Generalized Anxiety Disorder: The CBT Approach

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

disorder

s in this video I am going to talk about

generalized

anxiety

disorder

also known as

generalized

anxiety disorder GA D is a diagnosable condition characterized by excessive worry and a set of physical symptoms such as muscle tension restlessness fatigue irritability and sleeping difficulties In recent decades we have learned a lot 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 and more detailed understanding of GA D and show how cognitive-behavioral professionals have used that understanding to develop treatment.

Highly effective research-backed for generalized anxiety disorder. I'm also going to provide some guidelines and how you can distinguish between a tendency to worry and a full-blown GA D. First I would like to make it clear that it is desirable and appropriate for generalized anxiety disorder to be a diagnosable condition and deserves it. designation because GA D is not just the tendency to worry or be nervous, we all have the tendency to worry from time to time, to be nervous and feel tense, in fact, those tendencies can be adaptive, they can help us prepare for emerging difficulties However, the worried intention may be excessive and therefore warrant therapeutic attention.

Research has shown that generalized anxiety disorder is a completely different animal. The person with GA D would describe themselves as a constant warrior and those who do so who knew you well would agree with that assessment your worries are persistent you feel stuck in your state of worry, you would also describe yourself as trapped in a state of physical tension. He could describe himself as tense and tense all the time. He is constantly alert and apprehensive, as one GAD patient put it. I feel like I'm always walking inward. a war zone we are all familiar with the notion of suspense as it applies to a novel or a movie suspense captures our attention creates tension in the good sense of the story however the world for the person with generalized anxiety disorder as reflected in their thoughts and concerns is like living from one suspense to another, but not in a good way, they are constantly besieged by thoughts like: do I have enough money?

Will there be a shooting at a school in my community? Do I need to develop? more skills? to keep my job could I be developing heart disease? Did I say something stupid at the party last night? Is the economy going to collapse? With generalized anxiety disorder, a part of them anyway thinks that their worry is unreasonable or excessive, they still cannot turn off the worry and that inability to turn off the worry is a central feature of GA D. An important diagnostic criterion for the GA D is that it is significant. Worry occurs almost every day for at least six months Worry goes from helpful to unhelpful The following questions can help eliminate the tipping point, for example, when I realize that I am absorbed and worried and I want to concentrate in something else, can I? to turn off worry if my worries bother me a lot they make it difficult to do things I worry so much that I can rarely relax I realize that I worry about things that others worry about, but in a more exaggerated way I worry most of the time without arriving at a possible solution for a particular problem.

Do I think that if I don't worry, a terrible event will be more likely to occur? If your answer to several of these questions is yes, you may have generalized. Things about our anxiety disorder and you might want to examine the tendency to worry so much. Generalized anxiety disorder can be a torment for the person who goes through it and certainly undermines peace of mind, it can hinder daily activities and responsibilities. intense that the person has difficulty functioning over time can contribute to physical health problems approximately 4% of the population struggles with generalized anxiety disorder, so what is the particular nature of GA D?

This different animal from the beginning, when researchers were beginning to identify the particular details of GA D, found it desirable to think that GA D has three basic components: a thinking component that basically involves worrying, a feeling component that involves feelings of anxiety and apprehension, as well as the physical symptoms I mentioned earlier, and a behavioral component, behavior. that goes along with GA D includes avoiding situations that worry the person were seeking reassurance about situations that worry Breaking down generalized anxiety disorder into its components has a number of benefits for many with GA D and those trying to help them find the condition We have spread this general tendency to worry when feeling tense, but by identifying 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 each other. They reinforce each other and a kind of negative cycle is generated, the more we worry, the more tense we feel, which then leads to avoidance or reassurance-seeking behavior that often evokes more worry, so the other side of this cycle is that when we can achieve a positive effect change in one component, the thinking component, worry, let's say it tends to generate a positive change in the feeling and behavior components of GA D, so let's go over the three areas starting with a thought or worry component, let's first define worry, worry is usually defined as focusing our thoughts on some type 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 tendency 10, we need to understand the particular quality of worry and those with GID when We focus on those with excessive worry.

