First, Bill learned about what anxiety is and how to recognize it (see What is Anxiety?). Then, he learned to understand the nature of GAD (see Generalized Anxiety Disorder).

This included information about what are considered excessive and uncontrollable worries. He learned that it’s normal to worry from time to time. However, Bill discovered that worry is a problem when it happens almost every day, causes a great deal of distress, and gets in the way of enjoying life.

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He also learned about what people with GAD typically worry about, as well as how worry affects a person’s body and behaviours. Most importantly, Bill learned that the reason individuals with GAD worry is because they get anxious whenever there’s uncertainty in a situation or if they’re not 100% sure about something. In other words, a person’s intolerance of uncertainty is the key factor that triggers worries and maintains GAD.

In order for Bill to manage his worries and anxiety successfully, he needed to better understand his worries and become good at catching himself worrying. Using a notebook, Bill created a worry diary with four columns: date and time, situation, worry and anxiety rating (see Worry Diary).

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Then, he spent two weeks taking daily notes of which situations triggered his worries (e.g., the night before meeting his business partner to discuss recent business expenses), what he worried about (e.g., "What if we have gone over budget? If we go over budget, we might not be able to pay our bills and will go into a deficit. If we go into a deficit, then we might not be able to get out of it given the recent economic climate…"), and how much anxiety he felt on a scale of 0 (no anxiety) to 10 (extreme anxiety).

Worries typically fall into two categories: a) worries about current problems, and b) worries about hypothetical situations or potential problems. Through his daily recording, Bill learned that he tended to spend most of his time worrying about hypothetical situations (e.g., "What if I make a mistake in my decisions and cause a huge loss in business revenue?", "What if I have not considered and researched every possible outcome about this issue and get caught off guard?").

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Bill also learned that worries about hypothetical situations (as opposed to current problems) require different management methods because the amount of control one has over each type of situation is different. With worries about current problems, one can use problem-solving skills to actively deal with them. However, with worries about hypothetical situations, one has almost no control, so there is very little one can do to change the situation. After learning more about his worries and knowing how to classify them, Bill was ready to start applying some specific strategies to manage his worries.

 

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CBT - Personal Story - Bill

TOOL # 1: Relaxation Skills

Bill’s excessive worrying caused him to feel very uncomfortable most of the time. He learned about various relaxation strategies that could help him "turn down the volume" on his anxiety, which could help him to feel less overwhelmed by his worries. He learned about calm breathing, which involves taking slow, regular breaths through his nose (see How to do Calm Breathing). He also realized that the goal of calm breathing was not to eliminate or avoid anxiety (because anxiety is not dangerous, and part of overcoming fears involves allowing yourself to experience anxiety rather than fight it), but to make it a little easier for him to "ride out" his feelings when facing uncertainty.

Bill also learned how to lower his overall tension and stress levels (which can contribute to anxiety) by doing a daily muscle-relaxation exercise. Bill would first tense the various muscles in his body and then relax them (see How to do Progressive Muscle Relaxation). He practiced these relaxation skills twice daily for at least 10 minutes per practice. Although he initially found it challenging to slow down his breathing and relax his muscles, he learned, with repeated practice, to relax himself and he felt less physically tense as a result.

Tool #2: Becoming comfortable with uncertainty

People with GAD tend to have a strong dislike for uncertainty and engage in a lot of excessive behaviours to increase the certainties in their lives. Bill, for example, constantly ran scenarios through his head to anticipate and prepare for the worst, and avoided delegating tasks to others. However, he learned that life is filled with uncertainty, because no one can predict the future, and his attempts to increase certainties weren’t working. Therefore, an important step for him was to learn to be more tolerant of uncertainty by acting "as though" he were comfortable with uncertainties (see How to Tolerate Uncertainty). /p>

First, Bill needed to work on identifying behaviours he did to try to feel more certain and less anxious. Then he made a list of these behaviours and ordered them according to the amount of anxiety (on a scale of 0= no anxiety at all to 10= extreme anxiety) he would feel if he could not do them. He ordered the behaviours from the least anxiety-provoking at the bottom to the most anxiety-provoking at the top. Here are some of the behaviours on Bill’s list:

Starting with the behaviour that caused him the least amount of anxiety (buying something without researching for the best deal), Bill worked his way up the list. He repeatedly practiced not engaging in the behaviour until he felt less anxious about not doing it. Every time he practiced tolerating uncertainty, he asked and answered the following questions:

What did I do?
I bought a printer for work and did not go online to search for the best deal. I just went to the local office supply store and bought the one I liked. /p>

How did I feel while doing it?
I felt anxious about not searching for deals first before buying the printer because I might not have gotten the best deal.

What happened (did everything turn out ok)?
I found out from a friend the next day that he bought the same printer and spent $10 less on it.

If it did not turn out as planned, what did I do to cope?
Even though I spent a bit more on the printer than my friend did, it wasn’t the end of the world. It didn’t make a big difference to my budget, and I saved a lot of time not searching for the best deal.

By answering these questions, Bill was able to learn that even when he did not engage in a behaviour that would make him feel "safer" and less anxious, things did not always turn out as badly as he had anticipated. Even when they did turn out negatively, he often was able to cope with the negative outcomes.

