What is Generalized Anxiety?
Everyone worries occasionally, especially when facing difficult situations in life. However, if worries are nearly constant and so consuming that they affect one’s quality of life or ability to function in daily life, it may be that one suffers from generalized anxiety.
Generalized anxiety is a frequently occurring but undertreated disorder. It is the most common anxiety disorder and affects approximately 4-5% of the population during their lifetime. According to international research, only two out of five seek treatment.
Untreated generalized anxiety rarely goes away on its own and is a risk factor for developing other disorders, such as depression, stress reactions, alcohol or drug dependence. And the social, occupational, and economic burdens can be comparable to those seen in severe depression.
Presentation
Generalized anxiety is characterized by excessive and persistent worry, which is experienced as difficult to control, combined with a range of anxiety symptoms such as palpitations, trembling, chest pressure, sweating, stomach upset, and restlessness.
The worries often revolve around everyday things, and to receive a diagnosis, one must worry about at least two different topics for more than six months. Examples may include concerns about family members or oneself being harmed, worries about health, or finances.
The focus of worries is shifting and not tied to specific situations, hence the disorder is often referred to as free-floating anxiety. The worries are usually not linked to specific, recently occurring events, such as job loss or illness, but may be reinforced by these specific events.
Worries are often accompanied by a range of psychological and somatic complaints, such as restlessness, bodily tension, fatigue, headaches, difficulty concentrating, irritability, and sleep problems.
During assessment, it is important to ensure that the condition is not better explained by another specific anxiety disorder. For example, fear of being the center of attention (social anxiety), fear of having a specific illness (health anxiety), fear of having a heart attack (panic disorder), or OCD (obsessive-compulsive disorder, Angstens udtryk). It is also important to rule out depression, which also increases anxiety and worry.
Differential Diagnosis
Excluding other anxiety disorders is not always easy, especially when the individual has multiple anxiety disorders simultaneously. Therefore, thorough assessment and so-called differential diagnosis are important.
This means distinguishing between different mental disorders or conditions with overlapping symptoms to make the correct diagnosis and thus find the right treatment. If a person has multiple anxiety disorders simultaneously, it is important to address this in therapy, as they often reinforce each other and may require tailored treatment.
Prognosis and Treatment
Generalized anxiety has traditionally been described as a chronic condition that is difficult to treat and characterized by many relapses. Previous research has shown full recovery in only 38-40 percent. However, in recent years, several effective treatment methods have been developed, and there is now more optimism about the prognosis. With treatment, most people experience significant improvement, and many become completely free from the disorder.
Where to Get Help?
Most people plagued by generalized anxiety function well in everyday life despite their worries. Therefore, many only seek treatment when they are in stressful life situations that increase their anxiety symptoms, and they experience that it significantly affects their daily lives. And they cannot cope with what they have previously been able to.
Many are treated for generalized anxiety by a private practicing psychologist, possibly with a referral from their general practitioner. Moderate to severe anxiety disorders are often treated in psychiatric care until one feels better and either concludes or transitions to private practice.
When dealing with a severe degree of generalized anxiety, there are often several accompanying disorders, including depression, other anxiety disorders, personality disorders such as anxious personality structure, or physical symptoms without any identifiable physical cause.
Treatment
There is general agreement that psychological treatment of generalized anxiety is more effective than treatment with psychotropic drugs/medication.
However, some people also benefit from medical treatment, where antidepressant medication is often the first choice. Medical treatment can be particularly important if one also has depressive symptoms or periods of great restlessness, agitation, or sleep problems. Unfortunately, there is a lack of research on the effectiveness of combined treatments with medication and therapy.
In recent years, several psychotherapeutic or talk-based treatment methods have been developed, which have shown good effects for generalized anxiety. So-called meta-analyses, which summarize existing scientific studies, indicate that cognitive-behavioral therapy works well both in the short and long term. This is reflected in national and international clinical guidelines for the treatment of generalized anxiety.
Especially the newer developments of cognitive-behavioral therapy – often referred to as the third wave – such as metacognitive therapy and acceptance and commitment therapy (ACT) seem promising. Metacognitive therapy, which has received considerable attention in recent years, actually emerged as a way to further develop treatment for generalized anxiety.
Often, psychotherapeutic treatment of anxiety disorders starts with the premise that anxiety is primarily a natural feeling – an alarm reaction – developed through evolution to perceive danger and protect us. Treatment aims to increase awareness of what factors maintain and reinforce anxiety to a level that makes it troublesome and in need of treatment.
Most modern treatment models for generalized anxiety emphasize the importance of worry as a strategy to avoid inner unpleasant experiences. There is an assumption that worrying is an effective problem-solving method – an attempt to prepare, anticipate challenges, or be a kind of “buffer” against various disaster scenarios. Many believe that if they have worried about an unpleasant situation, they will be less affected if it actually happens.
However, through treatment, one learns that the tendency to worry, on the contrary, hinders more active problem-solving. Worrying reinforces anxiety and ends up becoming the problem itself rather than solving it. One cannot stop the initial trigger thoughts – the “what if” thoughts – but one can slow down the worrying spiral afterward. Techniques to do so are taught in therapy.
A common approach in the newer treatment methods is to create a distance from one’s worrying thoughts. Not seeing them as absolute truth and developing a different relationship with the thoughts. A relationship that largely involves letting the thoughts be, i.e., avoiding trying to push them away, which paradoxically reinforces them, or conversely, getting absorbed by them, giving them time, space, and energy in the form of long worrying spirals.
