Generalized Anxiety Disorder: The CBT Approach

Summary

In this video, Vince Greenwood, the director of the Washington Center for Cognitive Therapy, discusses Generalized Anxiety Disorder (GAD), a diagnosable condition characterized by excessive worry and physical symptoms. He outlines the components of GAD, including distorted thinking patterns, physical sensations, and behaviors like avoidance and reassurance seeking. Greenwood then describes the cognitive-behavioral treatment approach for GAD, which includes self-awareness, progressive muscle relaxation, and techniques to alter negative predictions and behaviors, aiming to reduce chronic worry and anxiety.

Takeaways

• 😀 Generalized Anxiety Disorder (GAD) is characterized by excessive worry and physical symptoms like muscle tension, restlessness, fatigue, irritability, and sleep difficulties.
• 😀 GAD is different from occasional worry; it is persistent, often daily for at least six months, and is a diagnosable condition.
• 😀 Key features of GAD include overestimating the probability of negative events and imagining worst-case scenarios (catastrophizing).
• 😀 Common beliefs in GAD sufferers include perfectionism, responsibility to focus on negative possibilities, and the idea that worry can prevent negative outcomes.
• 😀 The physical component of GAD involves symptoms like difficulty relaxing, trouble sleeping, irritability, and chronic over-arousal of the nervous system.
• 😀 Behavioral aspects of GAD include avoidance of perceived threats and reassurance-seeking behaviors, which reinforce worry.
• 😀 Cognitive Behavioral Therapy (CBT) is an effective, research-supported treatment for GAD, focusing on changing thoughts, behaviors, and physical responses.
• 😀 Self-monitoring and recording anxiety and worry states help identify specific components of GAD for targeted treatment.
• 😀 Progressive muscle relaxation is a key technique in CBT, helping reduce physical tension and break the cycle of worry.
• 😀 Challenging distorted thoughts and imagining coping with worst-case scenarios are effective CBT strategies to reduce worry.
• 😀 Addressing reassurance-seeking and avoidance behaviors is crucial in CBT to promote healthier coping mechanisms and reduce chronic worry.

Q & A

What is the Washington Center for Cognitive Therapy's area of specialization?

The Washington Center for Cognitive Therapy specializes in the treatment of anxiety disorders.

What is Generalized Anxiety Disorder (GAD)?

Generalized Anxiety Disorder (GAD) is a diagnosable condition characterized by excessive worry and a cluster of physical symptoms such as muscle tension, restlessness, fatigue, irritability, and sleep difficulties.

How does GAD differ from normal worry?

GAD is different from normal worry in that it involves persistent, excessive worry that feels uncontrollable and is often accompanied by physical symptoms, whereas normal worry can be adaptive and help prepare for difficulties.

What are the three basic components of GAD?

The three basic components of GAD are a thinking component (worrying), a feeling component (anxiety and apprehension along with physical symptoms), and a behavior component (avoidance and reassurance-seeking behaviors).

Why is it important to understand the components of GAD?

Understanding the components of GAD is important because it makes the condition less mysterious, identifies specific areas for treatment, and helps to break the negative cycle of worry leading to physical tension and back to more worry.

What are the two key distortions in thinking that characterize GAD?

The two key distortions in thinking that characterize GAD are overestimating the probability that something threatening might happen and catastrophizing, or overestimating the severity of an undesirable event.

What are the three beliefs associated with chronic worry in GAD?

The three beliefs associated with chronic worry in GAD are perfectionism (the belief that one should not make mistakes), an inflated sense of responsibility (believing it's irresponsible not to focus on negative possibilities), and controllability (the belief that worry can prevent negative outcomes).

How does cognitive behavioral therapy (CBT) address the physical symptoms of GAD?

CBT addresses the physical symptoms of GAD through techniques like progressive muscle relaxation, which helps to reduce tension and shift the body from a state of over arousal to a more relaxed state.

What is the purpose of self-monitoring during the initial stage of CBT for GAD?

The purpose of self-monitoring is to help clients identify when, where, and under what circumstances they experience anxiety, as well as to pinpoint the specific thoughts, physical symptoms, and behaviors associated with their worry, which can then be targeted for treatment.

How does CBT help change the behavioral component of GAD?

CBT helps change the behavioral component of GAD by targeting reassurance-seeking and avoidance behaviors, encouraging clients to engage in non-anxious behaviors, and teaching them to tolerate imperfection and let go of attempts to control everything.

