Anxiety is the central nervous system’s physiological and emotional response to a vague sense of threat or danger. Generalized Anxiety Disorder (GAD) is a disorder marked by persistent and excessive feelings of anxiety and worry about numerous events and activities. People with GAD feel worried and anxious most of the time about practically anything. This is sometimes called “free-floating anxiety.”

BASIC FEATURES OF GAD

For six months or more, a person experiences disproportionate, uncontrollable, and ongoing anxiety and worry about multiple matters. The symptoms include at least three of the following: edginess, fatigue, poor concentration, irritability, muscle tension, and sleep problems. In addition, there is significant distress and impairment (APA, 2013).

Most people with this disorder can still manage their social relationships and job activities, but they face difficulties. GAD may emerge at any age, but usually it first appears in childhood or adolescence. Women are twice as likely as men to have this disorder.

 

CAUSES AND TREATMENTS

PSYCHODYNAMIC PERSPECTIVE

Sigmund Freud believed that all children experience some level of anxiety as they grow up. To manage this anxiety, they use ego defense mechanisms. There are three types of anxiety.

Realistic anxiety happens when a child faces actual danger. Neurotic anxiety happens when a child is stopped by parents or by circumstances from expressing their id impulses. Moral anxiety arises when a child is punished or threatened for expressing these impulses.

According to Freud, those children who feel high levels of these anxieties or have weak defense mechanisms develop generalized anxiety disorder later in life. According to Freud, GAD can develop when a child has too much neurotic or moral anxiety during early development. Alternatively, some children’s ego defense mechanisms are so weak that they cannot cope with normal levels of anxiety.

Generalized anxiety disorder can happen due to the overprotectiveness of parents. When children are shielded from frustrations or threats, they do not get the chance to develop strong coping skills. This can lead to the development of GAD.

TREATMENT (PSYCHODYNAMIC PERSPECTIVE)

Psychodynamic therapists use the following techniques to treat GAD. These include free association, interpreting transference, resistance, and dreams. Freudian psychodynamic therapists focus on reducing fear of id impulses and making individuals more successful at controlling id impulses. Other psychodynamic therapists, such as object relations therapists, help resolve childhood relationship problems that continue to cause anxiety.

However, research shows that traditional psychodynamic therapy provides only modest help. But short-term psychodynamic therapy can significantly reduce anxiety, worry, and related symptoms.

 

COGNITIVE-BEHAVIORAL PERSPECTIVE

The cognitive-behavioral model says that psychological disorders often happen because of problematic behavior and dysfunctional ways of thinking. Although this approach focuses on both behavior and cognition, for some disorders like generalized anxiety disorder (GAD), it mainly focuses on cognition.

Early cognitive-behavior theorists believed that GAD is primarily caused by maladaptive assumptions. Albert Ellis said that many people have irrational beliefs, which make them act in inappropriate ways. He called these basic irrational assumptions. Examples include the belief that one must be loved by everyone, must be approved by others, and must be successful in everything. When someone with these beliefs faces stress, such as an exam or a first date, they may see it as dangerous and feel fear. Over time, this can lead to GAD.

SILENT ASSUMPTIONS

Similarly, Aaron Beck argued that people with GAD have silent assumptions, such as the belief that it is always best to expect the worst. Researchers have found that people with GAD actually hold maladaptive assumptions.

METACOGNITION THEORY

Metacognition theory is developed by Adrian Wells. This theory says that people with GAD hold both positive and negative beliefs about worrying.

Positive beliefs mean that they think worrying is helpful because it helps them prepare for danger. Negative beliefs mean that they also believe that worrying is bad and harmful. Because of these beliefs, they start worrying about their worry. This is called meta-worry. For example, they may think, “I am going to go crazy because I worry so much.” Research shows that people who have both positive and negative beliefs about their worrying are more likely to develop GAD.

INTOLERANCE OF UNCERTAINTY THEORY

This theory says that some people cannot handle uncertainty. They cannot tolerate the knowledge that negative events may occur, even if the possibility is very small. Because of this, they worry all the time, thinking that bad things might happen. Research shows that people with GAD have much higher intolerance of uncertainty than others. This trait may be biological.

THE AVOIDANCE THEORY

Thomas Borkovec’s avoidance theory says that people with GAD worry repeatedly in order to reduce uncomfortable states of the body. Uncomfortable feelings or physical reactions, such as higher heart rate and respiration, occur. Worrying helps them reduce these feelings because it distracts them from the physical discomfort. Research also supports this theory.

TREATMENT

Two kinds of cognitive-behavioral approaches are used in the case of GAD.

1. Changing Maladaptive Assumptions

Here, therapists use Ellis’ Rational-Emotive Therapy to help people with GAD. In this method, the therapist shows the client their irrational beliefs, suggests more appropriate assumptions, and gives homework.

2. Breaking Down Worrying

In this method, therapists help clients to recognize and change their dysfunctional use of worrying. This includes several steps. First, they educate them about the role of worrying in GAD. Next, clients observe their body reactions and cognitions in different situations. Then, they learn what triggers their worrying and their misconceptions about worrying. As clients understand better, they see the world as less threatening and learn better ways to deal with stress, and they worry less.

Now,
another approach is used called mindfulness-based cognitive therapy, as a part of Acceptance and Commitment Therapy (ACT). Here, therapists help clients to notice their thoughts and worries and teach them to accept thoughts instead of fighting them. This makes worries less powerful.

 

THE BIOLOGICAL PERSPECTIVE

Biological theorists believe that GAD is caused by biological factors. Family pedigree studies show that about 15% of relatives of people with GAD also have it. A closer relative, such as an identical twin, has a greater chance of having this disorder.

EXPLANATION: GABA

GAD is related to biological factors. In the 1950s, researchers determined that benzodiazepines, a group of drugs, help to reduce anxiety. To reduce anxiety, benzodiazepines attach to specific receptors in the brain. Further research found that these receptors are meant for GABA (gamma-aminobutyric acid), a neurotransmitter in the brain.

GABA, ANXIETY, AND ABNORMAL BRAIN CIRCUITRY

GABA carries inhibitory messages. When GABA is received at a receptor, it tells neurons to stop firing.

Here is how this works. During a fear or anxiety situation, key neurons start firing rapidly. This triggers more neurons and creates a state of excitability. This is experienced as fear or anxiety. To calm things down, a feedback system is activated. First, neurons release GABA. Then, GABA binds with the receptors and sends signals to stop firing. As a result, the brain and body return to a calm state. Some scientists believe that malfunction in this feedback system can cause fear and anxiety to keep going.

Experiments also show that when GABA cannot attach properly to its receptors, animals become more anxious. This suggests that people with GAD may have too few GABA receptors, or their receptors do not work well. However, this explanation has some problems. Other neurotransmitters may also play important roles in anxiety and GAD. It is unclear whether poor GABA function causes anxiety, or long-term anxiety causes GABA dysfunction. GAD is most probably related to a group of neurotransmitters rather than just one.

ABNORMAL BRAIN CIRCUITRY

Scientists have found that our emotions are linked to brain circuits. A brain circuit is a network of brain structures that work together, triggering each other into action and producing a particular kind of emotional reaction. For anxiety, this circuit includes the prefrontal cortex, the anterior cingulate cortex, and the amygdala. Recent studies show that in people with GAD, this anxiety circuit often functions improperly.