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CBT for Generalised Anxiety Disorder

People with Generalised Anxiety Disorder (GAD) tend to experience excessive worry which they find difficult to control. They tend to worry most days, for an extended period (over 6 months) and over a variety of different issues. In addition to this excessive worry, an individual with GAD will experience frequent anxiety which can contribute to physical tension (feeling “keyed up”), disturbed sleep, fatigue, irritability and difficulties with What if?concentration. The theme of the worries are not related to one particular area (health for example) and will be having a significant negative impact upon the person’s life.

Some degree of worry is normal, everybody does it. In GAD however, worry becomes a key feature in the individuals life, with even very minor things becoming an issue. It has been suggested that individuals with GAD are “living in the future” such that their preoccupation with “What if’s?” effects their ability to enjoy things as they are in the here and now. When we spend our time focusing upon potential future threats, our body responds as though we are facing a current, actual threat.

Some anxiety is a good thing. It keeps us safe. It is the product of millions of years of evolution and has been designed via natural selection as a quick fire system to get us out of danger whenever it presents. When we appraise something as being a threat, the parts of the brain responsible for emotional processing, the hippocampus and amygdala, trigger off a series of changes within our body which enable us to respond to the threat in a way which historically may have kept us alive. When you are anxious, you may experience your heart beating faster or your breathing become more rapid. This is a response to an increase in adrenaline within the body, arming you with the physiological essentials to fight the threat or to escape in flight.  For many of us today, however, it is not typical to experience actual physical threat and yet the experience of anxiety is as prevalent as ever. Why is this? Well, think about what happens whenever we worry. What is it that we are thinking about? Of course, we are thinking about potentially threatening scenarios, which, even though they are not necessarily taking place in the actual moment, may occur at some point in the future. As such, it would appear that our brains respond as though the threat is in the here and now, activating the fear response.

What to expect from CBT for anxiety.

Ideally, your CBT therapist will opt to use a treatment model which has been designed for Anxiety and has some evidence to support its effectiveness as a treatment. All this means is that your therapist will be using tools and approaches which have been shown to work. One popular model has been developed by researchers Michel Dugas and Melisa Robichaud. Their treatment approach is broken down into eight different stages and incorporates worry training, behaviour experiments and imagery work. Based upon scientific studies, they base treatment upon developing an individuals ability to tolerate uncertainty in the world. This “Intolerance of Uncertainty”, they argue is high in people with generalised anxiety and worry and behavioural changes (avoidance, overcompensation, reassurance seeking) are all used to give the individual the perception of certainty in the world. By using the tools of CBT to develop tolerance of uncertainty rather than sticking with their efforts to increase certainty, the individual ultimately experiences a reduction in their anxiety and move towards recovery.