The what if?– problem – general anxiety disorder
© Jorgan Harris.
Most of the people diagnosed with general anxiety disorder are always astonished at their diagnosis. It is precisely those people who are always calm and collected who may suffer from anxiety. Nevertheless, more than half of my practice consists of people with general anxiety disorder.
2. Do you suffer from general anxiety disorder?
A general anxiety disorder is characterized by chronic stress, present for at least six months, but without the associated panic attacks, phobias or obsessions. You simply experience constant stress and worries.
To get diagnosed with anxiety disorder, your anxiety and worries must focus on two or more stressful life events (such as finances, relationships, health, work or school performance) for the majority of days in a six-month period. It is common that when you have a general anxiety disorder you have a lot of worries and that you spend a lot of time focusing on your worries. You find it difficult to exercise much control over your worries. But more than that, the intensity and frequency of the worries are always out of proportion with the possibility that these things will really happen.
Diagnostic criteria of general anxiety disorder according to the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders Edition 5):
Excessive anxiety and concern (in which you only expect the worst), for a minimum of 6 months, about a number of events or activities. It’s hard for you to control the anxiety. The anxiety and concerns are associated with three (or more) of the six symptoms listed below:
- Restlessness or feeling upset or “on edge”
- Easily fatigued
- Problems to concentrate or your mind just going blank
- Muscle tension
- Sleep disturbance (difficulty falling asleep, staying asleep or restless unsatisfactory sleep).
You may find it difficult to relax. You feel restless throughout the day. You may find it difficult to watch a show on television without wanting to jump up to do something else. By the middle of the afternoon you may already be exhausted and feel sleepy. You may start reading a magazine for example, to realize after the first or second paragraph that you do not have an idea of what this article is about. Some people in their late middle age begin to believe that they begin to develop a form of dementia like Alzheimer’s disease. It may just be anxiety. You feel easily irritated and especially noise may frustrate you endlessly. You may experience muscle tension, especially in your shoulders and neck. You may think it is because you are all day in front of your computer, but it is not. Finally, you may be an insomniac. In short, you are known as a control freak. You are probably only suffering from a general anxiety disorder.
Your anxiety, worries or even physical symptoms cause a clinically significant problem in your social, occupational or other important areas of functioning.
3. How general anxiety disorder works
In our general language, a general anxiety disorder is known as stress. However, strictly psychologically speaking, there is no term like stress. This is general anxiety.
It’s usually not your circumstances that cause stress or anxiety, but how you think about it. This thought always begins with: “What if …?” “What if that happens?” Or “What if I do this or not do that?”
As a child I had a dog. This dog especially hated cats. One day my dog pinned a cat in a corner. What my poor dog did not realize was that this cat was a Siamese cat.
Bobbel held this cat in a corner when the cat started to hiss, bend his back, pull his muscles, his hair started to raise and he began to show his nails. I thought this cat was angry, but actually this cat was scared and was on survival mode.
The next moment the cat stumbled on Bobbel, hit his nose with blood everywhere and escaped over a wall higher than I ever thought a cat could leap over.
What happened here? In nature, an animal, when in trouble, secretes adrenaline and nor-adrenaline to enable him to fight or flee. Hence the so-called fight-or-flight response. The animal’s heartbeat increases, muscles span together, breathing becomes faster and flatter to enable him to fight harder or run faster. When the danger is over, the animal goes to sleep to rebuild its’ adrenaline levels.
There are certain similarities and differences between us and animals. The similarity is that we share more or less the same central nervous system with animals. When we feel we are in danger, we produce adrenaline and nor-adrenaline, just like the cat to avoid the danger by fighting or running away without necessarily thinking.
If a taxi would swerve in front of you, your cerebellum and brain stem (that’s the part of your brain focused on survival), your small brain or your reptile brain would kick in. You’re not going to use your neocortex (that part of your brain that has to do with logical thinking, language and logic) at that time. You are not going to think: a) Should I swerve? b) Should I brake, or c) Could there be an alternative option? By then you would be in a huge accident. It’s as if your instincts kick in – you do not think – you just act.
The similarity between us and animals is that our cerebellum and brain stem would do the right thing to avoid the accident, almost as if you would go on automatic pilot and instinctively do the right thing.
But there are also important differences between us and animals. We can’t always respond to the instincts of our cerebellum and brain stem.
