A fascinating study came out in May of 2020* that holds exciting implications for all of us. Researchers Lucas LaFreniere and Michele Newman asked the question: how many of the things people with generalized anxiety disorder worry about actually come true? The research design was simple and elegant: they collected a list of worries from people with GAD (generalized anxiety disorder), and one month later asked them to record how many of these worries actually came to pass. A whopping 91.6% of the items on their list never took place at all! And in a similar pilot study, they found that the other 8.4% of the worries on the lists did come to pass in some form, but in a way dramatically different than anticipated. More specifically, these events came to pass, but were perceived as much more ordinary and manageable than what the research subjects were expecting.
What is the moral of this story? Quite simply that most of our worries, a.k.a. anxieties, are completely fabricated from assumptions made long ago, usually in childhood when we didn’t have enough life experience to know better. Michelle did Montaigne put it this way: “My life was filled with terrible misfortunes…most of which never happened!”
Generalized anxiety disorder as a template for other anxiety disorders
What is so poignant about this study, in my opinion, is that it applies to all of us. Obviously, we are not all running around with a clinical GAD diagnosis. But when properly understood, a generalized anxiety disorder can be seen as simply a more extreme form of the “worrying” we all do.
There is an online generalized anxiety disorder test** that is intended to serve as an informal and highly simplified diagnostic tool. It asks just 10 questions that capture the broad themes of GAD, and they are:
1) “Are you a worrier?“,
2) “Do you imagine the worst?“,
3) “Do you worry about what people think of you?“,
4) “Do you worry about your health?“,
5) “Do you worry about your finances?“,
6) “Do you worry about relationships?“,
7) “Do you worry about the safety and well-being of loved ones?“,
8) “Do you worry about many things over and over again?“,
9) “Do you worry about making mistakes, your job, your career?“,
10)“How often do you worry about your safety and well-being?“
Again, this is a very simplistic way to try to diagnose GAD, but it illustrates an important point. GAD is, as the name suggests, “generalized“. I like to say it is anxiety that has not attached itself to one specific situation, object, or circumstance. It functions like a “free-floating anxiety“, ready to be triggered when it finds an opportunity one can imagine is somehow threatening.
Another way to say it, as is evident from this self test quiz, is that it’s anxiety about virtually anything, from people to health to finances to careers… literally anything! If one can imagine the situation is somehow threatening or potentially so, no matter how remote the possibility, their anxiety can be stimulated.
This is why I make the point that any of us can have generalized anxiety disorder symptoms, whether they rise to the level of a clinical diagnosis or not.
What is generalized anxiety disorder?
We’ve discussed some of the generalized anxiety disorder symptoms, but there is a formal definition given by the Diagnostic and Statistical Manual–the psychotherapists “bible” for understanding the different diagnostic categories.*** We don’t have room here to give all of the details about what the DSM says about GAD, but here is a brief overview:
“Excessive anxiety about a number of events or activities, associated with three or more of the following:
1) Restlessness, feeling keyed up or on edge.
2) Being easily fatigued.
3) Difficulty concentrating or mind going blank.
5) Muscle tension.
6) Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
Again, we can see that virtually anybody can find themselves in some part of (or perhaps all!) of this list. What distinguishes someone with clinical GAD from the average person suffering from these symptoms is a matter of degree – – what the DSM described as “excessive anxiety”, and whether they have three or more of the symptoms on this list.
Generalized anxiety disorder treatment
So while it may seem depressing at first glance to discover that GAD, at whatever degree of intensity, is part and parcel of the human condition, there is good news. As in the study mentioned at the top of our blog, we can discover that 91.6% of the things we worry about will never come true, and the other 8.4% will be experienced as something less catastrophic, more “normalized“ and more manageable than anticipated.**** This brings us to the question of how we treat generalized anxiety disorder.
As with everything else in our Deconstructing Anxiety model*****, GAD is understood as a reflection of the “core fear”, one’s the fundamental interpretation of how life can threaten our purposes. (See previous blogs for an exploration of the core fear and how to find it). With this understanding, we find that any problem, without exception, can be
deconstructed down to that singular core fear at the root of our anxious belief system.
Therefore, according to our model, we treat the symptoms of GAD as we do anything else: we find the core fear underneath it, become aware of the chief defense that has been hiding and preserving this fear, then “do the opposite“ of the chief defense (again, see previous blogs for more detail). This creates the necessary exposure to the fear at the source of the problem. And with that exposure, we are free to discover exactly what Michel de Montaigne and the researchers in the GED study said: the actual experience of what we were afraid of, discerned as we move through that experience with the exposure, is not at all what we had thought. More than 9 times out of 10 we find it was a complete illusion. The rest of the time it was a problem to be managed and dealt with, not the catastrophe we had imagined.
Only by having this exposure can we discover this remarkable truth in a way that resolves our anxiety. For having lived through what we were so afraid of and coming out the other side still intact, we become convinced that it really wasn’t something to be afraid of after all.
But as always, we have to be strategic in how we create exposure. An exposure that would have us haphazardly plunge into fear is not wise! At the least, it would be
ineffective, but I have even seen it cause greater anxiety and perhaps even a trauma response. According to our model, what is needed is the right insight combined with the right action. The right inside is, as always, insight into the core fear. The right action is informed by this insight, where we “do the opposite” of the chief defense that has been hiding the core of fear.
The important takeaway is this: GAD is a diagnosis that applies to all of us, whether it rises to the level of a clinical disorder or is simply understood as a generic set of “worries”. Guided by the discovery that whatever we are anxious about is a “lie”–a distortion or fabrication–we find our way out. Create the correct exposure, one that is the “opposite” of the chief defense and moves through the core fear, and we can resolve our anxiety, GAD or otherwise, by discovering this great truth for ourselves. —————————-
*LaFreniere, L.S. & Newman, M.G. (2020). “Exposing Worry’s Deceit: Percentage of Untrue Worries in Generalized Anxiety Disorder Treatment”. Behavior Therapy. 51(3):413-423. doi: 10.1016/j.beth.2019.07.003. Epub 2019 Jul 17. PMID: 32402257; PMCID: PMC7233480.
**See anxietycentre.com/tests/generalized-anxiety– test
***American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing.
**** When working with the dying, one often finds that even death is something we can adjust to, where it becomes manageable, something we can accept in a less anxious (and often even a peaceful) way.
*****Pressman, T. (2019). Deconstructing Anxiety: The Journey from Fear to Fulfillment. Maryland: Rowman and Littlefield.