One of the most common topics I am asked to address is Generalized Anxiety Disorder (GAD). GAD is generally categorized with other anxiety disorders such as panic disorder, agoraphobia, OCD and social anxiety. Today I was lucky enough to spend 30 minutes with Dr. David Carbonell. A clinical psychologist specializing in treating anxiety disorders, Dr. Carbonell is the author of “The Worry Trick” and three other books on anxiety and phobias. We had a most excellent talk about GAD, what it is, and how it’s treated.
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GAD vs. PANIC DISORDER
Generalized anxiety disorder is similar to panic disorder and agoraphobia in that the sufferer is subjected to anxious feelings and thoughts that create extreme discomfort. GAD, however, is driven by cognitive processes. Worrisome, recurrent thoughts drive the anxious state are interpreted as signs of danger. This triggers a “war” in which the GAD sufferer attempts in vain to either disprove those thoughts or banish them forcefully by trying to stop them from happening. This creates the physical sensations of anxiety. A GAD sufferer often reports being right on the edge of panic, or feeling like they are about to go over the edge but never do. In the case of GAD, the physical sensations are NOT the problem. They are a symptoms of the problem.
BEING HECKLED BY YOUR OWN THOUGHTS
Dr. Carbonell compares GAD to being “heckled” or taunted by your own thoughts. While many would think that trying to stop the anxious thoughts, trying to disprove them, and trying to stop them would be the solution, these strategies are really part of the problem. The solution lies in finding a new, more well-adapted way to relate to those thoughts.
THE “WHAT IF” CLAUSE – BECOME AWARE OF THE THOUGHT PATTERN
A typical GAD-centric thought will contain a “what if” clause, following by a catastrophe clause. Your thoughts will start with “what if” and will end with detailing a disaster of some kind based on that “what if”. The GAD sufferer will often forget that “what if” indicates a hypothetical situation, instead jumping directly into the catastrophe clause of the thought, ruminating on that, following it, trying to figure it out, and treating it as if it is a real even that is actually happening or is going to happen. Dr. Carbonell suggests strategies that GAD suffers can use to recognize then they are engaging with GAD-centric thoughts. Gaining an awareness of this activity leads being able to stop at the “what if” part of the thought before diving head first into the disaster brewing in the theater of one’s mind. The thoughts and thinking habits that drive GAD may start with major issues like financial ruin, career failure, relationship failure or abandonment (for example), often these habits begin to spread into almost every aspect of life. Worrisome thinking becomes the norm even when deciding what to have for dinner or what to wear on a given day.
LEARNING TO PLAY WITH WORRISOME THOUGHTS
Dr. Carbonell discusses strategies centered around learning to “play” with worrisome thoughts that drive GAD. Rather that arguing with those thoughts, running from them, or trying to squash them as if they represent true danger or peril, one can learn to treat an irrational thought as silly or insignificant. Creating poems from worrisome thoughts (i.e. haiku), writing songs about worrisome thoughts, or creating limericks from worrisome thoughts can reveal the true nature of those thoughts. This is NOT distraction. This is direct interaction with those thoughts to learn through experience that they are not automatically valid or true simply because they exist. Other strategies include making “worry appointments” where the GAD sufferer sets aside specific times for worrying, analyzing or “overthinking”. When anxious thinking kicks in, knowing that you can wait for your 6 PM worry appointment to deal with it can make a big difference.
WHERE’S THE EXPOSURE?
When dealing with GAD, the exposure comes in the direct confrontation of the thoughts that drive the problem. While some might think this is insanity, the way to “de-fang” worrisome thoughts based on hypothetical events and situations is to touch them, and fully experience them in a new way so as to learn that they are not truly threats and do not deserve a special place front-and-center in your daily life.
PERFECTIONISM AND GAD
Perfectionism is often a hidden driver of the thoughts that fuel GAD. One of the great lines in this episode is “You don’t have to be a perfectionist to worry, but it sure helps.”. Declaring oneself a perfectionist can be especially insidious when dealing with GAD because the very presence of the disorder can feel like failure and the inability to make it go away can be perceived as a flaw or a failure, when the propensity to make those judgments is contributing to the problem to start. Coming to the realization that perfection isn’t required and can never be attained can be a major step forward in resolving GAD.
CAN GAD BE “CURED”?
We define “cured” as having lost the fear of the thoughts that drive GAD. It is unrealistic and impossible to expect that one can completely eliminate anxiety, or even irrational or worrisome thoughts from one’s life completely. Humans just don’t work that way. We all have “crazy” thoughts now and then. We all get stressed, and we all worry from time to time. The “cure” when it comes to GAD is to change your relationship with that part of your humanity so that you no longer see it as a disaster worthy of alarm.
Find Dr. Carbonell online at his website https://anxietycoach.com
Find his books – including “The Worry Trick” – at https://anxietycoach.com/anxiety-books.html
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Helpful Recovery Resources:
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Podcast Intro/Outro Music: "Afterglow" by Ben Drake (With Permission)
