General anxiety disorder [GAD] is more than just normal anxiety. It is punctuated by three hallmarks.
- irrationality: the anxiety is exaggerated out of proportion to the reality of the danger feared.
- paralysis: the anxiety is so strong that no problem-solving occurs.
- permanence the anxiety is not just a “state” that the person is in today, but is a trait of the person which is the usual way they feel.
In such a condition the person is always anticipating disaster and worry excessively. Worry is a problem solving process. The person ruminates on the problem without every finding solutions. The rumination often takes the form of automatic thoughts that repeat and repeat in the thought stream. Most people with GAD understand that their anxiety is more intense than the situation warrants, even though they cannot let it go. This is because such worry is self-reinforcing and despite the failure to find solutions, the catastrophe never occurs. Thus, it is like the fellow flapping his arms in the park. When asked why he was doing it; he said “to keep the elephants away”. The respondent states that there are not elephants in Philadelphia and the response is “see, it works!”.
Such people tend to feel tired, have trouble concentration and are unable to relax. They often have trouble falling or staying asleep. Their worries are sometimes accompanied by physical symptoms such as trembling, twitching, muscle tension, headaches, irritability, sweating or hot flashes. They may feel lightheaded or out of breath. They may feel nauseated or have to go to the bathroom frequently. Since any or all of these symptoms can have a medical cause or component, it is important for the individual to be thoroughly checked by a medical doctor before seeking psychological help. A good medical examination will rule out biological or environmental causes and possibilities.
GAD tends to come on gradually and most often hits people in childhood or adolescence, but can being in adulthood, too. It is diagnosed according to the Diagnostic and statistical manual of mental disorders, fourth edition, when the anxiety and worry are associated with three [or more] of the following six symptoms as being present for at least six months. Children may meet a less stringent standard.
- restlessness or feeling keyed up on the edge
- being easily fatigued
- difficulty concentrating or mind going blank
- muscle tension
- sleep disturbance [difficulty falling or staying asleep, or restless or unsatisfying sleep].
Other screeners include the limitations of the anxiety so that no Panic, Phobias, Obsessions or other specific syndromes are present; the circumstances are not due to the direct physiological effects of a substance [e.g., a drug of abuse, a medication] or a general medical condition [e.g., hyperthyroidism] and does not occur exclusively during another psychiatric condition.
It should be noted that the symptoms are not disconnected. For example, a failure to sleep can cause all five other critical symptoms. Thus a self report that the anxiety or worry is causing impairment in social, occupational or other important areas of functioning probably demands intervention. Since the interventions are not intrusive, they can be used preventatively with children.
Anxiety disorders can escalate or broaden into more specific and intense syndromes such as Panic Attacks, Phobias and Phobic Obsessions [fear of being contaminated], or fear of gaining weight [Anorexia] . Since all of these disorders are related to increased or focused anxiety, the interventions tend to be related.
Almost all reporters will indicate that Anxiety disorders are readily treatable with a combination of medication and psychotherapy. However, this is both false and misleading. First, it is false in the sense that medication is at all curative. At best, medication can be used cosmetically to diminish symptoms. Even in this best case scenario, helpers must be especially watchful of the individual becoming psychologically or physiologically addicted to certain anti-anxiety medications. Of course, this is serendipitous in that they must be taken forever, or the attacks return. Thus medication is not a treatment of choice.
The use of the term psychotherapy is an attempt to distort the truth that cognitive and behavioral approaches are effective. In fact, it is only through the inclusion of these social learning approaches that the research literature can indicate any significant effect for introspective psychotherapy upon “psychiatric” problems beyond the “placebo” effect.
The use of the term, which is normally applied to psychoanalytic or psychodynamic approaches to cover a social learning approach is mixing oranges and apples. The two are of fundamentally different orders. Both psychoanalytic and psychodynamic approaches assume that there is a psychological force or intrapsychic conflict which must be overcome through ‘insight’ in order to ‘cure’ the patient.
Cognitive and behavioral approaches have quite different assumptions. Behavioral approaches are based on a theory that the environment controls behavior by ‘teaching’ the person how to behave through reinforcement and conditioning. Cognitive approaches take the other side and say that the person’s beliefs drive behavior and that while the environment contributes significantly to these beliefs, the person can ‘learn’ how to think differently. Both theories assume that behavior is learned and can be relearned.
Once understanding the differences of approach, one can see that the literature is very clear that cognitive and behavioral approaches work and ‘insight’ or psychotherapy does not.