Everyone worries. Generalised anxiety disorder, usually shortened to GAD, is different. The worry is persistent, it moves from one subject to the next, and it feels very hard to switch off. Work, health, money, family, the future: as soon as one concern settles, another takes its place. Many people with GAD describe themselves as "a worrier" and assume it is simply part of their personality. Often, it is something that can change.
What GAD looks like
GAD involves excessive, difficult-to-control worry about a range of everyday matters, most days, over a long period. It usually comes with physical and mental strain, such as:
- Feeling restless, on edge or keyed up
- Tiring easily, or feeling worn out by the end of the day
- Difficulty concentrating, or your mind going blank
- Irritability
- Muscle tension, headaches or a tight jaw
- Difficulty falling or staying asleep, often because your mind won't stop
What distinguishes GAD from ordinary concern is less the subject of the worry than its quality. The worry is out of proportion to the situation, it is hard to stop once it starts, and it often takes the form of a chain of "what ifs" that leads further and further from anything likely.
GAD in capable, conscientious people
GAD is common in people who are reliable, thorough and successful. In many ways, worry seems to have served them well: it keeps them prepared, careful and one step ahead. That is part of why it is so hard to let go of. The cost tends to show up elsewhere, in exhaustion, poor sleep, difficulty being present, and a background sense that something is about to go wrong.
It often overlaps with perfectionism, and over time it can contribute to burnout.
Why worry keeps going
CBT research has identified several patterns that keep GAD in place. Understanding them is often a relief in itself, because it shows that the problem is not weakness or lack of willpower.
Beliefs about worry itself. Many people with GAD hold two kinds of belief about worry at the same time. On one hand, that worry is useful: it helps them prepare, prevents bad things from happening, or shows that they care. On the other, that worry is uncontrollable, or even harmful. The first keeps them worrying; the second makes them anxious about the worrying.
Intolerance of uncertainty. Worry is often an attempt to resolve uncertainty by thinking through every possibility in advance. Because the future is uncertain by nature, there is always something left to worry about. This is a concept I write about in relation to OCD in OCD and intolerance of uncertainty, and it is equally central to GAD.
The behaviours that go with worry. Over-preparing, checking, seeking reassurance, procrastinating on things that feel uncertain, or avoiding news and difficult conversations all bring short-term relief. They also prevent you from discovering that you could have coped without them.
How CBT can help
CBT is one of the treatments recommended for GAD in the UK's NICE guidelines, and it has a strong evidence base. Treatment begins with understanding how worry works for you: what you worry about, what you believe worry does for you, and what you do to manage it. From there, the work focuses on the beliefs and patterns that keep the worry going, rather than on the content of each individual worry.
Working with someone matters here, because worry is persuasive. Trying to argue yourself out of it tends to become more worry, and the beliefs that keep it going often feel like common sense from the inside. A therapist who understands the mechanism can help you see the pattern clearly and change it in a way that lasts.
When to seek help
It may be worth speaking to someone if worry takes up a large part of your day, if it is affecting your sleep, concentration or relationships, or if you have been "a worrier" for as long as you can remember and are tired of it. GAD is very treatable, and many people are surprised to find that worry turns out to be far less necessary than it felt.
In my practice
Many of the people I see with GAD are high-functioning professionals who have managed their worry for years through preparation and effort. They often arrive expecting that therapy will ask them to care less. It doesn't. It helps them stop paying such a high price for caring. You can read more about how I work with anxiety on my anxiety therapy page.
If any of this sounds familiar, you may find it useful to talk it through. I offer an initial assessment, online or in person in Queen's Park, and can tell you honestly whether I think treatment with me is the right fit.
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BABCP-accredited CBT therapist and EMDR Europe accredited practitioner, in clinical practice since 2015. Guy works with adults online and in Queen's Park, North West London, with a particular focus on OCD, anxiety and trauma. More about Guy