What we see? Research has allowed us to point out fundamental forms of thinking that we characterize as distorted thinking. Two ways people with GAD interpret life events. The first distortion involves overestimating the probability of something threatening. or something undesirable could happen, for example, a person with GA D upon hearing a report that the economy is not doing so well might conclude that she is likely to lose her job. The second key distortion involves overestimating the severity of the undesirable thing that is happening. that has been labeled catastrophic, for example, the person who worries about losing their job may see that possibility not only as something undesirable or quite stressful, but as having irrecoverable, ruinous and very damaging impacts on their life or their family;

They imagine the worst-case scenario with chronic worriers. It's not so much what they worry about, they tend to worry about the same kinds of things as those who are not chronic worriers, such as health problems, work or school performance, finances, trying to be a good friend or family member, not It is not what they worry about, but rather how they worry specifically with these two distortions: the overestimation of the probability and the overestimation of the severity of some undesirable event. The threshold of worry is very low. The person with GA D always feels on high alert for danger. lurks in addition we have I also identified three beliefs associated with chronic worry.

These beliefs are sort of ground rules of the road that reflect GA D patients' attempt to protect themselves from threats, but these beliefs end up simply reinforcing the state of worry. The first believes in his perfectionism. The belief that one cannot or should not. making mistakes and that making mistakes in decision making, parenting work or whatever represents incompetence in managing life with this belief there is constant pressure to always make the right judgment or display the perfect behavior the second belief is It relates to responsibility that it is irresponsible not to focus on negative possibilities, therefore the words that arise in the mind should not be ignored and that worrying means one is being responsible, while not worrying is being irresponsible.

The third key belief we have identified is called controllability, the belief that worry is a way to gain control and prevent negative outcomes from becoming reality. This is reflected in thoughts such as I am glad I worried about my daughter because she arrived healthy and healthy. save home after a trip. These three beliefs maintain worry and anxiety and help explain why people chronically worry. They have so much difficulty turning off their worry and anxiety, although there is a part of them that wants to turn it off, there is also a part of them that feels that turning it off would be irresponsible and could even increase the possibility of some unwanted outcome.

The good news is that our detailed understanding of these thinking errors and beliefs that lead to chronic worry has allowed us to design specific treatment strategies to counteract and help those for whom worry seems so intractable. The second component of GA D is the physical component which refers to physical sensations or symptoms such as restlessness, difficulty relaxing, problems falling asleep or staying asleep, usually due to a racing mind, also getting tired easily, headaches, gastrointestinal difficulties and feelings of irritability and nervousness. These physical sensations are the result of our brain sending a message to our autonomic nervous system.

The message sent is that there is some type of threat and we need more energy. The energy that accompanies our fight or flight system. We need that energy to deal with it. the threat now let me give just a brief description of how our nervous system works the autonomic nervous system has two branches called the sympathetic branch and the parasympathetic branch the sympathetic branch accelerates our energy to deal with the threat the parasympathetic branch slows down this activation of energy when it is already The parasympathetic branch is not necessary, it helps us regain our emotional balance and restores our body to a normal resting state;

However, research on gid suggests that there are low levels of parasympathetic control, meaning that people with GA D do not brake as frequently or effectively as they would. Should the result be that our bodies get stuck in a higher arousal state when they no longer need to be in a high arousal state, sort of like being stuck in third gear in situations where they only need to be in second gear, which explains the classic physical symptoms of GA D, such as muscle tension, difficulty sleeping, irritability, and difficulty relaxing, the third component of g ID is behavior.

We want to highlight three types of behavior in relation to GA d. First, there is behavior that is a direct result of Anxiety such as difficulty concentrating and restlessness. We want to focus on this behavior because it compromises the 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 is not always bad, but if we do. If we overestimate the threat, avoiding it only reinforces the notion that the threat is serious by preventing us from missing the opportunity to see that perhaps the threat is not as bad as we predicted or that we can cope with it even if it is somewhat difficult.

Another significant behavior involves what we call excess caution or reassurance seeking. For a more detailed understanding of the components of GA D, let us move on to the treatment

approach

. GA D cognitive behavioral treatment is a scientific

approach

in which you develop skills to think, behave, and physically react in new ways to overcome your chronic worry and anxiety with CBT. You will learn how to alter the negative predictions that lead you to feel insecure and out of control. You will learn to alter them by thinking more precisely about the real possibilities of something bad happening. You will learn to think less catastrophically and rehearse how to deal with it. difficulties of real life and CBT, you will learn how to shift your body from its tense state caused by constant overexcitation of your nervous system to a more relaxed state, thus interrupting the vicious Woori cycle that leads to physical tension that leads to more worry, etc You will learn how to change your reassurance-seeking behavior to learn that the dangers you predict do not happen or realize that you can cope with them.

