Generalized anxiety disorder as described as excessive worry about a number of different topics. These worries can span anywhere from big themes – such as family, relationships, the future – all the way down to every day concerns like appointments and whether we will like a new restaurant.
Most people have worries, however, folks with generalized anxiety disorder tend to find their worries excessive (e.g., worrying hours every day) and hard to control. Moreover, worries generalized anxiety tend to come with a set of symptoms:
- restlessness
- irritability
- sleep problems
- concentration difficulties
- fatigue
- muscle tension
Thinking conceptually about GAD
There’s been a lot of research over the years to understand more about GAD. Well-known researchers, such as Dr. Michel Dugas, began to think about GAD as a fear of the unknown.
People with GAD tend to have an ‘allergy’ to uncertainty. In fact, they may even sometimes prefer being certain of a negative outcome rather than staying in ambiguity. For example, they might say “I’d rather just know I failed the test so I can stop worrying about it.”
The issue is that life is full of uncertainty. We cannot even be sure about what the next day will bring, let alone the next year. Therefore, we need to figure out ways to change our relationship with uncertainty.
Fortunately, there have been a number of research-backed strategies based on this understanding that we can use to reduce symptoms of GAD.
Evidence-based strategies for GAD
Below are a few described strategies to work on symptoms of GAD:
1. Worry Logs
Worry logs are a way to track incidents in daily life that leads to anxiety. You can spread it out into 4 columns: 1) Situation, 2) Worry Thought, 3) Emotion, and 4) Type of Worry.
The situation can be any moment that led to a worry. For example, “thinking about a medical appointment that I have to attend on Monday but I don’t have childcare.”
Then you write out the worry thought: “I’m worried I won’t find childcare and then I will miss an important medical appointment.”
Afterwards, you can include your emotions and their intensity: “Anxiety (80%) and Sadness (50%).
Finally, you write down whether the worry is productive (that the problem is immediate, will likely happen, and needs a solution) or hypothetical (the problem is in the future, is unlikely to happen, and there is no obvious solution). In this case, the need for child care would be productive. However, sometimes we can have hypothetical worries, such as whether our 2-year-old child will be able to go to college that they desire.
2. Problem Solving
When worries are ‘productive’ then it is best to use a problem-solving approach. Problem-solving is exactly how it sounds, and everyone problem solves on a day to day.
In therapy, we sometimes use a structured approach, which includes 1) defining the problem 2) defining the solution 3) brainstorming non-judgmentally for as many solutions as possible 4) picking the solution with the most pros and least cons 5) breaking the solution into steps and then 6) carrying out the solution.
3. Written Exposures
Some worries are ‘hypothetical’ and therefore unproductive to problem-solve (because there’s no immediately solution!).
In this case, it can be helpful to complete a written exposure which is when a person takes time to write out a fear and the worst consequences they can think of – for example, writing about a fear that they have if their parents were to pass away.
Although this can be scary at first, the point is to slowly habituate to the fear through repeated writing exposures. Moreover, we sometimes begin to feel more capable of handling the worst case scenarios, or recognize that it is unlikely to happen in a disastrous way. This can subsequently reduce anxiety.
4. Behavioural Experiments
Behavioural experiments directly target intolerance of uncertainty. The idea behind behavioural experiments is that we hear our anxious brain make a prediction (e.g., “I won’t like the food at this restaurant if I order it”), but decide to be a curious scientist and test it out anyway.
Behavioural experiments can be very powerful because they do two things: 1) they show that our anxious brains are not always correct and 2) that even if it is sometimes correct, that we can cope with these outcomes.
To make starting behavioural experiments simple, you can start with low stakes experiments, such as trying out a new restaurant, calling up an old friend, or deciding to say yes to events rather than immediately rejecting them.
SMART Goals for GAD
SMART Goals are a way to engage in some of these evidence-based strategies in a way that is Specific, Measurable, Achievable, Relevant, and Timebound. Here’s a detailed guide if you’re interested more generally about creating SMART goals.
Below I provide a few SMART goals that are related to dealing with GAD symptoms.
- Write out three situations using the worry log every week
- Brainstorm a possible solution to a problem. Carry out the first step of a solution for one problem.
- Write out an imaginal exposure once a day for at least 15 minutes.
- Conduct one behavioural experiment each day and report whether the outcome was positive, negative, or neutral. Tally up the number of different outcomes at the end of the week.
- *Examples of behavioural experiments can include: making an appointment without preparing, ordering from a new restaurant, going to a new café to study, calling a friend to hang out (or anything else that helps you tolerate uncertainty!)
Consistent with the ‘Specific’ and ‘Realistic’ components of SMART goals, please feel free to cultivate goals that are consistent with your needs!
Best wishes,
P
Simply mental health 