CBT Therapy for anxiety, phobias, worries, and generalised anxiety disorder (GAD) in Belfast.
Normal and abnormal worry
It is completely normal to worry — everyone has worries. In fact, a study carried out by Dupuy and colleagues in 2001 found that a person without a psychological disorder is likely to worry, on average, around 55 minutes a day. However, if you are suffering from Generalised Anxiety Disorder, or GAD, that amount of time will increase significantly, to an average of 5 hours per day. There are other differences between going through a difficult period of your life, where financial, health, or other worries take over your mind, and the diagnosis of Generalised Anxiety Disorder. For example, everyday worries tend to be temporary and less intrusive for those without GAD. People with GAD experience a heightened level of distress and their worries are long-term and not limited to one situation or one specific set of circumstances.
Two features that differentiate people with GAD from those who simply worry are that someone with GAD perceives the worries as uncontrollable. This perception generates additional worry about the fact that they worry excessively. It is not uncommon for people with GAD to believe that their worry will harm them either psychologically (e.g. I will go mad, I will end up depressed, I will not be able to function), or physically (e.g. worrying will give me cancer, will damage my heart).
After the initial assessment with John or Sylvia, it can be determined if you are suffering from Generalised Anxiety Disorder or simply going through a difficult time in which worrying is a natural response. Regardless, CBT can be helpful and provide you with enough tools to deal with distressing emotions and manage your worries in a more adaptive manner.
What does "Worry" Look Like?
Worry involves thoughts about perceived negative events that might happen in the future. It usually begins as a "what if" question:
What if I am not able to complete this task?
What if my daughter misses her train?
What if my boss thinks I am incompetent?
What if I am not able to function tomorrow because I cannot sleep?
While these worries can be present in people with or without GAD, only a thorough assessment will determine whether your worries are just normal worries or indicative of GAD.
Am I just worrying or am experiencing symptoms of Generalised Anxiety disorder?
You may be suffering from Generalised Anxiety Disorder or GAD if you believe that your worries are uncontrollable and dangerous to your mental or physical health, you have at least two areas of concern that cause worry and three of the following symptoms have been present for more than 6 months.
Muscle tension, aches or soreness
Trouble falling asleep or staying asleep
Stomach problems, nausea or diarrhea
Jumpiness or unsteadiness
Edginess or restlessness
Feelings of dread
Inability to control anxious thoughts
Inability to relax
Fear of losing control or being rejected
For the diagnosis of GAD to be made, it is absolutely essential for the anxiety, worry or physical symptoms to cause distress and impairment in day-to-day functioning.
At times, people who worry excessively may experience panic attacks in response to severe stress. However, experiencing panic attacks is not the same as suffering from panic disorder. Panic attacks are associated with fear of bodily sensations and an imminent catastrophic outcome rather than a social catastrophe (e.g. realising that you are anxious, sweating or shaking).
What do people worry about when they are suffering from Generalised Anxiety Disorder?
For the most part, people with GAD worry about the same things that others worry about; they just worry more frequently than other people, as well as meeting the criteria established above. People with GAD do not cope well with uncertainty, are highly perfectionist, and tend to feel excessively guilty. Most of their worries are about minor matters such as:
- Time pressures to keep appointments or being on time (e.g. What if I am late for my flight)?
- Worries and pressures at work or in class (e.g. failing to meet deadlines, pass tests, interviews, complete tasks competently or choose the right career path). Questions which may plague them are for example, what if I do not get this job? What if I made a mistake becoming a teacher? What if my boss is not happy with my performance?
- Worries about friends and family, such as relationships or getting along with others (e.g. What if I have chosen the wrong boyfriend/girlfriend? What if I am not in love with my partner? What if I offend people by asking personal questions? What if I am not funny or entertaining when I am with my friends? What if people think I am lazy? What if my boss thinks I am not good at my job)?
- Worries about health; for example, personal health or the health of loved ones (e.g. What if I die in a plane crash and leave my children orphans? What if I get a serious disease? What if my husband gets into a car accident)?
- Worries about the future and the world; such as the environment, war in the world (e.g. What if there is a storm and it floods my house? What if in 30 years I do not have enough money to retire)?
It is important to note that all the above mentioned worries can be associated with other disorders such as social anxiety, health anxiety, OCD, or no disorder at all if the person is going through a difficult time. Sylvia and John will be able, after a careful assessment, to devise effective ways of dealing with your worry and anxiety.
CBT treatment for Generalised Anxiety Disorder
Sylvia and John use two Cognitive Behavioural models to deal with Generalised Anxiety Disorder. One is Beck's Cognitive Model and the other is a newer treatment called Metacognitive Therapy.
A. BECK'S COGNITIVE THERAPY FOR GAD is likely to include a combination of the following methods:
- Identifying and challenging maladaptive beliefs/ core beliefs in order to find more adaptive ways of thinking about the nature of the worries.
- Problem-solving strategies: Focus on finding practical solutions to what you may be worrying about.
- Imaginal Exposure to habituate to what you fear until you do not experience any more anxiety about the worry you are experiencing.
- Coping Imagery: Rehearsing mentally coping with feared situation.
- Behavioural Experiments to test predictions about the validity of your catastrophic assumptions about what may happen in the future.
- Applied Relaxation: It reduces the physical sensations associated with your worry.
- Reduction of maladaptive behaviours maintaining the vicious circle of worry: Thought suppression, distraction, excessive self or other reassurance seeking behaviours, neutralising thoughts or images, avoidances of situations/people, checking or the use of any safety behaviour intended to reduce uncertainty.
- Assertion techniques that enable management of interpersonal relationships without feeling pressured or excessively guilty.
B.METACOGNITIVE THERAPY FOR GAD
This type of therapy shows the client how to disengage from worries without trying to modify the content of his/ her thoughts through the use of detached mindfulness, learning to shift the attention without engaging in distraction, or other maladaptive ways to control worry (e.g. reducing avoidance, distraction techniques, reassurance seeking behaviours).
It also examines the validity of assumptions associated with the advantages and disadvantages of worrying as well as using behavioural experiments to test predictions about the controllability and dangerous aspects of worrying.
Please contact Anapsys to make an appointment if you think your worries interfere with your life. John and Sylvia are experienced CBT psychotherapists who can provide the professional help you require to achieve attitudinal restructuring, and the self-confidence that will enable you to take control of your life.
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