As a human being, we can’t always use our adrenaline like an animal does. We can’t beat up that difficult colleague at work or run away from the receiver of revenue. Thus that adrenaline remains trapped in our body and therefore we get anxious. Adrenaline was produced, but never used.
There is another difference between humans and animals. Sometimes we wrongly experience something as a threat because of our irrational perception of it. When we think something is a threat, we use the same part of our brain (the cerebellum and brain stem) that we use when there is a real physical threat. Your body gets the message that there is danger and starts secreting adrenaline for the fight or flight response.
Such thinking usually starts with “what if?”. I call anxiety the what if disease. We torture ourselves with questions about possible catastrophic consequences. Most of our fears never happen anyway! Your cerebellum and brain stem, or reptile brain, does not understand that it’s just your imagination. This part is just too primitive and it does not understand language. That part thinks that your “what if” thinking is real, and then gets ready for the fight-or-flight response.
Looking back to the symptoms of anxiety as described above – it makes sense because you may be restless, easily exhausted, experiencing concentration problems, irritated, experience muscular tension or difficulty sleeping. Your body is constantly alert and ready for your imagined dangers. No person can relax, concentrate or sleep when the proverbial Bobbel pinches you in a corner. You are often tired because your adrenaline is depleted. Sleep helps you to rebuild that adrenaline and you may still struggle to sleep too. In itself it will not help much with your concentration and memory.
4. You may also experience the following:
People suffering from general anxiety disorder may experience some of the following:
A so-called nervous breakdown
It might be a good idea for you to know that there is no such thing as a nervous breakdown. It is only a severe anxiety or panic attack.
Look at the following heading.
Anxiety and panic attacks
Please visit my website jorganharris.co.za. Click Therapy, then go to Anxiety and Panic attacks. Here you may find that:
- you’re not going crazy (though it feels like that);
- you are not getting a heart attack
- you are not getting an asthma attack;
- you are not busy dying;
- you are not busy getting a stroke;
- You are not having a life-threatening disease that doctors can’t detect.
Obsessive Compulsive Disorder (OCD)
Although it is true that there exists something like an OCD personality disorder – most OCD is just the result of anxiety. You may experience one or more of the following:
- OCD of checking – You may want to check over and over again that your doors are locked or that the kettle is switched off, etc.
- OCD of washing – You may bath or wash your hands excessively.
- OCD of counting – You may want to count everything around you, and you may develop an obsession that all your numbers must come down to a certain number.
- OCD of perfection – Everything must be perfect at all costs. Paintings must hang perfectly. Everything should be perfect in their place. Of course, that fear of failure makes you work so hard to be perfect.
- OCD of hoarding – You can’t throw away anything. You keep on hoarding stuff you don’t need.
We are not doing so-called anger management in this practice. Why should you manage your anger if you can just get rid of it? You do not have to handle nor manage it.
One might think the cat in our story is angry. However, that is not the case. The cat is just ready for the possible danger waiting for him. Your anger may just be the result of suppressed anxiety. Someone once said that your anger is your hidden sadness. We will rather try to work through your unconscious sadness than focusing on anger.
People with anxiety are also likely to suppress their anger. It is literally like a large cement block placed over their volcano of anger. This cement block is known as psychological defense mechanisms. The volcano is pushing up and the defense mechanisms are pushing down and this tension between the two is what anxiety looks like.
Another metaphor is that you are like a bottle. Someone angers you and it’s like gas pumped into the bottle and you can handle (contain) it. More gas may be pumped into the bottle and you can handle that as well. The bottle becomes now under pressure because that gas has nowhere to go. Then, one day something small might happen and you literally lose it – you literally blow your top and that bottle explodes. People might then say to you: “It’s just a little thing that happened, why do you overreact so much?” Of course, that’s not the small thing that exploded the bottle, but it was all the built-up pressure that caused the bottle to explode.
Alcohol abuse and addictions
Alcohol, dagga as well as other drugs does help for anxiety, even if it is only to suppress all these thoughts. Although only in the short term, but it helps. The longer-term consequences is another story. You may not be an alcoholic, but you may drink too much. Your excessive intake of alcohol may decrease when you overcome your anxiety, and no longer need to drink as much to calm down.
