When Worry Consumes You

SUNDAY Feb. 24, 2008 -- Almost everyone worries about something -- credit card debt, car repair bills, an upcoming work review, whether your child will get into a good college. A little worry is natural and normal.

But when you become a 24/7 fret machine, that's not normal. You may have what doctors call generalized anxiety disorder, or GAD -- a condition marked by worry about most aspects of life that you feel you can't control. It can leave you feeling physically exhausted and emotionally drained, and also frustrate loved ones who must listen to you verbalize all that anxiety.

"This worry process never ends," said Dr. David H. Barlow, professor of psychology and psychiatry at Boston University and founder and director emeritus of the university's Center for Anxiety and Related Disorders.

"The key psychological feature of GAD is a state of chronic, uncontrollable worry," he added, noting that about 6 percent of Americans suffer from the condition at some point in their life.

"They are always anticipating the worst," Barlow said. They worry about major concerns as well as ones most of us would consider minor, he explained. They can't seem to stop the worrying, even when they know it's unrealistic or unfounded. And once one worry is over, the next one surfaces.

"There is always the next crisis to worry about," Barlow said.

People struggling with GAD "know the worry is out of proportion" to reality, said Jerilyn Ross, a licensed clinical social worker and president and CEO of the Anxiety Disorders Association of America. By way of example, Ross cited a woman whose husband is a wonderful family provider. But she'll worry incessantly about finances, even though she knows the worry is unwarranted.

All this worrying leaves GAD sufferers living in a chronic state of physical tension, Barlow said. Many have trouble sleeping, are irritable, can suffer from gastrointestinal distress, and can be left with frayed relationships. Other symptoms can include muscle aches and trembling and twitching, according to the U.S. National Institute of Mental Health.

Fortunately, mental health professionals have been paying increased attention to the disorder, leading to successful treatment approaches. And the treatments don't take years, Barlow and Ross said.

The trend is toward targeted, goal-driven sessions, with intense treatment lasting a couple of months or so, then tapering off to occasional sessions. Usually, cognitive behavioral therapy -- including talk therapy, cognitive "restructuring" to change the way people view situations that typically trigger worry -- can help, Barlow said. So can exercise.

The goal, Ross said, is to get the person with GAD to experience the feeling of worry and "desensitize" him or her to it -- "to experience it over and over again almost until it gets boring."

Ross said she helps GAD sufferers learn to tolerate the discomfort of their anxiety, over and over, until it starts to diminish. She helps them do this by having them ask themselves about their areas of concern: Is this a realistic worry? What are the probabilities of this happening? Then, she suggests they attempt to let go of the worry.

Curiously, when a wave of worry sweeps over them, most GAD sufferers "try to stamp it out, not experience it," Barlow said. "But ironically, that only serves to increase the intensity of the emotion. We teach them new ways to experience emotions, how to experience emotions in more positive ways, to ride them through, to accept them, to let them run their natural course."

In addition to cognitive or behavioral therapy, medications can also help, Barlow said, including the antidepressants Prozac (fluoxetine), Paxil (paroxetine) and Effexor (venlafaxine).

More information

To learn more about generalized anxiety disorder, visit the Anxiety Disorders Association of America.

Posted: February 2008


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