Are you a chronic worrier?
Most of us worry to some extent, and worry can be useful if it helps us arrive at solutions to problems. For example, if we worry that we might forget important items on an overseas holiday, we would be sure to double-check our packing. If we worry about passing a test, we would make sure we revise the material. The worrying is not pleasant at the time, but it may help things go smoothly. However, consider a person who worries about everything. What if this person’s worry is unproductive, that is, no amount of worry helps him or her come up with a solution? What if the ongoing worrying has substantial and obvious effects on his or her life and the lives of significant others?
Generalised Anxiety Disorder
This person might be diagnosed with Generalised Anxiety Disorder, or GAD, which in everyday terms means that the person experiences chronic worry. He or she may experience high levels of anxiety and apprehension over a range of issues, and the anxiety is often associated with feelings of restlessness or being “keyed-up”, difficulties concentrating, irritability, muscle tension, sleep disturbance and fatigue.
These experiences are very different from those associated with panic, in which a person has a marked nervous system surge, causing symptoms such as a racing heart and physical trembling. A panic attack is an acute episode of extreme fear, whereas chronic worry can be an ongoing state. Psychologists have developed a range of models in attempts to explain the factors that cause GAD to arise, and the factors that keep it going.
There is growing evidence to support the idea that, simply put, people with GAD are thinking so hard that they don’t have any attention left to create distressing images of the things they are worried about, images that would produce even more distressing emotions and physical sensations. Worrying is therefore reinforced; it stops upsetting images occurring. In addition, when the feared events do not actually happen, the importance or usefulness of worrying may also be reinforced.
Treating generalised anxiety with ACT
In recent years there have been a number of studies of treatments for GAD using ideas from Acceptance and Commitment Therapy (ACT). ACT is partly based on the idea that psychological problems and disorders result from attempts to avoid potentially upsetting feelings, body sensations, thoughts, memories and images, or attempts to change them. According to these ideas, people with GAD perceive emotions as threatening, and so try to avoid them, both in their behaviour and by worrying. This avoidance reduces distress in the short term. However, in the longer term the avoidance diminishes the extent that people engage in valued or meaningful activities. This causes more distress, triggering more upsetting internal events to be avoided, causing more worry and so on.
Treating generalised anxiety or chronic worry using ACT involves the person developing the capacity to “step back” from worry thoughts, and make room for, or allow, painful feelings and sensations. A range of mindfulness and other strategies can be used to help the person observe his or her thoughts coming and going without getting hooked into them or dwelling on them. For example, thoughts may be seen as a series of cars going past the house or leaves floating down a stream. The mind may be seen as a radio broadcasting “doom and gloom”, or thoughts may be visualised as words on a computer screen, instead of being seen as true, as orders, or as always necessarily wise or important. Painful feelings and sensations can be observed non-judgementally as a scientist would, with the aim of accepting and noticing their arising and passing, without needing to avoid, change or interfere with them.
By learning to “de-fuse” from thoughts and allow painful feelings and sensations, people with anxiety problems become more able to develop their lives in line with their values. Values-based goals can be developed to produce committed action, and the restrictions and limitations that GAD has placed on their lives are increasingly removed. The goal of ACT is the development of a rich, meaningful and values-based life.
If you experience ongoing problems with chronic worrying and generalised anxiety, please consider making an appointment with me, so that we can explore your difficulties and decide whether ACT would be an appropriate treatment for you. I invite you to also refer to my articles on ACT for social anxiety and About Acceptance and Commitment Therapy ACT