Other people will become aggressive under the influence of alcohol. Alcohol, of course, relaxes the grip of that block of cement (psychological defense mechanisms), which may cause these feelings of anger to emerge, and such a person may become aggressive. It does not help to try to reduce your alcohol intake, as it usually does not work. The anger, or the underlying anxiety, must be addressed.
Strictly speaking, a psychological concept such as low self-esteem, low self-image, poor self-confidence or whatever, does not exist.
A so-called low self-esteem is simply the consequence of the negative things (called irrational thinking) you think about and of yourself and negative thoughts tell you that you can’t do things or that you are not good enough.
If you think about it, it’s actually the fear of failure that stops you to try something.
I don’t like the term “social phobia”, and will rather call it social fear. You may simply fear rejection, or fear people’s opinions or what they think of you. “What if ..?”
You may also fear of the opinions of other people. What are other people thinking of or saying about me? No wonder the French philosopher Jean Paul Sartre once said: Hell is other people (and their opinions). Provided that you allow their opinions to affect you (in my opinion).
You may also fear rejection. You may rather reject others or cut them out of your life before they can reject you, and by doing this you sabotage yourself.
There is also no such thing as procrastination. You are simply afraid to do something for fear that it is too difficult, or that you will fail. Therefore you “prefer” to postpone it or to do other things rather than the task you should do.
Lack of assertiveness
Please check out my article on Assertiveness at jorganharris.co.za.
In short, there are three levels of assertiveness:
- Submissive behavior
- Assertive behavior
- Aggressive behavior.
Assertive behavior means to ask in a friendly but firm manner what you want and to say “no” to what you do not. Most people who suffer from anxiety tend to be submissive and neglect themselves.
You are too scared to hurt other people’s feelings, or too afraid of rejection if you do not “please” them. You just want to be accepted and want people to like you. But it frustrates you from time to time, and you may jump from submissive behavior right through assertiveness to aggressive behavior, which leads to guilt again. More about guilt later.
There is also no such a thing as a control freak. Control freaks are people who do not feel in control, or people who fear that they may lose control.
Those people may also be so-called manipulators. A so-called manipulator may just be somebody who is afraid to lose control. Thus, wants to force people and things to do things his or her way in order to control the anxiety and consequent feelings of not being in control in order to feel better about him or herself.
People suffering from anxiety may also struggle with excessive guilt feelings. You’re unnecessarily hard on yourself for what you did wrong, or maybe for what you haven’t done. If you think about it, guilt is the most useless emotion you can ever experience. It gets you nowhere. Feeling guilty is actually fear – a fear of Karma’s revenge or to end up in the so-called hell for the bad person you were.
Recent research has also shown that stress and anxiety are the main causes of weight problems.
Simply explained: you eat food. Food goes to your stomach. From your stomach it spreads to all the parts and organs of your body that need it for survival. The excess or unnecessary food you eat goes into one of two directions: it goes to your excretory channels or is absorbed into your body’s fat cells. The question arises why the food is kept into fat cells rather than being excreted.
The answer lies in the cerebellum and brain stem of your brain, the primitive brain or the reptile brain. This part of your brain has only one function: survival. This part is so primitive that when you’re anxious, it does not know you’re anxious about your boss at work that gives you trouble again. This part interprets anxiety in terms of survival. It thinks there’s a lion chasing you or there’s starvation. Your cerebellum and brain stem will then make sure you eat more and store your food in fat cells for energy to fight for survival.
You should lose weight when you overcome your anxiety and the cerebellum and brain stem no longer feel the need to store food or to eat more for energy for survival.
5. Possible causes of GAD
There may of course be many causes of GAD, but we’re not interested in that causes as such. GAD is rather caused by the future (or fear of the future) than the past. Our focus is therefore on the fears of the future. But if we have to dive into the past, we can look at the following possible causes: However, there can be so much more than these.
Trauma means what you experience as traumatic, is trauma for. You may have experienced a trauma or more in your life. Trauma can be anything from an event where your life was threatened to as little as something that made you feel negative about yourself.
It may happen that one or both of your parents suffer from anxiety and that you have formed this image of the world as a dangerous place. Perfectionist parents or parents who have high expectations of you may also have an influence.
Your birth order
Eldest children are more likely to develop anxiety than the younger children in the family of origin, as they bear more responsibilities and more are expected of them than from the younger children.
Stress about money, work, family, illness, etc. can cause anxiety.
