Generalized Anxiety Disorder: A CBT Approach to Treatment

It is not WHAT you worry about; it is HOW you worry.  

Do you feel like you are always on high alert? That worrying helps ward off unfavorable events from happening? Maybe you notice you have a hard time relaxing, getting to or staying asleep, or are offer feeling "edgy." These are a few of the symptoms of generalized anxiety disorder.  

In this blog, I will discuss two thinking patterns highly common with generalized anxiety disorder, common beliefs accompanying this thinking patterns and treatment targets to start address thinking patterns and reducing anxiety through a lens of CBT (cognitive behavioral therapy, 

Two Tendencies in Thinking Patterns with Folks who suffer from Generalized Anxiety Disorder 

  • A Tendency to Overestimate the Likelihood of a Negative Happening 

  • A Tendency towards Worst Case Scenario thinking 

Three Beliefs Fueling Chronic Worry: 

Perfectionism: 

That you can not or should not make mistakes.  

That to making mistakes means you are incompetent or inherently flawed in some way.  

Over- Responsibility: 

A belief that it is "irresponsible not to focus on negative possibilities." Holding a belief (conscious or unconscious) that "to worry is to be responsible." 

Demand for Control: 

That worrying somehow impacts how a person can "control" a situation.  

Behavioral Components of Generalized Anxiety Disorder 

1. Physical sensations:

restlessness, difficulty relaxing, difficulty falling asleep or staying asleep, mind-racing, headaches, gastrointestinal issues, irritability, on edge, difficulty concentrating and restlessness

People suffering from GAD, our brains send a message to our autonomic nervous system that there is a threat and that the body needs more energy. People with GAD tend to have difficulties switching to the parasympathetic nervous system (rest and digest phase) and therefore stay in a higher arousal state more often (autonomic nervous system), leading to the classic symptoms of GAD: muscle tension, difficulty sleeping, irritability and difficulty relaxing.  

2. Avoidance:

Feeling Threatened = Avoidance. By overestimating the threat and avoiding, we miss the opportunity for a brain and body to recognize that the "threat" was not indeed harmful. (reinforcing avoidance behavior)

3. Reassurance Behaviors:

acting out of fearful place to get reassurance that things are "okay." Example: Calling often to make sure loved ones are safe/not upset with you.   


What can you do? CBT Approach: Thinking, Behaving and Reacting in New Ways 

1. Self-Monitoring:

Target the thinking, behavior, and actions that contribute to anxiety by tracking.  

  • When? Where? Under What Circumstances? What thoughts? Physical Symptoms? What Behaviors Trigger Anxiety? This will be a tool to measure progress.  

  • Find Your Objective Observer: You can impact your level of anxiety! Empower yourself over your anxiety!

2. Addressing the Physiological:

(often what brings people into treatment- difficulty sleeping, etc.)

  • Progressive Muscle Relaxation- helping the body shift into the parasympathetic state, encouraging the mind and body to relax. In therapy, we start working with the body first, because if we change the physiological state/emotional state, then the cognitive component will follow.  

  • Utilize other somatic exercises to encourage progressive relaxation in the body.

3. Thinking: 

Address the tendencies to overestimate the likelihood of an adverse event and the propensity to image the worst-case scenario of an adverse event. 

Reference the self-monitoring data obtained. Get specifics. Evaluate the actual odds of something terrible happening. 

1. Challenge the tendency to overestimate the likelihood.  

  1. How many times have you worried about not being able to pay your bills, and how many times has it actually come true? Are there facts or data that you can seek out to determine the read odds of this unwanted outcome? Get evidence-based odds.  REALITY CHECK YOURSELF.

  2. Train your Brain. Begin to picture and image yourself paying your bills and feel the feelings that come along with paying your bills on time. Imagine your loved one getting home safely and experience the emotions that go along with those images. SEE THE SCENARIO PLAYING OUT IN YOUR FAVOR.

2. Challenge the tendency to imagine the worst-case scenario.  

  1. Picture the worst-case scenario and rate the severity of the undesirable outcome (scale of 0 to 100.) In the midst of worry, it can seem like a 100 (completely and utterly awful), but when we slow down to rate it, we can see that it won't actually be so earth-shattering, maybe it’s only a 65.

  2. Picture undesirable events and how you would cope with it. See yourself coping well, see a "mental movie" of yourself, from start to finish in which you handle the catastrophized situation with a level head. "Even if I get fired from my job, I can imagine coping with it, and see that it's not the end of the world." 

4. Behavioral: 

  • Reduce safety-seeking and reassurance behaviors

Example: Always checking in with family members to make sure they are okay. Or you are always staying late at work to minimize the chance of not getting your job done.  

Reassurance behaviors drive anxiety because a person is not able to see that the fear did not actualized before intervening. They "give in" to excessive worry.  

  • Learn to tolerate imperfection

  • Practice letting go attempts to control 

  • Let go of the responsibility of unlikely events 

  • Recognize that making mistakes of part of being human. 

These are just a few ways to begin to address generalized anxiety disorder through the lens of CBT. There are other modalities and methodologies to work to manage and reduce symptoms of anxiety. If you have felt that your anxiety is out of control, there ARE strategies that can help you! I can walk you through it!  





Loretta Miller