Worried.It is a part of human nature to worry; be it about health, finances, family, and relationships. Worry is adaptive in some contexts, as it can help us to preserve our safety and avoid injury or death; for example, when driving a car in dangerous conditions, or when walking on a tightrope. For this reason, worry can be adaptive. For many of us however, worry can be insidious, and may interfere with our lives in ways that are disruptive and distressing. Generalized anxiety disorder is a condition that involves chronic worry, in addition to symptoms such as muscle tension, feeling ‘keyed-up’ and on-edge, and irritability. Individuals with generalized anxiety disorder describe their worry as being uncontrollable and pervasive; arising in relation to various areas of life including work, relationships, education, finances, and health. When the normal phenomenon of worry reaches heights that are disruptive to this point, individuals may meet criteria for a generalized anxiety disorder. In the below sections, theories of worry are discussed in order to shed light on why this process arises, and why some individuals become stuck.

A verbal-linguistic process

Worry has been seen by some as an exclusively verbal process. That is, worry has been seen as a phenomenon involving thoughts, rather than images. According to the avoidance model of worry, individuals who engage in worry regularly, do so in order to avoid experiencing strong emotions that arise in relation to various events. For example, an individual may worry about their financial situation in order to avoid mental imagery of filing for bankruptcy. Alternatively, an individual may worry excessively about an argument they have had with their spouse in order to avoid negative mental imagery of their partner breaking up with them. Thus according to the avoidance model of worry, individuals may worry in order to avoid feeling emotions that may arise in the event of the ‘worst-case scenario’.

Intolerance of uncertainty

Researchers have argued that individuals who worry do so as a result of a reduced ability to tolerate uncertainty. Specifically, individuals who are prone to high levels of worry may engage in repetitive thinking about what might happen, or what to do if a negative outcome occurs, during situations where there is a degree of uncertainty. For instance, an individual who is prone to worry may worry excessively after apparently driving through a red light, but not knowing for sure whether the light was indeed red or orange. This individual’s uncertainty over whether they have committed an offense may lead them to repetitively reconstruct the situation in their mind in order to gain a sense of certainty, or alternatively, worry about how they are going to tell their partner about the prospect of receiving a hefty fine. This intolerance of uncertainty has been shown to be a significant risk factor for developing generalized anxiety disorder.

Emotion regulation

According to the emotion dysregulation theory of generalized anxiety disorder, individuals with this condition are prone to experiencing strong emotions in relation to various life events, and may consequently engage in worry as a strategy to regulate these emotions. The theory holds that individuals with generalized anxiety disorder experience emotions in a much stronger manner than those without the disorder, and thus are prone to perceiving these emotions as threatening. The theory also posits that those with generalized anxiety disorder may engage in a range of maladaptive emotion regulation strategies that result in them feeling even stronger negative emotions. Thus a cyclical pattern may occur where individuals with generalized anxiety disorder may experience strong negative emotions in relation to an event, worry excessively about the event and its outcomes in order to regulate these emotions, and then experience even stronger negative emotionality as a result of their worry. Take for example an elderly man who experiences strong feelings of sadness following the death of his wife. The man may worry excessively about his ability to cope without his wife, and these worries may then feed into his already vulnerable emotional state. In this example, the bidirectional relationship between strong emotion and worry would be apparent.

Avoidance of worry

Individuals with generalized anxiety disorder may ‘worry about their worry’. That is, individuals who worry to a severe extent may develop an aversion to situations and events that trigger their worrying. According to the metacognitive model of worry, individuals with generalized anxiety disorder may exhibit negative beliefs about worry, such as its uncontrollability, its threatening nature, and its abnormality. This worry is referred to as ‘type 2 worry’, and is thought to be a strong maintaining factor for worry in generalized anxiety disorder. Specifically, individuals with the disorder may engage in a range of unhelpful thought control strategies when they worry, such as suppression and avoidance, that ultimately lead to a failure to recognize the unthreatening and normal nature of worry. For instance, if an individual who chronically worries about her ‘bad breath’ during social situations, avoids these situations altogether, then she may fail to expose herself to the possibility (reality even), that she does not in fact have bad breath, and that if she did, the consequences are not all that disastrous.

Emotional contrast avoidance

A recent theory of generalized anxiety disorder and worry holds that individuals may worry in order to avoid sudden shifts in their emotional state, which they perceive to be intolerable. Thus individuals with generalized anxiety disorder may prefer to maintain a state of constant negative emotionality in order to risk being happy and then experiencing a sudden drop in their mood if a negative event takes place. This process may be especially apparent for individuals with generalized anxiety disorder, who may be prone to experiencing emotions at a more intense level than those without the disorder. Thus for individuals with generalized anxiety disorder, it may seem ‘safer’ to appear withdrawn and on guard in social situations, rather than allow themselves to be carefree and relaxed, and experience an emotional setback if they are criticized or rejected in such situations (which indeed may be rare).  This theory of generalized anxiety disorder and worry is in its infancy, yet has shown promising evidence in explaining the disorder thus far.

Treatment implications

It seems that we may worry for a number of reasons, including the avoidance of negative mental imagery, to tolerate uncertainty, to regulate our emotions, to avoid worry itself, and to avoid sudden drops in our mood. For individuals with generalized anxiety disorder these reasons may be more salient, and the worry may be more intense. Cognitive-behavioral therapy is a commonly used treatment not only for generalized anxiety disorder, but also for subclinical levels of worry and anxiety that occur in the majority of us from time to time. Cognitive-behavioral therapy helps us to recognize the intimate relationship between our thoughts, feelings, and behaviors, and how negative relationships between these three may result in us feeling ‘stuck’. For individuals who are prone to chronic worry, cognitive-behavioral exercises involving reappraisal of worrisome thoughts, exposure to situations involving uncertainty, and development of alternative ways to regulate emotions are evidence-based and have been proven to reduce worry and anxiety symptoms. In addition to cognitive-behavioral therapy, mindfulness-based therapies such as acceptance and commitment therapy have shown to be effective in treating generalized anxiety disorder and subclinical symptoms of stress, worry, and anxiety. Mindfulness is a way of thinking that involves an open, accepting, and non-judgmental attitude towards internal experience, which can be cultivated through meditation, guided relaxation, and thought monitoring exercises. Registered clinical psychologists are the primary providers of therapies such as cognitive-behavioral therapy and acceptance and commitment therapy.

Conclusion

Worry is a normal phenomenon that affects us all. Worry can be adaptive in situations where there is a real possibility of injury or death, but in the majority of instances, is not a successful strategy to deal with the vicissitudes of life.  Research shows that when worry becomes severe and excessive, individuals are at risk of developing generalized anxiety disorder; a condition involving chronic worry, muscles tension, and irritability. Individuals with this disorder may worry for a variety of reasons, such as to avoid mental imagery of disastrous outcomes, to tolerate ambiguity and uncertainty, to avoid worry itself, and to avoid sudden changes in the emotional status quo. Cognitive-behavior therapy and acceptance and commitment therapy have been proven as successful therapies in the treatment of chronic worry.

 

References

Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011-1023.

Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour research and therapy, 36(2), 215-226.

Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour research and therapy, 43(10), 1281-1310.

Newman, M. G., & Llera, S. J. (2011). A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry. Clinical psychology review, 31(3), 371-382.

Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and cognitive psychotherapy, 23(03), 301-320.