You will learn to deal with situations that you could have avoided due to your predictions.negative. Learn effective problem-solving strategies to deal with legitimate stressful events in your life. I'll describe some of these skill sets in a few minutes, but first let me describe the first stage of treatment that we call the self-awareness or self-control stage. is where we ask the client to monitor and record her states of anxiety and worry so that he can know when, where and under what circumstances she has anxiety. We also ask you to identify and record the particular thoughts that make up your worried state and the particular physical state. symptoms they experience when they are anxious and the behaviors triggered by their anxiety, including behaviors they display to try to obtain reassurance.

This self-monitoring step has a number of benefits, most importantly it identifies the particular thought feeling and behavioral components of anxiety that we want to focus on. for treatment, it also makes it easier to become an observer of one's own anxiety and worry rather than simply being a victim of them, by identifying the conditions under which one becomes anxious and the different components of anxiety, in this way this monitoring counteracts One of the main vulnerabilities of someone who has Down syndrome, that is, feeling that their anxiety and worry are unpredictable and uncontrollable. Becoming a more objective observer of your anxiety rather than simply giving in to it gives hope that this condition can perhaps be controlled and By keeping a record of the frequency and intensity of anxiety episodes, we have a record from which measure progress once we begin treatment strategies, after a few sessions of developing this self-control skill, the component of gid that we often direct our attention to first is the physical symptoms the physical tension that is one of the characteristics of Chronic worry This is an important target for change because painful physical symptoms are often the reason someone seeks treatment and because this state of chronic overarousal of the nervous system leads to an increased susceptibility to worry, it would certainly be desirable to have a tool to reduce this physical tension.

Well, there is a tool called progressive muscle relaxation where the person develops the ability to change their body from a tense state to a noticeably more relaxed state. To strengthen the parasympathetic branch of your nervous system, progressive muscle relaxation is much more than telling a person to relax, it is a key anxiety management skill that requires a lot of practice, another reason we introduce it early in the treatment, however, once learned, it can be quite useful, here's how it works First, we ask you to focus on a particular muscle group in your body. My muscle group, we simply refer to the muscles of a particular part of your body, such as the muscles of the shoulder area, the muscles of the upper body. muscles of the arms or forearms that surround the abdomen, so we start with a group of muscles, let's say the muscles in the shoulder area and we ask it to tense and those muscles contract the shoulders and make them tight and tense and then keep that tension.

For about 10 seconds in this step you try to create as much tension as you can and focus on that tension, then we give a signal which usually says the word relaxed, so we ask you to release the tension, just let the muscles relax and relaxed, we ask you to keep your attention on that same group of muscles and notice the contrast between the tension when your muscles were contracted and the release of tension, the relaxation. We ask you to keep your attention on relaxation for about 20 seconds, during which time we ask you to say a word to yourself typically the word relaxed every time you exhale now what is behind this technique how it is effective in creating tension and then releasing it we have learned that this facilitates the relaxation response gives some boost to the relaxation response It is something like a pendulum that is placed high and therefore swings to the other side.

The relaxation response is stronger after the release of tension. By focusing your attention on muscle groups, you learn that tension does not have to be your default state, but rather something you can also begin to exert some control by focusing on the body and the here and now. It is weakening the association between tension and worry. If you notice where it appears during the exercise, we can encourage you to do a mindfulness exercise such as imagining worries as clouds passing in the sky or background noise outside your apartment that you don't have to pay for - when we first teach relaxation progressive muscle in the office, we initially move from one muscle group to the next.

Through 16 different muscle groups in the body, we then ask the client to practice this progressive relaxation exercise with muscle relaxers at home without distractions. This takes a lot of time initially. It can take about 30 minutes to work through all muscle groups. However, we emphasize that it is a skill and like any skill requires time and practice, this is the progressive muscle relaxation training phase, then we move on to the application phase which initially involves reducing the number of muscle groups on day 16, not We eliminate no 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 and then we change the number from muscle groups to four, then two, and finally a complete one-step muscle relaxation change.

We ask the client to practice this one-step procedure with distractions so that they can then carry this skill of moving from tension to relaxation into real-life situations. Progressive muscle relaxation is not a magical panacea for all the components of AG d, but it is a concrete tool that provides relief, breaks the vicious cycle of tension that leads to worry, and gives the client hope that they can have control over what they do. that had been seen as something uncontrollable. condition let us now turn our attention to the thinking component, the intense worry we described above. Here we are not talking about constructive Ori that can help us prepare for a problem, but the worry is excessive and we cannot turn it off, fortunately there are many.

Techniques that we can apply to interrupt this tendency to worry. A colleague Robert Lee, in an excellent self-help book called The Worry Cure, has outlined many of these strategies, most of them cognitive techniques aimed at identifying questions and challenging the thoughts that make us think. Turn up the worry, remember that research has identified that two of the common characteristics of worry in those with GA D are the tendency to overestimate the probability of a negative event and the tendency to imagine the worst case scenario of a negative event, So how does this dispute work? Particularly to challenge these two key distortions in GA D, the first step is to identify the details that make up the concern.

