There are several types of anxiety disorders or anxiety-related disorders. Some features of anxiety are consistent across all types of anxiety. However, each anxiety disorder is comprised of elements that are unique in some ways. In this post I briefly review some of the key components of Generalized Anxiety Disorder or GAD.
The cognitive model for GAD details four major components of generalized anxiety. These include (1) intolerance of uncertainty; (2) beliefs about worry; (3) poor problem orientation; and (4) cognitive and emotional avoidance. Each will be discussed separately.
(1) Intolerance of uncertainty (IU). IU both predisposes people to GAD as well as maintains GAD once it has developed. People without clinical anxiety may not love uncertainty but they tolerate it and, overall, tend to believe that they will be able to cope with unfortunate circumstances. In contrast, those with GAD tend to believe that uncertainty is unacceptable. They assume that uncertainty or ambiguous information will cause problems and result in negative outcomes. They also assume that it is their responsibility to try and reduce the uncertainty or ambiguity.
As a first step, I often have my clients with GAD complete the IU scale in order to assess the extent to which they struggle with uncertainty.
(2) Beliefs about worry. People with GAD tend to have unhealthy or inaccurate beliefs about the worry process. They typically believe that worrying helps to avoid or prepare them for negative outcomes. And/or they believe that worrying is uncontrollable or dangerous. Some of their beliefs about worry, such as the belief that it is helping them in some way, often motivates them to keep engaging in the worry process. I will often hear clients tell me that even when stressors are not present (e.g., they are on a break from classes or are on vacation), they will find new things to worry about. This is because worrying makes them feel safe and prepared in some way.
One great CBT technique I use with clients is a cost-benefit analysis. It is an excellent way to help my clients identify their dysfunctional or inaccurate beliefs about worry.
(3) Poor problem orientation. People with GAD tend to view problems as threatening in some way. Of course, no one loves facing problems. But those without clinical anxiety often believe they can manage problems that may arise. In contrast, those with GAD have low confidence in their ability to solve problems and, thus, expect negative outcomes. Naturally, if you inherently believe you will be able to cope with most problems you face, you are not going to dread them as someone who doubts their ability to cope with or solve such problems. So, how does this poor problem orientation play out? Well, because people with GAD assume their problems will result in negative outcomes, they tend to overcompensate. They repeatedly try to come up with the “perfect” solution- one that they can be certain will work. However, since this potential problem is in the future, there is no way to be certain it will work because it hasn’t happened yet! So, they keep on searching for that perfect solution only to continue to be disappointed. If they trusted their ability to solve problems, they wouldn’t need to find a “perfect solution” to future problems because they would depend on their ability to figure out the solutions to the problems as they arise.
I often help clients to “test out” their predictions about their perceived poor-problem solving ability through behavioral experiments and exposure tasks.
(4) Cognitive and emotional avoidance. To cope with their intolerance of uncertainty, people with GAD tend to avoid distressing thoughts or emotions. They may try to think about something positive if they begin to stress about some future uncertainty. Or they may tell themselves not to think about the uncertainty that is causing distress. Or they may engage in behaviors that help distract themselves from such thoughts or emotions. For example, they might keep themselves very busy so they don’t have time to think about worry-provoking thoughts or emotions. Or they might drink excessively, take medication or take drugs to numb the emotion or thoughts.
I often help clients identify their anxiety-provoking thoughts or emotions by helping them identify their imagined worst-case scenarios and the safety behaviors they use to reduce the anxiety. Then I engage them in imaginal and in-vivo exposure exercises to reduce the anxiety associated with these thoughts and images.
I hope this overview of the cognitive model of GAD was helpful. There are numerous cognitive behavioral interventions and strategies that can be used to overcome the excessive worrying that is associated with this type of anxiety. Using CBT to address each of the four main components of GAD can help free you from anxiety and allow you experience more joy in life.