Depending on how you slice it, Generalized Anxiety Disorder is the most common diagnosis therapists and counselors give when a diagnosis is doled out early in therapy. Hence Generalized Anxiety Disorder treatment is the most common form of therapy provided. This is certainly the case in our NYC therapy practice where, in spite of our non-diagnositic approach, we’re often asked to produce a diagnosis so that our therapy patients can receive reimbursement as part of their out-of-network insurance plan.
But Generalized Anxiety Disorder treatment is about more than a generic diagnosis. Sure, generalized anxiety disorder is an easy diagnosis to give but that’s because anxiety is so prevalent in those seeking treatment.
Why Generalized Anxiety Disorder therapy?
It doesn’t exactly roll off the tongue, does it? The DSM-IV, the book that determines the diagnoses given by therapists and counselors, lists a number of specific anxiety disorders (including social anxiety, social phobia, panic disorder and post-traumatic stress disorder). Generalized Anxiety Disorder is meant to capture a broad (i.e. non-specific in it cause or manifestation) experience of anxiety. The idea is that lots of things trigger the anxiety and it’s often ever-present across a broad set of circumstances.
Anxiety is no joke
We’ve said dozens of times that a thoughtful critique of the practice of diagnosis in therapy is in no way meant to deny that many people who seek therapy experience serious emotional distress–distress that psychological diagnoses attempt to capture, and often capture well. (It’s the place those diagnoses–often uncritically–in shaping the therapy that concerns me.)
Anxiety lives in the body
When patients in our NYC therapy center speak to us of the anxiety they experience, so often their description of the experience is grounded physically. These therapy-seekers feel on edge, sick to their stomachs, uncomfortably alert, distracted, consumed by a feeling of urgency. It is in the experience of anxiety that we are most reminded that our minds and our bodies are not so separate at all.
Anxiety is not disconnected from our lives
There are myriad causes of anxiety including:
Often understood as Post-traumatic Stress Disorder (or PTSD), trauma can be a huge source of anxiety. Generalized Anxiety Disorder often captures anxiety that’s rooted in trauma or exacerbated by it but which falls short of the criteria for a specific PTSD diagnosis.
We often go through extended periods in our lives, typically in childhood, where we must endure challenging emotional circumstances but where there are not great opportunities to cope with it in healthy ways. These could include family difficulties such as divorce, bullying in school, circumstances related to poverty, immigration or violence. These circumstances understandably produce a great deal of anxiety, but anxiety can also be a strategy for coping as anxiety can be oddly numbing or distracting from even more painful emotions (fear, anger, sadness).
Anxiety isn’t always irrational. When we go through challenging periods in our lives (losing a job, a break-up, being a victim of a crime) we get anxious. While a few discrete incidences of this sort would not qualify as Generalized Anxiety Disorder, they’d certainly qualify as Acute Anxiety and are surely contributes to a prolonged experience of anxiety more broadly.
What can I do about my Generalized Anxiety Disorder
First, consider that relating to it as a disorder misses some of the complexity of what’s going on, and could interfere with growing away from it. The language of disorder, borrowed from medicine (hence the critique of the “medical model” that many progressive psychotherapists enlist), implies something internal, medical, disease-oriented and removed from our lives. Yes, we think it’s likely that some are more apt to anxiety than others as a product of genetics. But this does not nearly account for all what produces anxiety.
It is critical to stay connected to two features of anxiety:
1. Anxiety is learned
Being “stressed,” “nervous,” “worried,” “freaked out,” and “super anxious” are all emotional states that garner attention at the water cooler. Expressing these sentiments has an ironic sort of cache. It’s cool, it shows you’re important, or that you really care. It invites sympathy or conveys a shared (me, too!) experience. Whether we notice it or not, these sentiments are all around us and likely have been from a young age.
What’s important about seeing this is recognizing that if anxiety is learned, then we have the possibility of learning something else!
2. Anxiety is something that we produce
This surely isn’t the way we usually talk about anxiety (or many emotions). We tend to think of it as something that happens to us. It’s important to remember that anxiety is something we often sign up for, e.g. volunteering to give a toast, going after a tough promotion. A powerful response to anxiety of this variety is to remind ourselves, aloud, “I signed up for this.”
3. There are life-conditions that support anxiety and life-conditions that don’t
We think of it like mold. If you’re bathroom isn’t well ventilated, it’s likely to remain damp and will become a great place for mold to grow.
Some conditions that are a great place for anxiety to grow:
- Dating someone sketchy
- Delaying dealing with a tricky situation at work
- Getting in over your head without asking for help
- Isolating yourself socially
- Ignoring or attempting to suppress feelings like sadness
Conditions that don’t give anxiety much space to grow:
- Staying active
- Solving problems right away and getting help when you get stuck
- Creating a full life filled with healthy relationships
- Staying in touch with feelings and building relationships where feelings can be shared
Don’t just “treat” Generalized Anxiety Disorder
Medication can be of help, if that’s something you’re open to, and help in therapy that deals with the symptoms of anxiety can similarly provider relief. BUT, it’s critical not to stop there. If we accept that anxiety is connect to everything in our lives, then to fully deal with anxiety (and create a life where anxiety has no place) we have to anxiety-proof our lives. How? Just as you’d install a fan your bathroom to reduce or prevent mold, building a super-healthy emotional life is the best plan to keep anxiety at bay.
You’re not going to rid anxiety from your life
Nor would we recommend it. Anxiety can have a quite healthy place in a healthy life. When we go after a promotion, or take on a tough opponent at tennis, we’re likely to get anxious. That can be a huge rush, and even helpful. Fine by us.
What’s not okay with us is accepting a level of anxiety that takes over your life, causes physical discomfort and keeps you from being able to enjoy yourself and create more.