Generalized Anxiety Disorder (GAD) is a label often given to people who worry excessively about many different things. They worry both to the point of making themselves significantly distressed and to the point where others start to get exasperated because they really don’t find the anxious person's worries to be justified or realistic.
Why Do People Worry?
The first step in understanding the tendency to worry is to acknowledge that worrying is generally intended to be a helpful mechanism that reminds us of things to watch out for. Its purpose is to keep us from getting in trouble.
Worrying in itself is therefore not a problem. It is what makes me move my car from an area with unclear signage to avoid getting a parking ticket, and what makes me arrive 30 minutes early for a job interview just in case there would be an unexpected accident that would slow me down on my way. These kinds of anticipations of bad things happening generally serve me well. They help me plan for eventualities that could harm me and make me feel more in control of my life circumstances.
When Do We Worry Too Much?
In the life of someone with generalized anxiety disorder, however, worrying no longer serves it's intended function to help us adapt well to genuine risks and challenges in our environment.
Here the worries have a number of characteristics that make them more burdensome than helpful. This is because the nature of the worries frequently includes a number of different exaggerations that distort the true risks involved.
These exaggerations fall into a number of different categories, which it will be helpful to understand so we know what we are dealing with...
Here they are one by one...:
Frequent Worries of Highly Anxious People:
"I take too much responsibility for others instead of setting healthy boundaries:"
This kind of worry places excessive blame on myself if something were to happen to someone else. For example: “If my friend feels alone or depressed, it is probably because I am not doing nearly enough to hang out with them” or “if my boss gets annoyed or frustrated with me, it is probably because I am too lazy or unintelligent, or because I am a bad employee”. Not only does this kind of worry tend to turn to self-blame and excessive guilt, it also makes me feel that I constantly have to prove myself to others in order to be a good friend, good employee, good spouse and so on. It is therefore not unusual for people with generalized anxiety to overextend themselves, to take too much onto their plates, and to leave very little room for themselves and their own needs.
"I look to others for answers rather than trusting my own intuition:"
People with generalized anxiety often have a fundamental mistrust of their own decision-making. They fear that they would be unable to cope, or would be responsible for other people’s suffering, if they were to make a wrong decision. For this reason, people with generalized anxiety will often seek expert advice rather than consult with their own intuition, or they will defer to others about which restaurant to go to instead of feeling within what they are really in the mood for. This other-oriented living is just another way that the person with generalized anxiety silences their own voice and lives in hiding from their own needs, rights, wishes, and feelings.
"I externalize my anxiety rather than looking for the cause within:"
People with generalized anxiety live in constant anticipation of bad things happening around them that they think they would have prevented if only they were proactive enough or paid enough attention. Their constant attention to dangers in the environment conceals the fact that the real danger in generalized anxiety is often a danger from within. Clinical wisdom tells us that the fears that underlie my worries in GAD are really fears related to the eruption of emotions such as sadness, anger, or insecurity that I feel within myself and that I don’t think I can cope with. People with generalized anxiety often have an unconscious fear of disintegration, helplessness, and emotional overwhelm, which makes them live in fear of their own emotions and makes them want focus their attention outward instead of inward. Instead of dealing with their fears of their own emotions, they instead worry about physical symptoms in their body which they mistake for possible illnesses, or about other people for whom they feel responsible, or about eventualities in the future they can plan for or try to control.
"I blame myself rather than feel angry at others:"
People with generalized anxiety often have a hard time standing up for themselves, saying “no” to others, or feeling justified for having their feelings. Anger, which is the emotion that alerts us to boundary violations, injustice, and unfair treatment often evokes anxiety or feelings of guilt in people with generalized anxiety. As a result, the anger often gets converted into excessive people-pleasing and excessive self-blame. If someone gets mad at me, I internalize their anger and use it to beat myself up for my wrong-doings, or if someone offers a negative opinion about something I did, I take it to mean that I have inner defects or short-comings that I need to make up for. The lack of comfort with anger makes me invalidate my own perspective or right to self-define, and leaves me vulnerable and exposed to criticism from others.
How to Overcome Debilitating Anxiety:
The first step in overcoming generalized anxiety and excessive worry is to make the different kinds of excessive, unfair, or unrealistic patterns of self-protection which I have described above problematic to the anxious worrier. The person with generalized anxiety has to be helped to disentangle themselves from the part of them that worries or scares them. They have to realize that worrying and feeling anxious is something they do to themselves rather than who they are.
This differentiation of themselves from their worries is best facilitated by a therapist who can help them name both the ways in which they worry themselves and what it feels like to be on the receiving end of these worries. The outcome of this kind of differentiation is that they can begin to understand the needs and fears of the “worrier”, as well as the feelings of helplessness, inadequacy, and plight of the part of them that can never get a break from the “worrier”.
Helping the Worrier Turn Attention Inward:
Instead of the therapist simply joining with the more dominant worrier voice and helping this part of the person find the reassurance that it constantly wants but can never find, the therapist instead helps both parts of the person address the underlying emotional needs that never get tended to as long as the worrier simply pursues its agenda of finding reassurance outside of the anxious self.
The solution to the worrier’s problems is not to be found in getting reassurance or advice from the therapist, or finding ways to be better, stronger, smarter, more accomplished, more likable, or more in control. These are the pseudo-solutions the worrier tries to pursue to avoid addressing the source of their own vulnerability, and are ultimately very hurtful and damaging to the part of them that has to live underneath the weight of these responsibilities.
The Real Cause of Generalized Anxiety:
Once the person with generalized anxiety stops looking for solutions in never-ending self-improvement or never ending pursuit of more control, he or she is finally able to address the real issues at the heart of their worries. They can now gradually come to face the earlier life experiences that have made them feel too frail, too vulnerable, too unsupported, or too overwhelmed.
To do so, the person with generalized anxiety needs to be helped to turn their attention inward toward the pain they have avoided confronting, so they can become more comfortable with their own emotions and more grounded within themselves.
One reason that this has not been possible so far is that the person with generalized anxiety has learned to dismiss those feelings inside of them that were to uncomfortable or distressing to others around them .
The worrier came to be dismissive of their own feelings and needs because others were not there for them the way they should have been or because others could not handle or tolerate their emotions.
It is this original or ongoing rupture in compassionate understanding from others that often needs to be addressed in therapy so the person with generalized anxiety no longer needs to shut themselves down or turn their gaze outward.
The solution to generalized anxiety is therefore not to increase the effort to control situations and become ever more perfect. It is to become ever more comfortable with acknowledging your own vulnerabilities and learning to find ways to soothe and comfort the part of you that did not feel safe, supported, or reassured when growing up.
For more information about the underlying causes of generalized anxiety disorder, I highly recommend the book: Emotion-Focused Therapy for Generalized Anxiety by Jeanne Watson and Leslie Greenberg
About me: I am Rune Moelbak, Ph.D., a psychologist in Houston Texas who offers a deeper approach to working with generalized anxiety.