Generalized anxiety disorder

Anxiety disorders can take different forms. The best known is the specific phobia (for example, of spiders, heights or syringes). Furthermore, there is panic disorder, in which patients suffer from panic attacks. In social phobia, anxiety occurs in social interactions. Generalized anxiety disorder is more unheard of. It causes sufferers to worry and feel anxious all the time. The worries revolve, for example, around future events, the well-being of the family or one’s own health.

Normal worry or generalized anxiety disorder?

It is normal to worry from time to time. The future is not one hundred percent predictable. To some extent, our worries make sense, because they make us more alert and prepare us for contingencies. Nevertheless – and most people probably know this – these worries can be very annoying and, in the worst case, paralyze us.

The worry process
A small apprehension can trigger a worry process in the mind. The engine of worrying is fired up, so to speak. This happens more often in patients with generalized anxiety disorder than in healthy individuals. Their minds uncontrollably keep producing new fears that get the worry process going.

Normal worrying vs. pathological worrying
As mentioned earlier, a certain amount of worrying is normal and even helpful. When exactly does worry become pathological? When does a generalized anxiety disorder exist? To assess this, psychologists look at the following characteristics:

Extent to which worry is uncontrollable: Can sufferers distract themselves or stop the worrying process? In generalized anxiety disorder, worries and fears are experienced as unstoppable and move in incessant loops.
Causes of worry: Is the cause of worry appropriate or is it worry that is not based on the current situation? If a generalized anxiety disorder is present, then the worries also occur permanently regardless of current occasions.
Frequency and length of the worrying process: Patients with generalized anxiety disorder worry an average of six hours per day. A worry log helps to assess the extent of worry.
Suffering pressure due to worry: If the suffering pressure is already high in the affected persons themselves or also in relatives, then this speaks for a generalized anxiety disorder in need of treatment.

These characteristics should be considered when the question arises whether the worries have become independent and a generalized anxiety disorder has developed.

Other symptoms of generalized anxiety disorder

There are other symptoms of generalized anxiety disorder besides very pronounced worry. There may be restlessness, easy fatigability, difficulty concentrating, irritability, increased muscle tension, and sleep disturbances. In addition, a time criterion must be observed for the diagnosis. The worries must have already existed for six months on most days. It is also typical for the disorder that the symptoms increase or decrease in phases. This is often related to the general stress level of the affected person.

Causes of generalized anxiety disorder

The causes that lead to generalized anxiety disorder are complex. Some people are already more insecure and anxious because of their personality. They are more likely to develop generalized anxiety disorder. In addition, real and appropriate fears may be avoided by constant worrying. If the worries permanently turn in circles, then it is very difficult to really deal with a pressing issue in a constructive way. Worrying in this case is a way out of confronting difficult issues.

Two types of worry

Looking more closely at the disorder pattern of generalized anxiety disorder, two types of worry emerge whose interaction gives rise to and maintains the disorder (Wells, 1995):

  • worries that revolve around concrete events and feelings (for example, finances, family, social relationships, housing situation, health) and
  • worries that revolve around the worries themselves (meta-worries).

To get to the bottom of the complex mechanism of how worries are created and maintained, it is necessary to look closely at meta-worries. It turns out that patients evaluate their worries either positively or negatively.

Positive evaluation:

– “Without worrying, I would appear shallow, conceited, and inconsiderate.”

– “Worrying helps me solve problems.”

– “If something bad happens that I didn’t worry about before, then I am responsible.”

Negative rating:

– “Without control over my thoughts, I go crazy.”

– “My thoughts interfere with my concentration.”

– “I would be a stronger person if I worried less.”

Worries are thus perceived as disturbing on one hand, but useful on the other. Positively, they are seen as an active attempt to solve problems, whether or not they lead to a result. Moreover, worrying supposedly helps to alleviate one’s own insecurity. Thus, worrying has a certain function. This function has a self-reinforcing effect, so that the worries take on ever greater proportions.

Excursus: The complicated term “uncertainty intolerance” is often associated with generalized anxiety disorder. It describes that affected individuals are unable to cope with uncertainty and unpredictability. They are very alert to future events in order to be well prepared for them. They have a tendency to experience the future as uncertain and stressful. Accordingly, many worries occur and the risk for generalized anxiety disorder increases.

Treatment of generalized anxiety disorder

There are different starting points in the treatment of generalized anxiety disorder. One is cognitive questioning of meta-anxiety, the other is confronting the actual fears. In addition, there is the increase of tolerance for uncertainty, for example through behavioral experiments. Thus, by way of example, the following topics might come up in treatment:

  • Interrogating uncontrollability: elaborate factors that influence worry (for example, distraction, brooding stop, presence of other people…).
  • Information transfer: worries are commonplace. Almost all people worry at least once a day, worry is not dangerous.
  • Paradoxical intervention: Instructing people to ruminate as much as possible can reduce ruminating after the fact.
  • Worry chair: Limiting the time and place of worrying, for example, only half an hour per day in a specially selected chair.
  • Behavioral experiment: Actively put yourself in a situation where you worry a lot. In doing so, log the worries and see what really occurred in hindsight.
  • Fear confrontation: Describe and live through the apprehension very concretely, so that confused and vague worries decrease.

Generalized anxiety disorder is a complex disorder. The therapist must proceed cautiously and develop a model of the disorder together with the patient. Both must be able to understand how the worry process has taken on a life of its own and which thought processes are particularly prevalent. Through appropriate interventions and intensive cooperation, the way out of the worry trap can be found.


(1) Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and cognitive psychotherapy, 23(3), 301-320

(2) Wittchen, H. U., & Hoyer, J. (2006). Clinical psychology & psychotherapy (Vol. 1131). Heidelberg: Springer.

Categories: Anxiety disorders

Verena Klein
Autor Verena Klein
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