What is the ultimate goal of CBT for treating GAD?

The ultimate goal of CBT for treating GAD is to help individuals worry less, cope more effectively with problems, and reduce the self-defeating behaviors that contribute to their anxiety.

Outlines

00:00

🤔 Understanding Generalized Anxiety Disorder (GAD)

Vince Greenwood, the director of the Washington Center for Cognitive Therapy, introduces Generalized Anxiety Disorder (GAD) as a diagnosable condition characterized by excessive worry and physical symptoms like muscle tension and sleep difficulties. He emphasizes that GAD is more than normal worry and can significantly impact a person's life. The video aims to provide a clear understanding of GAD components, including thoughts, feelings, and behaviors, and to distinguish between everyday worry and GAD. The speaker also highlights the importance of recognizing when worry becomes a disorder and the persistent nature of a GAD sufferer's worries.

05:00

🔍 The Nature of Generalized Anxiety Disorder

This paragraph delves into the specifics of GAD, identifying its three main components: thinking, feeling, and behavior. The thinking component involves excessive worrying, the feeling component encompasses anxiety and apprehension along with physical symptoms, and the behavioral component includes avoidance and reassurance seeking. The paragraph explains how these components interact in a negative cycle, reinforcing each other. It also discusses the cognitive distortions prevalent in GAD, such as overestimating the probability and severity of negative events, and the beliefs that maintain worry, like perfectionism, responsibility, and controllability.

10:03

💪 The Physical Manifestations of Anxiety

The physical aspect of GAD is explored here, detailing symptoms like restlessness, difficulty relaxing, and irritability, which stem from the autonomic nervous system's response to perceived threats. The explanation includes the role of the sympathetic and parasympathetic branches of the autonomic nervous system, noting that individuals with GAD often have reduced parasympathetic control, leading to a constant state of heightened arousal. This paragraph also discusses the impact of these physical symptoms on daily life and the importance of addressing them in treatment.

15:03

🛠 Behavioral Components and Treatment Approaches for GAD

The behavioral elements of GAD are highlighted, such as difficulty concentrating, restlessness, avoidance, and reassurance seeking. The paragraph then transitions into discussing the cognitive-behavioral treatment (CBT) approach for GAD, which includes developing new skills to alter negative predictions, think more realistically, and manage physical tension. The self-awareness or self-monitoring stage of treatment is introduced as the first step, where clients monitor their anxiety and worry states to identify triggers and patterns, setting the foundation for targeted treatment.

20:05

🧘‍♂️ Progressive Muscle Relaxation as a Tool for Anxiety Management

This paragraph introduces progressive muscle relaxation as a technique to reduce physical tension associated with GAD. The process involves tensing and relaxing different muscle groups to develop the skill of shifting from a tense to a relaxed state. The benefits of this technique are explained, including breaking the cycle of tension and worry and providing a sense of control over anxiety. The paragraph outlines the training and application phases of learning this skill, emphasizing the importance of practice and gradual reduction of muscle groups to achieve a more efficient relaxation technique.

25:06

🤯 Challenging Excessive Worry and Cognitive Distortions

The focus shifts to addressing the thinking component of GAD, specifically the excessive worry that is difficult to control. Techniques for identifying, questioning, and disputing the thoughts that make up worry are discussed, targeting the overestimation of negative event likelihood and the tendency to catastrophize. The paragraph outlines a process of self-monitoring to identify specific worries, evaluating their real odds, and imagining more realistic outcomes. It also touches on the importance of picturing coping mechanisms for the imagined negative events to reduce the intensity of worry.

30:06

🚫 Addressing Reassurance Seeking and Avoidance Behaviors

The behavioral strategies for managing GAD are discussed, emphasizing the need to reduce reassurance seeking and avoidance behaviors that can reinforce worry. The paragraph explains how engaging in these behaviors can prevent individuals from challenging their anxious thoughts and learning that they can cope with negative outcomes. The goal is to replace these behaviors with non-anxious behaviors that promote tolerance for imperfection and a recognition of the humanness of making mistakes. The paragraph also suggests that behavior change is more effective after individuals have learned relaxation and realistic thinking skills.

