Learn the skills to manage your anxiety


Worry: the Agony of Not Knowing

We all worry and feel stressed at times; it's part of the human condition.But most people know someone whose entire thinking style seems to be riddled with worry almost all of the time, like an instrument that can only play songs in one key. These chronic worriers may have what psychologists call Generalized Anxiety Disorder (GAD). GAD is diagnosed when a person worries persistently, excessively and unrealistically about a whole range of everyday issues for 6 months or more. If the condition is of mild severity, a person may still be able to work and function socially, but when it is severe, a person's worry consumes and incapacitates them. People with acute GAD can even worry themselves into panic attacks. In U.S. society, women are twice as likely as men to be afflicted with GAD. Earlier, I used the term "thinking style." This is meant to convey that chronic worrying is often an entrenched pattern of thinking, but that the pattern or style--like styles of driving, dressing or TV watching--does not have to be an incurable lifelong fait accompli. It takes self-awareness and perseverance, but people change their styles of thinking and relating to others every day. Cognitive Behavior Therapy treatments for GAD are based on a combination of cognitive restructuring and exposure to fear of consequences (that, happily, usually don't come to pass).

With a therapist's help, chronic worriers can become more aware of how they are thinking about everyday issues. Usually, they find that they are making cognitive errors such as all-or-nothing thinking, jumping to conclusions, catastrophizing, and overestimating the likelihood of something dangerous happening*. By repeated practice, they can learn to catch themselves making these errors and gradually sift them out of their thinking.

Along with cognitive restructuring work, exposure treatments for GAD involve purposefully holding back from seeking reassurance that a feared consequence might happen. Enduring the discomfort of not knowing what is going on with a loved one, a job application, a health condition. Because, at it's most elemental level, GAD is a disorder of intolerance of uncertainty. An afflicted person just can't stand the agony of not knowing what is happening or what will happen, and lives in constant mental and physical agitation as a result.

To be able to accept and even to embrace life's endless mysteries and uncertainties is part of the definition of mental health. It is the vision of recovery that every loved one and every therapist holds for the chronic worriers we care about and want to see healed.


* These terms were developed by Dr. David Burns in his groundbreaking cognitive therapy book Feeling Good.