Managing worry in generalized anxiety disorder

Managing worry in generalized anxiety disorder

By Srini Pillay, M.D.

Harvard Health Blog

Everyone worries, but some people worry more than others. When worry is excessive, people may develop generalized anxiety disorder (GAD). In fact, close to a quarter of people who go to their primary care physicians with anxiety suffer from this.

In general, stressful events in childhood and adulthood, having strained economic resources, being divorced, and being female all put you at risk for GAD. But what do all of these different high-risk groups have in common psychologically? Why do they worry so much? And what can they do about this?

The surprising benefits of worry for people with GAD

A recent study explained why people with GAD worry so much — and the findings may surprise you. While many people think they are just worriers, they do not realize that they actually worry for a reason. Their worry is an attempt to protect themselves! If you’re wondering how such a nagging, persistent, annoying and sometimes distressing psychological state can be helpful, you’re probably not alone. But the findings do in fact make some sense.

It turns out that worrying about something puts your mind into a negative state, but this helps, because when something negative does happen, you don’t feel that much worse. You’ve already been feeling bad. For people with GAD, it’s better to feel bad most of the time so that a negative event — someone being ill, sudden financial challenges, or rejection from a loved one — doesn’t have the power to create a massive emotional swing. It’s the sudden shift from a neutral or positive mood to a negative one that is of great concern to worriers. They will do anything to avoid this, include preparing to be miserable. They really hate the contrast of a situation unexpectedly going south. To people who aren’t worriers, this would sound counterintuitive, but they don’t have the same sensitivity to sudden emotional shifts. In fact, for them, worry is undesirable, whereas worriers find worry helpful.

This poses a dilemma for treatment, then. If someone has GAD, just asking them to lose the worry will not work. And if you have GAD, expecting your brain to simply stop worrying on command is a tall order. Another study has helped us understand that people who are prone to worrying are soft-wired to pay attention to threatening news, thereby building up a library of evidence in their brains that worrying is necessary. Think about it. On any given day, there are so many threatening things happening in the world — anything from new viruses, terrorist attacks or political conflicts to a hostile email or upcoming storm are all real events. Yet, if you only pay attention to the threats, you have no space left in your brain to process anything else. Threat becomes your reality, and worry becomes your justifiable response. Anyone telling you to give up your worry will sound out of touch, to say the least.

What you can do to get your worry under control

As challenging as this sounds, there are things that you can do to retrain your brain to stop worrying. Cognitive behavioral therapy, a type of talk therapy where you simply revisit your assumptions in an attempt to reframe your thoughts, works according to some studies but not others.

It’s important to remember that you can benefit from other forms of talk therapy, though, and that you can benefit from medications as well. But if you want to try changing the way you think right now, prior to therapy or while you’re waiting, you might consider the following approach.

Rather than challenging yourself or someone else about worry, you can actually accept that the worry is serving a purpose — to avoid a sudden negative swing. Then, start to delve deeper so you can discover that the negative swing is probably less negative than you think. Giving up the struggle and control with worry, and accepting that it has not been helpful, is the next step. You can then re-examine your library of negative “proof” and swap out threatening realities for positive ones. In fact, this kind of deliberate optimism can protect you from GAD.

Worry in GAD can be debilitating, but there is an increasing amount of data that shows you can address this effectively.

(Srini Pillay, M.D., is a contributor to Harvard Health Publications.)