35:07

🎯 Conclusion: The Efficacy of CBT for GAD

In conclusion, the paragraph summarizes the effectiveness of Cognitive Behavioral Therapy (CBT) in treating GAD by addressing the components of worry, physical tension, and self-defeating behaviors. It emphasizes the availability of research-tested treatment programs for those suffering from chronic worry and encourages individuals to seek help. The speaker reiterates the importance of treating GAD and the potential for individuals to gain control over their anxiety through targeted CBT techniques.

Keywords

💡Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder, or GAD, is a diagnosable mental health condition characterized by excessive, uncontrollable worry and physical symptoms such as restlessness and fatigue. It is the main theme of the video, as the script discusses its diagnosis, impact, and treatment. For example, the script mentions that 'the person with GA D would describe himself as a constant worrier,' illustrating the persistent nature of GAD.

💡Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy is a psychological treatment approach aimed at changing negative thought patterns and behaviors. In the context of the video, CBT is presented as an effective treatment for GAD, teaching individuals how to manage their anxiety and worry. The script outlines that 'the cognitive behavioral treatment of GA D is a scientific approach in which you develop skills to think, behave, and react physically in new ways to overcome your chronic worry and anxiety.'

💡Worry

Worry, in the script, refers to the excessive and persistent thoughts about potential negative outcomes or threats. It is a central component of GAD and is addressed as a target for change in CBT. The script notes that 'worry is usually defined as focusing our thoughts on some kind of threat,' and it differentiates between normal worry and the excessive worry characteristic of GAD.

💡Anxiety

Anxiety is an emotion characterized by feelings of tension, apprehension, and unease. In the video, it is associated with the physical and mental symptoms experienced in GAD. The script relates anxiety to the autonomic nervous system's response, stating that 'the more one worries, the more one feels tense,' which can lead to a range of physical symptoms.

💡Catastrophizing

Catastrophizing is a cognitive distortion where an individual imagines the worst possible outcome of a situation. The script identifies it as a key feature of GAD, where individuals 'overestimate the severity of the undesirable thing happening.' It is a distortion that CBT aims to challenge and change.

💡Physical Symptoms

Physical symptoms are the bodily manifestations of anxiety, such as muscle tension, irritability, and sleep difficulties. The script explains how these symptoms are a result of the body's response to perceived threats and are targeted in CBT for GAD treatment. For instance, the script mentions 'physical symptoms such as restlessness, fatigue, irritability, and sleep difficulties' as part of the disorder.

💡Progressive Muscle Relaxation (PMR)

Progressive Muscle Relaxation is a technique used to reduce physical tension and anxiety by systematically tensing and relaxing muscle groups. The script describes PMR as 'a key anxiety management skill' that helps individuals with GAD to 'shift their body from a tense state to a noticeably more relaxed state.'

💡Self-Monitoring

Self-monitoring is a process where individuals track their anxiety and worry states to identify patterns and triggers. The script emphasizes its importance in the initial stages of CBT, as it helps clients to 'learn the when, where, and under what circumstances they have anxiety.'

💡Behavioral Component

The behavioral component in the context of GAD refers to actions and habits that stem from anxiety, such as avoidance and reassurance-seeking behaviors. The script discusses how these behaviors can reinforce worry and are targeted in CBT to help individuals face their fears and reduce anxiety. An example from the script is 'behavior that goes along with GA D includes avoiding situations that the person worries about.'

💡Reassurance-Seeking Behavior

Reassurance-seeking behavior is an action taken to alleviate anxiety by seeking validation or confirmation that a feared outcome will not occur. The script identifies this behavior as a target for change in CBT, as it can prevent individuals from realizing that their worries are unfounded. The script states that 'reassurance seeking behavior...ends up contributing to your chronic worry.'

💡Avoidance

Avoidance is a behavior where individuals steer clear of situations that trigger anxiety. In the script, avoidance is discussed as a behavioral aspect of GAD that maintains worry and prevents individuals from confronting and coping with their fears. The script mentions that 'avoidance is another important behavioral component of GA D when we feel threatened by something we tend to avoid it.'

Highlights

Generalized Anxiety Disorder (GAD) is characterized by excessive worry and physical symptoms like muscle tension, restlessness, fatigue, irritability, and sleep difficulties.

GAD is a diagnosable condition that affects approximately 4% of the population and requires therapeutic attention.

Individuals with GAD perceive themselves as constant worriers, feeling stuck in a state of worry and physical tension.

Worry in GAD is persistent and different from the adaptive worry that helps prepare for difficulties.

GAD sufferers often live in a state of constant vigilance and apprehension, akin to 'walking in a war zone'.

