Two aspects of GAD (Generalized anxiety disorder): 1. Excessive Worry; 2. Physical Tension
Both of these create a vicious cycle feeding off of each other.
Driving you too hard. Becomes unproductive after a certain point.
Often does not enjoy life – too many important things to do. Leisure activities given up.
Emphasis is on striving for perfection. Strong sense of responsibility. Guardedness and control in an effort to prevent bad things from happening. Difficulty stopping or “turning off” the worry.
Core doubt is: thinking you are out of control; doubting your ability to cope.
Have a physical exam. Rule out menopause or thyroid problems, etc.
Amount of practice is important.
Learning to recognize your own anxiety
Learn to be an observer rather than a victim.
Thoughts, Behaviors, Physical Symptoms
Objective as well as Subjective monitoring.
Use the Worry Record anytime you feel a sharp increase in your anxiety, any time you find yourself worrying, any time you feel physical symptoms.
Look for patterns from your records. Challenge your sense of uncontrollability. See if you can learn from your records – type of events, thoughts, time of day, day of week, triggers.
Once you identify patterns then try to change or react differently to your triggers.
Anxiety has one overriding purpose: that is Protection and Preparation.
Anxiety is fear and doubt about what could happen in the Future.
What is anxiety for one person could be challenging for the next.
Triggers can be deadlines, failure, criticism, loss of mastery and control, etc.
Anxious people tend to believe negative events or terrible things are particularly likely to happen, even though their actual probability is very low. Also to focus on the worst possible outcome.
Negatively Predicting the Future – “what if…”
Exaggerating the Negative
A Sense of Uncontrollability
“Safety checks” provide immediate relief, but maintain the long-term nature of the worry. “Avoidance Kills – Coping Saves”.
Relaxation inhibits worry. Physical tension increases anxious thoughts in a negative feedback loop.
Purpose is to interrupt an escalating cycle and turning it into a downward cycle.
Other important issues in the maintenance of anxiety:
Tendency to see the world as more dangerous and threatening than do most people.
Tendency towards too much perfectionism, responsibility, control
Negative Life Experiences – having been victimized or not having been taught how to cope with stressful life experiences.
Not a disease, but a way of responding to stress.
Selectively focusing on negative events as if they really could happen when in fact the probability is very low. Negatively Predicting the Future.
Blowing things out of proportion. Catastrophic thinking. Exaggerating the negative.
Shifting from one image or thought of disaster to another without allowing time to question and examine the validity of the original image.
Tendency to misinterpret the negative events that do happen to all of us (big or small) as further evidence for the dangers and threats of the world, and as further justification for worrying.
Recognizing that your worrying is excessive and unreasonable which leads you o attempt to resist worrying or to try to distract yourself from worrying. Instead of resisting worries, it is more effective to challenge them and replace them with appropriate alternatives or solutions.
Emotional arousal and worry
Belief that worry prevents future negative events
Attempts to resist and distract without reaching alternative solutions
Ineffective problem solving
Progressive Muscle Relaxation
Tapes are helpful
Lower arms, Upper arms, Lower legs, Upper legs, abdomen, chest, shoulders, neck, mouth, throat, jaw, eyes, forehead
Use a keyword – calm, slow, etc.
Music, hot bath, leisure time, reading, etc.
Thoughts – Overestimating the Risk
Is your judgment of danger or risk valid? Examine the facts. Get other opinions. Question the evidence.
Go from “what ifs” to alternative, realistic, more factually-based self-statements.
Develop alternative problem-solving solutions should the fear come true. “I can cope” alternatives if the feared alternative does come true.
Question the Realistic Probability of the feared event ever occurring.
If the feared event did occur how would you cope – Generate Alternative Solutions to how you would cope.
Challenging your thoughts does not mean just “positive thinking”. It is reality, truth, realistic perspective. If the feared thing does happen then being realistic and problem solving.
Thoughts tend to become automatic and habit-like.
