Generalized Anxiety Disorder
Despite its name, the main symptom of Generalized Anxiety Disorder (GAD) isn't anxiety itself, but rather persistent and uncontrollable worry about everyday events. In GAD, this worry is chronic, lasting for at least six months, and isn't just triggered by a specific stressor in the person's life. Individuals with GAD may experience six physical symptoms, though only three need to be present for a diagnosis:
- Restlessness or feeling on edge
- Easily becoming fatigued
- Difficulty concentrating or a blank mind
- Irritability
- Muscle tension
- Sleep disturbances
These symptoms occur frequently, typically on more days than not, for a period of at least six months. For a GAD diagnosis, the worry and anxiety must also cause significant distress or impairment in daily functioning (American Psychiatric Association, 2013).
When we feel calm and centered, it’s easier to think clearly and evaluate situations accurately. But during emotional distress, our thoughts can become distorted, leading to a negative and inflexible outlook. For example, not being invited to a friend’s party might be interpreted as proof of being unlikeable, even though there could be many other explanations. This kind of thinking often spirals into self-criticism, lowering one’s mood even further.
Distorted thinking is at the root of many psychological challenges. These patterns typically arise from deeply held beliefs that become activated during stressful times. For instance, someone coping with depression after a breakup might say, “I’ll always be alone” (a form of fortune-telling) because they believe they’re unworthy of love or connection.
Common thinking traps include:
- Black-and-white thinking: Seeing everything as all-or-nothing, e.g., “People are either completely trustworthy or not at all.”
- Jumping to conclusions: Making snap judgments without enough information, e.g., “One session of therapy didn’t help, so it never will.”
- Mind-reading: Assuming you know what others are thinking, e.g., “My boss didn’t say hello, so she must be unhappy with me.”
- Labeling: Defining yourself or others with negative generalizations, e.g., “I didn’t follow the group discussion, so I must be stupid.”
- Emotional reasoning: Believing your feelings are facts, e.g., “I feel like a failure, so I must be one.”
At Counselling Services For York Region, we help clients recognize and address these unhelpful thinking patterns. Our evidence-based therapies, like Cognitive Behavioral Therapy (CBT), are designed to guide you toward healthier, more balanced ways of thinking. Whether you’re dealing with anxiety, depression, or other challenges, we’re here to help you regain control and live with greater clarity and confidence.
If these patterns resonate with you, know that you’re not alone. Take the first step toward a brighter future—schedule a consultation with us today.
What does GAD look like?
Worry About Everyday Events
People with Generalized Anxiety Disorder (GAD) tend to worry about many of the same things as everyone else—family, work, school, finances, health, relationships, and even small matters like being on time or making minor decisions. The key difference is the intensity and persistence of their worry. If you have GAD, worrying might feel like a constant presence in your life, always in the background.
Some days, the worry might feel stronger, while on other days, it might feel quieter—but it’s rarely absent. You may also notice that what you worry about shifts depending on the situations you face. In our clinical practice, we often compare worry to background music: the tune may change from day to day, and the volume might go up or down, but it’s always there, playing in your mind (Robichaud 2008).
Excessive and Uncontrollable Worry
It can be difficult to determine when worry becomes excessive or uncontrollable, as these are subjective terms. Generally, worries are considered excessive in GAD if they go beyond what is reasonable for the situation, persist even when there's no clear reason to worry, or if others have pointed out that you worry too much. It’s important to note that excessive worry is more than just worrying frequently. For example, if you've recently lost your job and are facing financial difficulties, worrying about your finances would be a normal reaction. However, if you haven’t faced such setbacks and still find yourself constantly worrying about money, your concerns might be excessive.
Uncontrollable worry refers to how difficult it is to stop worrying once it starts. For those without GAD, it’s often possible to push worries aside or decide to think about them later. In contrast, with GAD, worries can feel overwhelming and relentless, like a freight train that’s hard to stop. Even if you want to pause your worrying, it can feel nearly impossible. Many people with GAD resort to time-consuming behaviors—such as keeping busy, calling a friend, or going for a walk—in an effort to distract themselves. However, like many others with GAD, you may have found that these strategies only provide short-term relief, if any (Robichaud 2008).
Chronic Worry
For people with Generalized Anxiety Disorder (GAD), worry isn’t an occasional experience—it’s a constant presence. If you have GAD, you might feel like you’ve been a worrier for as long as you can remember. Many people notice that their worries become more intense and frequent as they get older, often because life’s responsibilities grow over time.
It’s common for major life milestones—like entering adulthood, going to college, starting a career, getting married, or having a family—to bring new sources of worry. While these moments are often positive, they can add to the mental load. Over time, this increase in both the intensity and frequency of worry can start to feel overwhelming and difficult to manage (Robichaud 2008).