The inability to turn off worry is a central feature of GAD, with significant worry occurring almost daily for at least six months.

GAD can be distinguished from normal worry by its excessiveness, persistence, and the impact on daily functioning.

GAD has three basic components: thinking (worrying), feeling (anxiety and apprehension), and behavior (avoidance and reassurance seeking).

Cognitive Behavioral Therapy (CBT) is an effective, research-supported treatment for GAD.

CBT helps individuals with GAD to develop new skills to alter negative predictions and manage physical tension.

Worry in GAD often involves 'distorted thinking', including overestimating the probability and severity of negative events.

Three key beliefs associated with chronic worry in GAD are perfectionism, responsibility, and controllability.

Progressive muscle relaxation is a tool in CBT that helps reduce physical tension and provides relief from the cycle of worry.

CBT techniques for the thinking component of GAD include identifying, questioning, and disputing the thoughts that make up worry.

Behavioral components of GAD, such as reassurance seeking, can be changed through CBT to build tolerance for imperfection and reduce avoidance.

The self-awareness or self-monitoring stage of CBT treatment helps clients identify the triggers and components of their anxiety.

CBT aims to help individuals with GAD to worry less, cope more effectively with problems, and improve overall quality of life.

Transcripts

hello my name is Vince Greenwood I am

the director of the Washington

Center for cognitive therapy a mental

health organization that specializes in

the treatment of anxiety disorders in

this video I am going to talk about

generalized anxiety disorder also

referred to as GA D generalized anxiety

disorder is a diagnoseable condition

characterized by excessive worry and a

cluster of physical symptoms such as

muscle tension restlessness fatigue

irritability and sleep difficulties over

the past few decades we have learned a

good deal about generalized anxiety

disorder and its treatment I am going to

describe the components of generalized

anxiety disorder the particular thoughts

feelings and behaviors that make up GA D

so that you have a clear more detailed

understanding of GA D and show how that

understanding has been utilized by

cognitive behavioral practitioners to

develop a highly effective research

supported treatment for generalized

anxiety disorder I am also going to

provide some guidelines and how you can

distinguish between a tendency to worry

and full-blown GA D first I'd like to

make the point that it is desirable and

appropriate the generalized anxiety

disorder is a diagnosable condition it

deserves that designation because GA D

is not just the tendency to worry or be

keyed up we all have the tendency to

worry from time to time to be keyed up

and feel tense indeed those tendencies

can be adaptive can help us prepare for

emerging difficulties however worried

intention

can be excessive and therefore deserving

of therapeutic attention research has

shown that generalized anxiety disorder

is a different animal altogether the

person with GA D would describe himself

as a constant warrior and those who knew

him well would agree with that

assessment his worries are persistent he

feels stuck in his worried state he

would also describe himself as stuck in

a state of physical tension he might

describe himself as uptight and tense

all the time

he is constantly vigilant and

apprehensive as one GA D sufferer put it

I feel like I'm always walking in a war

zone we are all familiar with the notion

of a cliffhanger as it applies to a

novel or a movie the cliffhanger

captures our attention it creates

tension in a good way for the story

however the world for the person with

generalized anxiety disorder as

reflected in their thoughts and worries

is like living from one cliffhanger to

the next but not in a good way they are

constantly besieged by thoughts such as

do I have enough money is there going to

be a school shooting in my community do

I need to develop more Skills to keep my

job might I be developing heart disease

did I say something stupid at the party

last night is the economy going to

collapse and on and on the world for the

GED sufferer often shrinks down to this

endless do loop of worries even if the

person with generalized anxiety disorder

a part of them anyway thinks their worry

is unreasonable or excessive they still

can't turn the worry off and that

inability to turn the worry off is a

central feature of GA D a major

diagnostic criteria for GA D is that

significant worry occurs almost every

day for at least six months

does worry tip from being helpful to not

helpful the following questions can help

flush out the tipping point for example

when I notice I am wrapped up and

worried and want to focus on something

else am I able to switch the worry off

are my worries extremely upsetting to me

make it difficult to get things done do

I worry so much that I am rarely able to

relax do I notice that I worry about

things that others worry about but in a

more exaggerated manner do I worry much

of the time without ever reaching a

possible solution for a particular

problem do I believe that if I don't

worry a terrible event will be more

likely to happen if your answer to a

number of these questions is yes you

might have generalized things our

anxiety disorder and might want to

examine the tendency to worry so much

generalized anxiety disorder can be a

torment for the person going through it

ga d certainly undermines peace of mind

it can get in a way of daily activities

and responsibilities it can get so

