anxiety there are 3 main features of any anxiety:

Trying to Control Chaos – Feeling out of control and powerless over our external world. We believe the more we gain control the more secure we will feel, when in reality, our attempts to control the uncontrollable only make us feel more powerless and more anxious. We become afraid of accepting the inevitable.
Avoidance – When we are anxious, we tend to avoid what we fear as we believe it makes us safer, when in reality it only makes us more afraid. As we avoid our fears, those fears become larger and larger and begin to seem insurmountable. We will break these fears down into smaller parts and begin to face them at a slow and steady pace.
Assurance seeking – When we are anxious, we want confirmation that everything is “ok.” When reassurance is impossible, we once again feel out of control and helpless. When reassurance is possible, we risk becoming overly dependent on it and therefore never learn how to completely trust ourselves to handle a crisis. We will work together to practice resisting this urge to seek reassurance, and instead learn to trust in ourselves to act appropriately when the time comes.

These 3 concepts will be common themes in our work together. They may not resonate with you completely right now, but as we begin to unpack your anxiety, you may begin to see the ways you are playing these out without your awareness. The ultimate goal is to help you identify when you fall into these patterns so you can stop avoiding the things you are afraid of. We will work together to help you build confidence in yourself so that even if things “go wrong,” you will feel prepared to navigate any problem after it arises, so you don’t have to waste time and energy obsessing about it before it happens.

One final note - I am not a psychiatrist so I cannot prescribe meds, but if this is something you are interested in, I can certainly offer referrals. Research indicates that medication plus anxiety has better outcomes than medication alone or therapy alone.