People with GA D usually feel lost in a sea of ​​worry, unable to see their anxiety and worry objectively, yet in that self-monitoring phase. of treatment clients realize that their worries are actually a list of specific thoughts, almost always predictions about something bad that might happen in the future. By identifying concerns as specific predictions, the client begins to feel less overwhelmed by their worries and feels that they are in a better position to question those predictions. The next step is to do just that. To evaluate the real probabilities of something undesirable happening, we ask questions. such as what you think the real chances are of the negative prediction coming true, how often you have worried about a particular negative outcome, for example, getting fired or a loved one getting into a car accident.

How many times have you worried about those things and how many times have they come true? Are there facts or data you could look for that could help you make decisions? a more accurate prediction, such as statistics on the probability that someone will be in a serious car accident, so the client learns to ask questions that help determine the actual probabilities of some negative event occurring questions that lead to answers that have a meaning of integrity are based on evidence, the next step that arises from this questioning is to express in words or images the most realistic scenario to imagine your spouse arriving home safely in the car or perhaps imagine a conversation with your supervisor where the supervisor might not be totally happy. with your job 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, imagine that you are going to be fired after turning in a less than perfect report, imagine that you are going to declare bankruptcy after incurring a small debt. Well, first we always want to question the probability of these particular negative predictions, but then we go ahead and encourage the person to imagine the worst case scenario for them. and we ask them to rate the seriousness of it in the midst of worry, they have almost always considered the event as something terribly catastrophic, something they simply could not bear, but if they are asked to rate it, we usually suggest a scale of zero to one .

A hundred or a hundred represents the most horrible thing they imagine, they often recognize that the event they are worried about is not the most terrible event, the event is undesirable, perhaps very undesirable, but they recognize that it may not be absolutely horrible. The next question. is to ask them to imagine the undesirable event and then imagine how they could cope with it, how life could continue even if the undesirable event occurs, most people with GID do not take this step and therefore in their minds they are always stuck This type of suspense image is about the bad thing that is happening or is about to happen, but not what might happen next.

By imagining how they could cope, they realize that they are not trapped in a cliffhanger and that there might be things they could do to deal with the unfortunate event. D catastrophize goes from the thought, oh my God, what happens if this or that thing happens to the thought? Even if something unfortunate happens, I can figure out how to deal with it and it's not absolutely unbearable. Now let's move on to the behavioral component of GID, one of the key behavioral components of GA D that we want to target for change are what we call reassurance or reassurance seeking behavior.

This is a behavioral design to try to reduce the possibility of some negative outcome or to try to reduce worry about that outcome. Examples may arise constantly. check in with your family to make sure they are safe or always stay late at work to minimize the chance that you won't finish your work on time. This behavior may briefly bring someone peace of mind, but when relied upon, it ends up reinforcing worry because the person doesn't give themselves the opportunity to see that the negative thing they're worried about isn't happening or, if it does, they can do it instead of challenging it.

The thought involved in your worry engages in behavior that gives in to excessive worry. We try to reduce this anxiety-driven, reassurance-seeking behavior and replace it with non-anxious behavior, such as calling your family less frequently about your safety, not feeling obligated to stay at work late every night to always finish your work on time. The goal here is to develop the behavior that accompanies tolerating imperfection, letting go of attempts to control everything, letting go of this sense of responsibility for improbable events, and recognizing that making mistakes is part of being human when someone opposes your safety. , looking for a behavior that may cause increased anxiety in the short term, therefore we generally focus on behavior change after the person has learned the coping skills of relaxation and more realistic thinking, then they can Use these skills to develop new behavior that undermines your general tendency to worry. and being tense and constantly seeking 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 them to take on these situations, especially since they now have new skills coping strategies that reject tendencies to seek Tranquility and the tendency to avoid situations that need to be addressed will help cement the tendency to worry less and help resolve problems.problems more effectively.

This is the ultimate goal of treatment. I hope this has given you a brief overview of how CBT can help generalized anxiety. disorder by addressing the components of preoccupied physical tension and counterproductive behavior with specific techniques. I describe some of the techniques, but there are many other techniques that may be useful if you would like to learn about these techniques or about treating other anxiety difficulties, please feel free to visit our website. I want to conclude by emphasizing that GA D is a condition worth treating, and fortunately, there is an effective, research-proven treatment program to help those suffering from chronic worry.

Thank you.