intense that the person has difficulty

functioning over time it can contribute

to physical health problems

approximately 4% of the population

struggles with generalized anxiety

disorder so is that what is the

particular nature of GA D this different

animal early on when researchers were

beginning to identify the particular

details of GA D they found it desirable

to think of GA D as having three basic

components a thinking component which

basically involves worrying a feeling

component which involves feelings of

anxiety and apprehension as well as

those physical symptoms I mentioned

earlier

and a behavior component behavior that

goes along with GA D includes avoiding

situations that the person worries about

were seeking reassurance about

situations that worries about breaking

generalized anxiety disorder down into

component parts has a number of benefits

many with GA D and those trying to help

them find the condition to be diffused

this pervasive tendency to worry in feel

tense but by pinpointing its specific

components we make the condition less

mysterious and identify the particular

components that then become targets for

treatment and change we have also

learned that these three components have

a dynamic relationship with one another

they reinforce one another and a kind of

negative cycle the more one worries the

more one feels tense which then leads to

avoidance behavior or reassurance

seeking behavior which often evokes more

worry and so on the flip side of this

cycle is that when we can effect a

positive change in one component the

thinking component worrying let's say

that tends to generate positive change

in the feeling and behavioral components

of GA D so let's go through the three

areas starting with a thinking or

worrying component first let's define

worry worry is usually defined as

focusing our thoughts on some kind of

threat that something undesirable is

happening or could happen now this can

be helpful at times but with GA d the

worry is excessive and counterproductive

to understand this 10 tendency we need

to understand the particular quality of

worry and those with GID

when we zero in on those with excessive

worry what do we see

research has enabled us to pinpoint to

fundamental ways of thinking which we

characterize as distorted thinking two

ways in which those with GA D interpret

life events the first distortion

involves overestimating the probability

that something threatening or

undesirable might happen for example a

person with GA D hearing a report that

the economy is not doing so well might

jump to the conclusion that they are

likely to lose their job

the second key distortion involves

overestimating the severity of the

undesirable thing happening a tendency

that has been labeled catastrophizing

for example the person who worries about

losing their job might view that

possibility not just as something

undesirable or quite stressful but is

having very damaging ruinous

unrecoverable impacts on their life or

family they imagine the worst case

scenario with chronic worriers it is not

so much what they worry about they tend

to worry about the same kinds of things

as those that are not chronic worriers

such as health concerns job or school

performance finances trying to be a good

friend or family member it's not what

they worry about but how they worry

specifically with these two distortions

the over estimation of the probability

and the over estimation of the severity

of some undesirable event the threshold

for worry is very low the person with GA

D always feels on high alert the danger

is lurking in addition we have also

identified three beliefs associated with

chronic worry these beliefs kind of

basic rules of the road reflect the GA D

sufferers attempt to ward off threats

but these beliefs end up just

reinforcing the worried State the first

believe his perfectionism the belief

that one cannot and should not make

mistakes and that to make mistakes in

judgment decision-making parenting work

or whatever represents incompetence in

managing life with this belief there is

the constant pressure to always make the

right judgment or display the perfect

behavior

the second belief relates to

responsibility that it is irresponsible

not to focus on negative possibilities

thus words that pop up in one's mind

should not be ignored and that worrying

means you are being responsible whereas

not worrying is to be irresponsible

the third key belief that we have

identified we label controllability the

belief that worry is a way of gaining

control and preventing negative outcomes

from coming true this is reflected in a

thoughts such as I am glad I worried

about my daughter because she made it

safely home from a trip these three

beliefs maintain the worry and anxiety

and help explain why chronic worriers

have such difficulty switching off their

worry and anxiety even though there is a

part of them that wants to switch it off

there is also a part of them that feels

that switching it off would be

irresponsible and might even increase

the possibility of some unwanted outcome

the good news is our detailed

understanding of these thinking errors

and beliefs that lead to chronic worry

have enabled us to design targeted

treatment strategies to counteract and

help those for whom worry has become to

seem so intractable the second component

of GA D is the physical component which

refers to the physical sensations or

symptoms such as restlessness

difficulty relaxing trouble falling

asleep or staying asleep usually due to

the mind racing also feeling easily

tired headaches gastrointestinal

difficulties and feeling irritable and

on edge these physical sensations are a