Change occurs through practice and recognition.
It is essential to become skilled in knowing exactly what you tell yourself in different situations.
Judgments of Risk
Overestimation of the likelihood of negative events happening.
Jumping to Conclusions
Not being realistic about Probabilities.
“Even though it hasn’t happened yet – it could!!”
“The negative events haven’t happened because I have always managed to prevent them from happening.”
“But I have had bad things happen to me before and I don’t want anything like that to ever happen again, so by being worried I can prepare myself for the worst and be ready for it.”
Assuming that since the thought occurs; the event is going to happen. “Emotional reasoning”. Important not to confuse thoughts or images with facts.
Treat your thoughts as hypotheses and test them out; be a scientist in your evaluation. It is much more effective to challenge and change your thoughts than it is to simply dismiss the thoughts.
Place probabilities on a scale of 1 – 100. Then evaluate if you have overestimated. Realistic estimation.
Challenge your anxious thoughts – much more effective than telling yourself not to worry.
Viewing the consequences of specific negative events as being catastrophic, drastic, or unmanageable.
Decatastrophizing – imagining the worst possible outcome, and then judging its severity or “how bad” that outcome would be.
If the bad thing were to happen it would be manageable and time-limited.
Recognize your ability to cope with negative events by recognizing alternative solutions to problems, versus a continued focus upon negative outcomes. Think of the same event with a sense of ability to cope. Realize we usually do cope. Sometimes people’s greatest strength and mastery come out of conditions of real threat. Life goes on and you adjust to cope with whatever stressors arise.
Mental health = flexibility and adaptability.
Basis of anxiety is overestimation and catastrophizing.
Direct Worry Control
Cognitive distortions leading to anxiety – overestimation and catastrophizing. Actively challenging your thoughts. Developing stronger realistic thinking styles. With repetition your new thinking styles become automatic and habitual.
Relaxing, Questioning the Evidence, Considering Alternatives, and Strengthening the Alternative Realistic-Based Ways of Thinking.
Anxiety reduces with Repeated Exposure. Actively coping with and desensitizing an anxious thought or image requires Worry Exposure.
Make a short list of your major worries. Sit in a quiet place and try to imagine the following as vividly as possible. Spend at least 15 minutes on each worry. Desensitize.
Try to come up with alternatives to the worst possible outcome happening. Write them down. Question the evidence. Rate the realistic odds or probability of each event happening.
If the worst were to happen how would you cope with it? Write it down.
The more you practice challenging your worries the quicker you will gain control.
Sometimes gets worse before it gets better.
Summary – Realistic Thinking: Questioning the Evidence and Thinking of Realistic Ways of Coping.
From Worry Exposure to Worry Prevention.
Make a list of all the behaviors you do that you can recognize as being excessive, and based on worries that you realize are examples of overestimating risks and catastrophizing.
Practicing Coping or bringing on anxious thoughts or “worry thinking” give you opportunities to practice applying strategies to manage anxiety: relaxing, questioning the evidence, considering alternatives, and strengthening the alternative realistic-based ways of thinking.
Exposure to the same image or thoughts provides habituation, or desensitizing the worry. Anxiety reduces with repeated exposure with a scientific attitude of examining the evidence and accepting the most rational, realistic explanation. Telling someone else about your worries often helps be realistic and rational.
Goal is to learn to tolerate things not being perfect, to let go of the attempt to control everything, and to let go of the sense of responsibility for unlikely events.
Some people take on too many tasks and feel overwhelmed.
Set Realistic Daily Goals, Prioritize (A,B,C’s), and Do What You Can, and let go of the rest or carry on to the next day. Have a calendar and schedule.
Schedule in relaxation, leisure, fun time. Every day needs fun time. Learn to make regular activities fun.
Learn to Say No
Stick to your Agendas – with flexibility
Learn to Problem-Solve through Brainstorming
Dealing with Real Problems: Time Management, Goal Setting, and Problem Solving
Consequences of those Options