Tool #3: Rethinking the usefulness of worry

People with GAD often believe that worrying is helpful or useful in some way. That’s why they keep worrying! There are five positive beliefs that people with GAD typically have about their worries (see Self-Help Strategies for GAD for the complete list). Bill learned that he tended to believe that worrying would prevent bad things from happening. For him to manage his worries more effectively, he needed to rethink the usefulness of his worrying.

In order to examine whether his worries were doing what he thought they were doing, Bill asked and answered the following questions:

Has anything bad ever happened in my life even though I worried about it?
Sure, there were times that bad things still happened even though I worried about them. For example, my high school girlfriend broke up with me because she became interested in someone else, even though I had worried a lot about this happening.

Is there a way that I can test out my theory, by worrying one day to see what happens, and then not worrying another day?
I can give myself a week to test out my belief that worrying about my financial stocks could prevent them from going down. I can spend Monday, Wednesday, and Friday worrying about it and not worrying about it on other days. If my stocks go up and down regardless of whether I worried about them or not, then perhaps worrying about my stocks does not prevent them from going down.

Although Bill started to see, after the belief-testing experiment, that his worrying did not seem to have much influence over the outcome of things, he was still not fully convinced that worrying was not useful at all. After all, he had spent years worrying! Therefore, he evaluated the pros and cons associated with worrying and its impact on different areas of his life. He asked and answered the following questions:

Has worry affected my friendships or relationships with others?
Are people annoyed with me for worrying? Worrying has definitely affected my relationship with my wife. She finds it really annoying that I won’t buy anything without spending hours looking for the best deal. She also doesn’t like me calling her whenever she is out late because it makes her feel that I don’t trust her. We argue about these issues all the time.

How much time, effort, and energy have I spent worrying?
I spend a lot of time and energy worrying. I often feel exhausted after spending a few hours worrying about something.

Is it worth it?
Definitely not worth it.

How has worry affected me physically?
Constant worrying makes me feel tense all the time and my back and neck muscles often ache from the tension. I have a really hard time falling asleep and frequently wake throughout the night. I am also tired all the time and cannot concentrate well.

After objectively evaluating the usefulness of worrying, Bill realized that his worrying didn’t help him in ways he thought it would. He also realized that his worrying had a negative impact on his relationship with his wife and on his general sense of well-being.

Tool #4: Improving problem-solving ability

The best way to deal with worries about current problems is to use problem-solving skills to solve them!

Many people with GAD think they are problem solving when they are worrying. But worrying about a problem does not solve it, because problem solving requires action. That is, one needs to carry out the solution in order to solve a problem. Actively solving your problems not only gives you fewer things to worry about, but it also helps you become more comfortable with uncertainty. This is because finding a solution to real-life problems almost always involves some uncertainty.

Since Bill’s primary worries were associated with hypothetical situations, he focused more on other worry-management skills and less on problem solving. For more information about this skill, see How to Solve Daily Life Problems.

Tool #5: Writing a worry script

The best way to deal with worries about hypothetical situations is to write a worry script every day for a week or two. Although problem solving is a great tool for dealing with worries about current problems, it’s not very effective in dealing with worries about hypothetical situations because no amount of problem solving will help you with worries about something that hasn’t happened and may never happen.

A worry script is like a journal entry, where you write about your worry and what you are afraid will happen. In other words, write about the worst-case scenario for one of your worries. For example, Bill wrote a script about his fear of making a huge business-related mistake that would lead to the loss of a large sum of business revenue and to bankruptcy, and how he would disappoint his family, causing them to leave him all alone in the world.

Writing a worry script is different from worrying because a worry script will help you to experience the negative emotions associated with your fears and worries, rather than avoid them. Research has shown that people with GAD have a hard time dealing with their negative emotions (e.g., sadness or fear). They either try to push the negative feelings away, or they keep switching worry topics. Unfortunately, neither of these avoidance strategies works in the long run. Pushing bad thoughts and feelings away requires constant hard work, and these bad thoughts come right back to you the minute you slip. Switching worry topics, on the other hand, prevents you from fully "digesting" your fear and clearly seeing what you are really afraid of.

Bill learned that rather than putting all of his energy into avoiding upsetting thoughts and emotions, he could instead face his fears head-on. By writing about his biggest worry, he faced his negative thoughts and feelings. He got a clear picture of what he was really afraid of: his loved ones leaving him and being all alone in the world. Writing the worry script gave him a chance to "digest" his anxiety and changed how he thought about his fear. Bill realized through writing the script that his fear was exaggerated and that his loved ones would never leave him, no matter how badly he screwed up.

Bill found that his CBT skills were helping him to better manage his GAD. However, he needed to remember that learning to manage anxiety is a lot like exercise – he needed to "keep in shape" and practice his skills regularly. Bill tried to make practicing the skills a daily habit. However, he learned that sometimes during times of stress or transition (e.g., when the economy is doing poorly), it’s possible to slip into old patterns. This is normal. It just means he needed to get out his GAD toolkit and start using the tools he learned (see How to Prevent a Relapse). Bill realized that coping with anxiety is a lifelong process. The good news is that now he has the skills to do it!