What Chronic Worry Is and Its Treatment

Generalized Anxiety Disorder (GAD) involves excessive anxiety and worry associated with a number of physical symptoms. We emphasize worry, because people who do not report worry as being a major problem do not fulfill the criteria for GAD. Most people who worry chronically are very distressed by it. They feel keyed up, have physical symptoms such as tension, restlessness, difficulty concentrating, and their minds are constantly conjuring up terrifying scenarios of what could happen. One worry can lead to another: "If I do this, this will happen, but if I do that, that will happen." If worry is so aversive, why do people still worry? Well, there are perceived benefits: "Worrying shows that I care." "Worrying prepares me to cope." "Worrying prevents me from feeling guilty." "Worrying will prevent disappointment." "Worrying prevents disaster." Two compelling reasons for learning to curb worry are that it interferes with quality of life, preventing the person from living in the here-and-now (which is the only life we have), and problems that do not exist, cannot be solved.

The exact biological underpinnings to worry are unknown at this time but - from our observation - the brains of people with chronic worry seem to have a compelling "need" to worry. Yet this idea should be viewed with caution because biological and psychological factors interact. Worry can be seen as a well-ingrained habit, which has helped the brain create pathways facilitating it further. From a cognitive-behavioral perspective, it is a way to deal with uncertainty and ambiguity, and there is the sense of lack of control. People with excessive worry often handle real-life issues as well as the average person. Troublesome are things that are not occurring at the moment, hence, intolerance of uncertainty seems to be at the core.

In the cognitive-behavioral treatment of worry, strategies are utilized that have been proven effective in changing the patterns of worry. Fortunately, we now have proof that these treatments can change the brain's functioning. Some strategies are behavioral, others cognitive, depending on the nature of the worry. Historically, the treatment for GAD has not looked sufficiently at the behavioral components. For instance, there are avoidances the person engages in, such as not inviting guests over, not reading the mail, not listening to the news, not making decisions, procrastinating; there is the use of safety devices, such as unnecessary or repeated checking, acting carefully, making lists, overprotecting the children; and reassurance-seeking, such as calling a loved one too much to make sure they are OK, asking others to make decisions, asking for their opinions in order to avoid relying on oneself, and so forth. As is the case with phobias and obsessions, these types of behaviors help maintain the disorder. Looking for and paying undue attention to potential threat also has been shown to maintain it. Where the average person assumes safety unless proven otherwise, the worrying person assumes danger unless proven otherwise. And here is one of the impossible sticking points, how can you "prove" that there is not going to be danger - in fact anywhere?

In the treatment, we work jointly on the strategies, as well as addressing avoidance and safety patterns, and aim at tolerating uncertainty. Uncertainty is often even a blessing. But rather than uncertainty, isn't it that the person really would like to know if misfortune is coming with the idea of controlling or preventing it? If so, we get into the realm of thinking we can control our destiny and the future. All work on anxiety disorders requires us to accept the basic premise that nothing in life is absolutely safe or secure. We can still learn to live a full life while accepting such a reality.

This work is by far most effective when done in group format. We are restarting a Worry Group, led by Elke Zuercher-White, Ph.D., ABPP on Tuesday, February 4. The group meets on Tuesdays 4:00-6:00 pm. It consists of 4 Modules of 4 sessions each, for a total of 16 sessions. There are weekly home assignments, associated with the strategies being learned. At times someone needs fewer or more than the 16 group sessions, but for most this is very adequate to affect meaningful change. We need an assessment session prior, so if interested, please call ASAP. We will postpone the start date some only if there are not enough clients for that day.

By Elke Zuercher-White, Ph.D., ABPP