result of our brains sending a message

to our autonomic nervous system the

message sent is there's some kind of

threat and we need greater energy the

energy that goes along with our

fight-or-flight system we need that

energy to deal with the threat now let

me give just a brief description of how

our nervous system works the autonomic

nervous system has two branches called a

sympathetic branch and the

parasympathetic branch the sympathetic

branch revs up our energy to deal with

the threat the parasympathetic branch

puts on the brakes to this energy

arousal when it's no longer needed the

parasympathetic branch helps us to

regain our emotional balance and

restores our body to a normal resting

state however the research on gid

suggests that there are low levels of

parasympathetic control which means that

those with GA D don't put on the brakes

as frequently or effectively as they

should the result is our bodies get

stuck in a state of higher arousal when

they no longer need to be in a state of

high arousal kind of like they're stuck

in third gear in situations in which

they only need to be in second gear

which explains the classical physical

symptoms of GA D such as muscle tension

sleep difficulty irritability and

difficulty relaxing the third component

of g ID is behavior we want to highlight

three kinds of behavior in relation to

GA d first there is the behavior that is

the direct result of anxiety such as

difficulty concentrating and

restlessness

we want to target this behavior because

it compromises one's ability to solve

problems avoidance is another important

behavioral component of GA D when we

feel threatened by something we tend to

avoid it that's not always a bad thing

but if we are overestimating the threat

then avoiding it just reinforces the

notion that the threat is serious by

avoiding we miss the opportunity to see

that perhaps the threat is not as bad as

we predicted or that we can cope with it

the threat even if it is somewhat

difficult

another meaningful behavior involves

what we call over cautiousness or

reassurance seeking behavior examples

might include calling frequently to make

sure your family members are safe or

being overprotective with your children

such behavior may provide reassurance

briefly but ends up contributing to your

chronic worry now that you have a more

detailed understanding of the components

of GA D let's turn to the treatment

approach the cognitive behavioral

treatment of GA D is a scientific

approach in which you develop skills to

think behave and react physically in new

ways to overcome your chronic worry and

anxiety with CBT you will learn how to

alter the negative predictions which

lead you to feel unsafe and out of

control learn how to alter them by

thinking more accurately about the real

possibilities of something bad happening

you will learn how to think less

catastrophic ly and to rehearse coping

with real-life difficulties and CBT you

will learn how to shift your body from

its tense state caused by a constant

over arousal of your nervous system to a

more relaxed state thereby interrupting

the vicious cycle

Woori leading to physical tension

leading to more worry and so on you will

learn how to change your reassurance

seeking behavior so you learned that the

dangers you predict either do not happen

or you realize you can cope with them

you will learn how to take on situations

you may have avoided because of your

negative predictions and you will learn

effective problem-solving strategies to

deal with the legitimate stressful

events in your life I will describe some

of these skill sets in a few minutes but

first let me outline the first stage of

treatment which we call the

self-awareness or self monitoring stage

this is where we ask the client to

monitor and record their anxiety and

worry states so they can learn the when

where and under what circumstances they

have anxiety we also ask them to

pinpoint and record the particular

thoughts that make up their worried

state and the particular physical

symptoms they are experiencing when

anxious and the behaviors triggered by

their anxiety including behaviors they

display to try to get reassurance this

self-monitoring step has a number of

benefits most critically it identifies

the particular thinking feeling and

behavioral components of anxiety that we

want to target for treatment it also

facilitates becoming more of an observer

of one's anxiety and worry rather than

just being a victim of it by pinpointing

the conditions under which one gets

anxious and the different components of

the anxiety this manner this monitoring

counteracts one of the core

vulnerabilities of someone who has gid

namely that they feel that their anxiety

and worry is unpredictable and

uncontrollable becoming more of an

objective

observer of their anxiety rather than

just being swept up in it gives hope

that this condition can perhaps be

controlled and by keeping a record of

the frequency and intensity of the

anxiety episodes we have a record from

which to measure progress once we start

the treatment strategies after a few

sessions developing this self monitoring

skill the component of gid that we often

turn our attention to first is the

physical symptoms the physical tension

that is one of the hallmarks of chronic

worry this is an important target for

change because the physical symptoms are

painful often the reason someone seeks

out treatment and because this state of

chronic over arousal of the nervous

system leads to a greater susceptibility

to worry it would certainly be desirable

to have a tool to reduce this physical

tension well there is such a tool called

progressive muscle relaxation where the

