How Does Anxiety Work?!
Show of hands for who’s felt anxious in their lifetime 🙋🏽🙋🏻♀️🙋🏿♂️
If this were a physical room, we would probably see hands come up; some more tentative than others. The reality is that the overwhelming majority of us have experienced the tightness in the chest, shallow breathing and feeling of dread that is so characteristic of anxiety. If this happens occasionally it’s manageable; but what if it a constant in your life?
When worrying is persistent and chronic, it may be diagnosed as Generalized Anxiety Disorder (GAD). Around 2% of people in Europe have been diagnosed with GAD. But how is this different to the anxiety you may have raised your hand for?
In this article, we’ll discuss what anxiety is in the context of GAD and provide different models that explains why it occurs, how it operates., and what you can do about it.
So What is Generalized Anxiety Disorder (GAD) ?
Generalized Anxiety Disorder, or GAD, is characterized by persistent and overwhelming worry. People with GAD often find themselves trapped in a cycle of anxious thoughts that extend across a broad spectrum of concerns, persisting for at least six months. This constant worrying significantly impacts their daily lives, causing distress and hindering normal functioning.
To receive a formal GAD diagnosis, individuals must exhibit at least three of the following symptoms alongside excessive worry:
Restlessness or a constant sense of unease.
Excessive fatigue, even without strenuous activity.
Difficulty concentrating or experiencing mental blankness.
Heightened irritability.
Persistent muscle tension.
Sleep disturbances, such as difficulty falling asleep or staying asleep.
We can see how the occasional worry or anxiety doesn’t necessarily fit into the above. And if you found yourself ticking off more than three of the above symptoms, we would recommend seeking professional help.
Now let’s get into the meaty part of this article! Let’s tackle the BIG question: how does anxiety work?! There are countless studies from different disciplines that shed light on this. We have chosen five different models that propose an explanation for how anxiety works and how it’s maintained.
The Avoidance Model of Worry
The Avoidance Model of Worry offers insights into why individuals with GAD engage in persistent worrying and how this behavior affects their emotional well-being. This model likens worrying to a cognitive process that diverts attention away from vivid mental images and the associated emotional and physical reactions that typically accompany fearful situations. It's a way for the mind to avoid confronting fear.
In typical situations, when individuals confront anxiety-inducing scenarios, their minds and bodies collaborate to adapt and eventually reduce the fear response. However, excessive worry represents an attempt to solve problems that may not exist, effectively avoiding the emotional experience of fear. This avoidance reinforces the belief that worrying is beneficial for problem-solving and preventing future negative outcomes.
In reality, excessive worrying doesn't provide meaningful solutions but rather distracts from the actual issues. Therapists use techniques grounded in this model to help GAD patients confront their fears gradually, change thought patterns, and focus on the present moment to manage their worries in a healthier manner.
The Intolerance of Uncertainty Model
The Intolerance of Uncertainty Model posits that people with GAD struggle with situations characterized by ambiguity or uncertainty. They find such situations exceptionally distressing and tend to respond by excessive worrying, believing that it will either enhance their problem-solving abilities or prevent potential issues.
This constant worrying exacerbates GAD symptoms and leads to negative thinking patterns regarding problem-solving. Whcih can result in a loss of confidence in problem-solving skills, perceive problems as threats, experience heightened frustration during problem-solving tasks, and anticipate unfavorable outcomes. This reinforces the cycle of anxiety.
Therapeutic interventions based on this model focus on helping individuals become more comfortable with uncertainty. Treatment involves self-monitoring, education about intolerance of uncertainty, evaluating worries, enhancing problem-solving skills, and gradually exposing individuals to uncertainty to break the cycle of worry.
The Metacognitive Model (MCM)
The Metacognitive Model of GAD distinguishes between two types of worry:
The 1st type of worry encompasses concerns about external events.
The 2nd type is known as "worry about worry," and revolves around apprehensions regarding the uncontrollable and dangerous nature of worrying itself. This type leads to unhelpful strategies such as seeking reassurance, checking behaviors, thought suppression, distraction, and avoidance.
The model suggests that negative beliefs about worry and worrying about worrying differentiate individuals with GAD from those without the disorder.
Metacognitive Therapy (MCT) offers a solution by addressing these negative beliefs, teaching new coping strategies, identifying worry triggers, and encouraging individuals to focus on the present moment. MCT challenges the notion that worrying is always helpful or necessary.
The Emotion Dysregulation Model (EDM)
The Emotion Dysregulation Model explores how individuals with GAD may manage their emotions. It likens emotional experiences to waves, with GAD sufferers often experiencing intense and frequent emotional waves, particularly negative ones. The model identifies four main components:
Intense Emotions: Individuals with GAD experience emotions intensely, especially negative ones.
Poor Understanding of Emotions: They struggle to recognize and articulate their emotions effectively.
Negative Attitudes About Emotions: People with GAD often view their emotions as overwhelming or threatening.
Unhelpful Ways of Coping: In response to intense emotions, they employ ineffective strategies such as excessive worrying, suppression, or emotional outbursts.
Emotion Regulation Therapy (ERT) aims to help individuals with GAD navigate their emotions more effectively by incorporating relaxation exercises, changing negative beliefs about emotions, fostering emotional awareness, and introducing new coping strategies.
The Acceptance-Based Model of GAD (ABM)
Our final model regarding anxiety is the Acceptance-Based Model; which emphasizes four core components that are present in individuals diagnosed with GAD.
Internal Experiences: These include thoughts, feelings, and physical sensations. Which all humans experience.
Problematic Relationship with Internal Experiences: People with GAD often react negatively to internal experiences and become overly entangled with them.
Experiential Avoidance: Which results in a coping mechanism involving active efforts to avoid or escape from internal experiences.
Behavioral Restriction: The avoidance then grows to also encompass activities once enjoyed. Although not purposefully, this is often the byproduct of overusing avoidance as a way to cope.
Acceptance-Based Behavioral Therapy (ABBT) is a therapeutic approach rooted in this model. It includes psychoeducation to help individuals understand the model, mindfulness and acceptance exercises to enhance emotional awareness and acceptance, and behavior change techniques that align actions with personal values.
In conclusion, understanding and treating Generalized Anxiety Disorder (GAD) can be approached through various conceptual models, each shedding light on different aspects of the disorder. These models provide valuable insights into why individuals experience anxiety and offer effective strategies to manage it. Treatment approaches vary but often involve cognitive restructuring, emotion regulation, mindfulness, and behavior change to help individuals break free from the cycle of anxiety and worry.
If you’re interested in taking the next steps to making a dent in your anxiety and gain some peace of mind, speak to a therapist today!
Lieb, R., Becker, E., & Altamura, C. (2005). The epidemiology of generalized anxiety disorder in Europe. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 15(4), 445–452. https://doi.org/10.1016/j.euroneuro.2005.04.010