There may be many other factors we can investigate, but I do not believe in genetic or biological factors at all. As there is no proof of that I am not a great advocate of anxiety medication.
The possible causes mentioned above are discussed very briefly and your own unique situation will be investigated in more depth during consultation.
6. The bad news is:
That you think life should be like this. That’s how you are and that’s how you’re being put together. People with general anxiety think they are the craziest of them all, but:
7. The good news is:
That it is not part of your personality. You are not born as such. It is also not genetic. It is simply the result of your thinking and your learned thinking. Just because your parents had anxiety and their parents had anxiety, does not mean your anxiety is in your genes.
The answer is that you are conditioned from childhood that the world is a bad place since your cerebellum and brain stem havr been fully developed from childhood, but your neocortex was not developed yet. Subsequently you will simply believe that the world is a bad place, despite the evidence of the contrary. I call general anxiety the sophisticated person’s problem. You must have a high intelligence to think about all these irrational thoughts. A beggar only thinks about survival and does not experience anxiety. It’s just about survival for him or her.
General anxiety, more than depression, is considered to be the “disease of our time”. GAD is much more common than even depression.
In fact, this is the most general problem in my practice.
But it is also the easiest problem to solve. Because it is so common, a lot of research has been done about it. It is a disorder that we understand very well and can easily be solved. Perhaps you are more than a Siamese cat than you realize!
8. Tips to handle anxiety
We will address all the aspects of your anxiety during therapy. For now, it can help just doing these three things:
Take a deep breath – Breathing is the essence of relaxation. Breathe in, almost as if you inhale it into your stomach and abdomen. Your breathing is the one thing you always have absolute control over. You can read more about this in my article on breathing on my website: jorganharris.co.za.
Scan your body for tension – Become aware of your forehead, let it feel smooth and relaxed with every easy breath that you breathe out. Then relax your jaw, let your jaw feel loose and relaxed. Become aware of your shoulders, let your shoulders droop and relax. Then be aware of your abdomen, allow your stomach to relax deeper and deeper relax with every easy deep breath that you exhale. You can continue to scan the rest of your body for tension and to relax those parts.
Change your thinking – There is nothing you have to “do” or nothing that “must” happen or not happen, and ask yourself:
- What’s the worst thing that can happen?
- If that happens, how bad is that really?
- What are the chances in any case that it’s going to happen, as 95% of the things we’re worried about are never going to happen?
9. Life does not have to be like this
Somebody once said: Relax, you are not in control anyway!
We are not in control in anyway. Why should we worry so much? We are conditioned that the world is a dangerous place and that we should be on guard. We make life difficult for ourselves. Even in the Holy Scriptures there are many quotes telling us that we do not have to worry about anything. We will not achieve anything by worrying about it.
The best of all this is that it is not part of your personality. It is all learned behavior.
I’m not a big advocate of medication. Medication may help you to suppress those terrible symptoms of anxiety, but it does not take away your problems or your way of thinking. It may help you in the short term and I may even suggest medication, but there are too many side effects.
I am also not an advocate of Cognitive Behavior Therapy (CBT). To help you think differently about your anxiety may affect your thinking in your neocortex (your thinking brain), but your cerebellum and brain stem (your feeling brain) do not understand language and will still feel threatened.
Even if you ensure yourself that there is no reason to stress, your cerebellum and brain stem will still feel stressed and be ready for the fight or flight response.
That’s why I like techniques that speak directly to the cerebellum and brain stem, such as hypnosis and BWRT. Techniques the neocortex may not understand, but the cerebellum and brain stem will.
11. Beck Anxiety Inventory (BAI)
About: This scale is a self-report measure of anxiety
Internal consistency for the BAI = (Cronbach’s a=0.92)
Rest-retest reliability (1 week) for the BAI = 0.75 (Beck, Epstein, Brown & Steer, 1988)
The BAI was moderately correlated with the revised Hamilton Anxiety Rating Scale (.51), and mildly correlated with the Hamilton Depression Rating Scale (.25) (Beck et al., 1988)
Add all your scores together.
The total score is calculated by finding the sum of the 21 items.
Score of 0-21 = low anxiety
Score of 22-35 = moderate anxiety
Score of 36 and above = potentially concerning levels of anxiety
References: Beck, A.T., Epstein, N. Brown, G., & Steer, R.A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56,893-897.