person develops the skill to shift their

body from a tense state to a noticeably

more relaxed state a tool to bolster the

parasympathetic branch of their nervous

system progressive muscle relaxation is

much more than telling a person to relax

it is a key anxiety management skill

which requires a good deal of practice

another reason why we introduce it early

in treatment however once learned it can

be quite helpful here's how it works

first we ask you to focus on a

particular muscle group in your body my

muscle group we simply mean the muscles

in a particular part of your part of

your body such as the muscles in your

shoulder area muscles in your upper arms

or lower arms muscles surrounding your

abdomen

so on we start with one muscle group

let's say the muscles in your shoulder

area and ask you to tense up and those

muscles to scrunch up your shoulders and

make them tense and tight and then to

hold that tension for about 10 seconds

in this step you try to create as much

tension as you can and to focus on that

tension then we give a signal usually

saying the word relaxed whereby we asked

you to let go of the tension just let

the muscles go limp and relaxed we ask

you to keep your focus on that same

muscle group and notice the contrast

between the tension when your muscles

were scrunched up and the release of

tension the relaxation we ask you to

keep that focus on the relaxation for

about 20 seconds during which time we

ask you to say a word to yourselves

typically the word relaxed every time

you exhale now what's behind this

technique how is it effective by

creating tension and then releasing it

we've learned that this facilitates the

relaxation response it gives the

relaxation response some momentum kind

of like a pendulum that's set up high

and therefore swings higher to the other

side the relaxation response is stronger

after the release of tension by focusing

attention on the muscle groups you learn

that tension doesn't have to be your

default state but something you can

begin to exert some control over also by

focusing on the body and the

here-and-now you are weakening the

association between tension and worry if

you do notice where he's popping up

during the exercise we can encourage you

to do a mindfulness exercise such as

picturing the worries as clouds passing

by in the sky or is background noise

outside your apartment that you don't

have to pay it

- when we first teach progressive muscle

relaxation in the office we move from

one muscle group to the next initially

we go through 16 different muscle groups

in the body we then ask the client to

practice this progressive muscle

relaxants relaxation exercise at home

without distractions this is time

consuming initially it can take about 30

minutes to go through all the muscle

groups however we emphasize that it is a

skill and like any skill requires time

and practice this is the training phase

of progressive muscle relaxation we then

move to the application phase which

initially involves reducing the number

of muscle groups from 16-day we don't

eliminate any muscle groups we just

combine them so the client tenses and

relaxes more muscle groups together

covering a larger portion of the body by

reducing the number of muscle groups to

eight we shorten the procedure the

client then practices this until he

develops some mastery with it then we

shift the number of muscle groups to

four then two and finally a one-step

entire muscle relaxation shift we ask

the client to practice this one step

procedure with distractions thus they

are then able to carry this skill of

shifting from tension to relaxation into

real-life situations

progressive muscle relaxation is not a

magical cure-all for all the components

of GA d

but it is a concrete tool that provides

relief breaks up the vicious cycle of

tension leading to worry and gives the

client hope that they can have control

over what had been seen as an

uncontrollable condition now let's turn

our attention to the thinking component

the intense worry we described earlier I

here we're not talking about

constructive Ori which can help us

prepare for a problem but worry that is

excessive worry we can't turn off

fortunately there are many techniques we

can bring to bear to disrupt this

tendency to worry a colleague Robert Lee

he in an excellent self-help book called

the worry cure has outlined many of

these strategies most of them are

cognitive techniques aimed to identify

question and dispute the thoughts that

make up the worry

remember research has identified that

two of the frequent characteristics of

worry with GA D sufferers are the

tendency to overestimate the likelihood

of a negative event and the tendency to

imagine the worst-case scenario of a

negative event so how does this

disputing work particularly to challenge

these two key distortions in GA D the

first step is to identify the specifics

that make up the worry people with GA D

typically feel lost in a sea of worry

unable to view their anxiety and worry

objectively however in that

self-monitoring phase of treatment

clients realize that their worries are

really a list of specific thoughts

almost always predictions about

something bad that might happen in the

future by identifying the worries as

specific predictions the client begins

to feel not so overwhelmed by their

worries and feel that they are in a

better position to question those

predictions the next step is to do just

that to evaluate the real odds of

something undesirable happening we pose

questions such as what do you think the

real odds are of the negative prediction

coming true how often have you worried

