Understanding anxiety from CBT perspective
14th May, 2008
What is generalized anxiety disorder?
All of us feel anxious at times. We may worry about things that might happen. We may have a restless night of sleep, but people with generalized anxiety disorder have physical symptoms that interfere with their normal lives. These problems may have to do with:
How you feel
Anxious, nervous, worried, frightened
Feeling, something dreadful is going to happen
Tense, stressed, uptight, on edge, unsettled
Unreal, strange, detached
How you think
Mind jumping from one thing to another
Imagining the worst and dwelling on it
“I’m losing control”
“I’m cracking up”
“I’m going to faint”
“My legs are going to collapse”
“I’m going to have a heart attack”
“I’m going to make a fool of myself”
“I can’t cope”
“I’ve got to get out”
What happens to your body
Heart pounds, races, skips a beat
Chest feels tight or painful
Tingling or numbness in toes or fingers
Having to go to the toilet
Feeling jumpy or restless
Dizzy, light headed
What you do
Pace up and down
Start jobs and not finish
Can’t sit and relax
On the go all of the time
Talk quickly or more than usual
Snappy and irritable behaviour
Eat more (or less)
Avoid feared situations
Who has generalized anxiety disorder?
About 7% of population will suffer from generalized anxiety disorder. Women are twice as likely to have this problem. This is a chronic condition, with many people saying that they have been worriers all their lives. Most people with anxiety problems have a variety of other problems, including phobias, depression, irritable bowel syndrome and relationship problems. Many people who have this problem find that they avoid others, because of fear of rejection or that they become overly dependant on others because of their lack of confidence.
What are the causes of generalized anxiety disorder?
Only 30% of the causes of anxiety are inherited. There are certain traits that may make people more likely to develop this problem. This include: general nervousness, depression, inability to tolerate frustration and feeling inhibited.
People with generalized anxiety disorder also report more recent lie stressors such as conflict with other people, changes in their work and additional demands placed on them. People suffering from anxiety may not be as effective in solving problems in everyday lie as they could be.
What keeps anxiety going?
Sometimes anxiety can go on and on, and become a life long problem. There can be a number of reasons for this:
If someone has an anxious personality and is a worrier, then they will probably be in the habit of feeling anxious. Sometimes people have ongoing stresses over a number of years which means they develop the habit of being anxious. Vicious circle of anxiety - as the bodily symptoms of anxiety can be frightening, unusual and unpleasant, people often react by thinking that there is something physically wrong, or that something truly awful is going to happen. This in itself causes more symptoms, and so a vicious circle develops.
“Fear of Fear” - Someone who has experienced anxiety in a certain situation may start to predict feeling anxious, and become frightened of the symptoms themselves, this in turn actually causes the very symptoms that are feared. Avoidance - Once a vicious circle has developed with lots of anxious thoughts increasing the anxiety symptoms, avoidance is often used as a way of coping. It is natural to avoid something that is dangerous, but the sorts of things that people tend to avoid when they suffer from anxiety are most often not real dangers but busy shops, buses, crowded places, eating out, talking to people etc. Not only are these things not dangerous, but they are quite necessary. Avoiding them can make life very inconvenient and difficult. This sort of avoidance can also result in a great loss of confidence which can affect how good you feel about yourself, which in turn makes you feel more anxious, another vicious circle!
How does your thinking affect generalized anxiety disorder?
People with anxiety seem to be worried that bad things are going to happen most of the time. They predict that terrible things will happen even when there is a very low probability of bad things happening.
They think that the fact that they feel anxious means that something bad is going to happen, that is they use their emotions as evidence that there is danger out there somewhere.
Many people who worry believe that their excessive worry may help them from being surprised, or that worrying might prepare them for the worst possible outcome.
If you are a chronic worrier you probably notice yourself saying ‘yes but what if’? This what if, floods you with a range of possibly bad outcomes that you think have to prepare you for. There seem to be no end to the things you worry about. In fact even when things turn out to be fine , you may say to yourselves: well, that’s no guarantee that it could not happen in the future.
We have seen the role that thoughts have in keeping going the vicious circle of anxiety. Sometimes there may also be pictures in your mind.
To give an example, imagine you are running for a bus one day. All of a sudden you get a pain in your chest and feel really breathless. The thought goes through your mind, “I’m having a heart attack”. This thought is of, course, very frightening, and so your heart starts to beat faster which makes you think “there really must be something wrong with my heart”. You may very well have a picture of the ambulance on its way and you on a stretcher.
Changing Behaviour Related to Anxiety
Try to recognise when you are avoiding things and wherever possible try to tackle these fears, not all at once but in a gradual way.
Set yourself very small goals. Write down here goals that you would like to tackle. Start with the easiest first and tick off any activity you achieve.
People often get into the habit of escaping from situations that make them anxious. Instead of escaping try gradually to increase how long you stay in a situation that makes you anxious. Anxiety often reaches a peak, then starts to go away naturally. If you stay in an anxious situation what do you predict will happen to your anxiety? People often think it will just keep getting worse and worse. This is not the case. It will start to come down. People not only avoid situations and try to escape, they also often do things to make themselves feel safer, eg hanging on to a chair, lying down. These “safety behaviours” may help at the time, but they also help to keep the anxiety going because the anxious person never learns that nothing awful would have happened even if the chair wasn’t there. Also, imagine how frightening it would be if no chair was available.
Try to do things to test out whether your anxious thoughts are realistic, eg “would I really faint if I didn’t get out?”
It really is very important to recognise that the more you avoid something, the more difficult it will seem to overcome, which will in turn make you more anxious.
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