Baseer Maroof, LCSW · Raleigh, NC · Adults 21+
Generalized anxiety
When your mind runs every possible disaster on a loop. Here’s what GAD is, why worry is so sticky, and a tool to sort and park it.
In short
- GAD is worry that’s excessive, hard to control and about many things, on most days for at least 6 months.
- It comes with body symptoms: restlessness, fatigue, poor focus, irritability, muscle tension and bad sleep.
- Worry feels like problem-solving but usually isn’t. Sorting real problems from “what ifs” helps.
- Postponing worry to a set daily window cut worry, anxiety and insomnia in a randomized trial.
What GAD is
Paraphrased. A clinician makes the diagnosis.
The worry
Excessive anxiety and worry about a number of things (work, health, family, money, small daily stuff), on more days than not, for at least 6 months. You find it hard to switch off. (StatPearls GAD; NIMH)
The body
At least three of: restless or keyed up, tiring easily, trouble concentrating or going blank, irritability, muscle tension, sleep trouble.
The cost and the rule-outs
It causes real distress or impairment, and isn’t better explained by a substance, a medical condition or another disorder.
How common
2.7% of U.S. adults in a given year; 5.7% at some point in life. Women 3.4%, men 1.9%. (NIMH)
Worry sorter
Worry sorter
Sort a worry, then park it until worry time. Saves on this device only.
Worry postponement as tested by McGowan & Behar (2013): one 30-minute worry window, same time and place, every day.
Why worry sticks
It feels useful
Worry feels like preparing. Most of what you worry about never happens, so it looks like the worry worked. That’s a false link, and it keeps the habit going.
It’s a way of avoiding
Thinking in words about a feared future can be less intense than actually picturing it or feeling it. So worry can work as a form of avoidance, and it never resolves.
What to do instead
Real problem you can act on? Pick the next step and do it. A “what if” or something out of your hands? Park it until worry time. At worry time, give it full attention for up to 30 minutes, then stop.
Treatment
Guideline view
NICE recommends stepped care: education and self-help first; if that’s not enough, either individual CBT or applied relaxation, or an SSRI. It says neither therapy nor medication has been shown to be better, so choose by preference. If medication is chosen, sertraline is suggested first. (NICE CG113)
The worry-window trial
53 high worriers were randomized for two weeks. The group that confined worry to a daily 30-minute window, same time and place, had bigger drops in worry, anxiety and insomnia than the comparison group. (McGowan & Behar 2013)
Medication
Talk to your doctor or psychiatrist about whether medication fits, and don’t stop one suddenly without their guidance.
Sources
All sources, linked4 references⌄
- StatPearls. Generalized Anxiety Disorder. NCBI Bookshelf NBK441870. www.ncbi.nlm.nih.gov/books/NBK441870/
- National Institute of Mental Health. Generalized Anxiety Disorder (NCS-R statistics). www.nimh.nih.gov/health/statistics/generalized-anxiety-disorder
- McGowan SK, Behar E (2013). A preliminary investigation of stimulus control training for worry: effects on anxiety and insomnia. Behavior Modification, 37(1), 90–112. pubmed.ncbi.nlm.nih.gov/22977265/
- NICE (2011, updated 2020). Generalised anxiety disorder and panic disorder in adults: management (CG113). www.nice.org.uk/guidance/cg113/chapter/Recommendations
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