about a particular negative outcome

for example getting fired or that a

loved one will get in an automobile

accident how many times have you worried

about those things and how many times

have they actually come true are there

facts or data you could seek out they

might help you make a more accurate

prediction such as the statistics of the

likelihood of someone getting into a

serious automobile accident

thus the client learns how to pose

questions that help determine the real

odds the real likelihood of some

negative event happening questions that

lead to answers that have integrity

meaning they are based on evidence the

next step that flows from this

questioning is to put into words or

pictures the more realistic scenario to

picture your spouse arriving home safely

in the car or perhaps picture a

conversation with your supervisor where

the supervisor might not be totally

happy with your work but the

conversation doesn't result in you

getting fired now how do we deal with

the second distortion and unproductive

worry

the tendency to imagine the worst case

scenario for example imagining that

you're going to be fired effort after

turning in a less-than-perfect report

imagine that you're going into

bankruptcy after incurring a little bit

of debt well first we always want to

question the likelihood of these

particular negative predictions but then

we go ahead and encourage the person to

picture their worst case scenario and

ask them to rate the severity of it in

the midst of worry they have almost

always considered the event as awful

god-awful catastrophic something they

just couldn't bear but if asked to

actually rate it we usually suggest a

scale of zero to a hundred or a hundred

represents the most awful thing they

imagine they often recognize that the

event they are worried about is not the

most awful event the event is

undesirable perhaps very undesirable but

there's a recognition that it is perhaps

not absolutely god-awful the next

question is to ask them to picture the

undesirable event and then imagine how

they might cope with it how life might

go on even if the undesirable event

happens

most people with GID don't take this

step and therefore in their minds

they're always stuck in this kind of

cliffhanger image the bad thing

happening or about to happen but not

what could happen next by picturing how

they might cope they realize they are

not stuck in a cliffhanger image and

that there might be things they could do

to deal with the unfortunate event D

catastrophizing is going from the

thought oh my god what if such-and-such

happens to the thought even if something

unfortunate happens

I can imagine coping with it and that

it's not absolutely insufferable now

let's turn to the behavioral component

of GID one of the key behavioral

components of GA D that we want to

target for change is what we call

reassurance or safety seeking behavior

this is behavior design to try to reduce

the possibility of some negative outcome

or to try to reduce the worry about that

outcome examples might be constantly

checking in with your family to make

sure they are safe or always staying

late at work to minimize the chance you

won't get your work done on time

this behavior may provide someone with

reassurance briefly but when relied upon

ends up reinforcing the worry because

the person doesn't give himself a chance

to see that the negative thing they are

worried about doesn't happen or if it

does can be made

instead of challenging their thinking

involved in their worry they engage in

behavior that gives in to the excessive

worry

thus we try to reduce this reassurance

seeking anxiety driven behavior and

replace it with non anxious behavior

such as calling your family less

frequently about their safety

not feeling compelled to stay at work

late every night to always get your work

done on time

the goal here is to build up the

behavior that goes along with tolerating

imperfection letting go of attempts to

control everything letting go of this

sense of responsibility for unlikely

events and recognizing that making

mistakes is part of being human when

someone pushes back against their

reassurance seeking behavior that can

cause an increase in anxiety in the

short run

therefore we usually focus on behavior

change after the person has learned the

coping skills of relaxation and thinking

more realistically they can then bring

these skills to bear on building up new

behavior new behavior that undermines

their general tendency to worry and be

tense and constantly seek reassurance

likewise if someone with GID has been

avoiding legitimate problems such as

seeing a doctor when appropriate or

developing a realistic budget we

encourage taking on these situations

especially since they now have new

coping skills pushing back on the

tendencies to seek reassurance and a

tendency to avoid situations that need

to be tackled will help cement the

tendency to worry less and help solve

problems more effectively this is the

ultimate goal of treatment I hope this

has given you a thumbnail sketch of how

CBT can help those

generalized anxiety disorder by

addressing the components of worried

physical tension and self-defeating

self-defeating behavior with specific

techniques I describe some of the

techniques but there are many other

techniques that can be helpful if you

want to learn about these techniques or

about the treatment of other anxiety

difficulties please don't hesitate to

visit our website I want to conclude by

emphasizing the GA D is a condition

worthy of treatment and fortunately

there is a research tested effective

treatment program to help those who

suffer from chronic worry thank you

you