Sleep Problems
Many people with GAD struggle with either falling asleep or staying asleep. If you have trouble falling asleep, you may find that as soon as your head hits the pillow, your mind begins racing with worries. This happens because when you’re at rest, your mind is free to focus on your concerns. During the day, you might notice you worry less because you’re distracted by other activities, but your worries don’t disappear—they’re just pushed to the back of your mind, only to resurface when you try to relax or sleep.
Others with GAD have difficulty staying asleep. They may wake up multiple times during the night, sometimes due to their worries. Even while sleeping, your mind remains active, and the anxieties from the day can spill over into the night. Since excessive worry can be exhausting, and sleep disturbances are common for people with GAD, it's not surprising that you might feel easily fatigued (Robichaud 2008).
Feeling Restless
If you’re constantly worried, you likely experience a sense of anxiety throughout the day. Anxiety activates your body’s fight-or-flight response, which physically prepares you to confront or escape a threat. As a result, you may feel jittery, restless, and on edge, as your body gears up for action (Robichaud 2008).
Interestingly, these feelings of restlessness or agitation are often unnoticed by others, making GAD a deceptively functional condition. On the outside, you might seem to be managing just fine, while internally, you’re anxious and tense.
Three Levels of Thinking:
Negative automatic thoughts (NATs) are quick, situation-specific thoughts that pop into your mind when you’re feeling anxious or down. They often seem believable and are hard to ignore. For example, someone who arrives late to a meeting might think, “I’m always late. I’m so careless. Everyone will look down on me.” These thoughts can arise from external situations, like being late, or internal experiences, such as noticing a fast heartbeat and thinking, “I’m having a heart attack!” NATs can also appear as mental images, like imagining yourself “dying of embarrassment” after making a mistake at an important event.
Often, people are more aware of how they feel than of the thoughts causing those feelings. That’s why tools from Cognitive Behavioral Therapy (CBT), like asking questions such as, “What went through your mind at that moment?” are so helpful. These techniques make it easier to identify and challenge these automatic, unhelpful thoughts, helping clients take steps toward healthier ways of thinking.
Underlying assumptions (like “If I impress others, then I’ll succeed”) and personal rules (such as “I must never let people down”) influence how we think and act. These assumptions and rules often operate in the background, making them hard for individuals to recognize. Assumptions usually follow an “if...then” or “unless...then” pattern, while rules often appear as “must” or “should” statements. These beliefs serve as a way to avoid confronting deeper, negative core beliefs (e.g., “I’m not good enough”). Unfortunately, because the validity of these core beliefs is rarely questioned, the assumptions and rules end up reinforcing them. Problems arise when behaviors don’t align with these expectations, standards aren’t met, or rules are broken. When this happens, negative core beliefs become activated, often leading to emotional distress. According to Beck et al. (1985), maladaptive assumptions tend to revolve around three key themes:
- Acceptance: “I’m nothing unless I’m loved.”
- Competence: “My worth depends on what I accomplish.”
- Control: “I can’t ask for help.”
Core beliefs, also called schemas, are the deepest level of thought and form the foundation of how we view ourselves, others, and the world. Negative core beliefs are often overgeneralized and absolute, such as “I’m hopeless” or “I’m unlovable.” These beliefs typically develop during early life experiences and remain dormant until triggered by specific events. For instance, a person who values being efficient and disciplined may see themselves as incompetent if they fail to meet their own standards.
When activated, negative core beliefs distort how we process information. They highlight evidence that supports them and dismiss anything that contradicts them. For example, someone thinking, “I’m always late,” might ignore the fact that they are usually punctual. Core beliefs can center on:
- The self (e.g., “I’m unworthy of love”),
- Others (e.g., “People can’t be trusted”), and
- The world (e.g., “Everything is against me”).
Once the emotional distress causing their activation fades, negative core beliefs tend to return to a dormant state, allowing for a more balanced perspective. However, individuals with personality disorders may have these negative beliefs activated most of the time, making their experiences and outlook more consistently distressing (Davidson, 2008). Recognizing and challenging these core beliefs is key to lasting psychological change.
Robichaud, M., Dugas, M. J. (2015). The Generalized Anxiety Disorder Workbook: A Comprehensive CBT Guide for Coping with Uncertainty, Worry, and Fear. United Kingdom: New Harbinger Publications.
Why Burnout Needs to Be Assessed and How to Help with It
To help with burnout, it’s important to first identify the signs—whether through self-reflection, employee surveys, or wellness checks. Once identified, strategies such as workload adjustments, fostering social support, promoting work-life balance, and encouraging breaks are crucial in mitigating its effects. Additionally, cultivating a culture that values mental health and providing access to counseling or therapy can significantly aid in recovery. Proactively assessing and addressing burnout not only restores well-being but also enhances productivity, satisfaction, and long-term success.
Burnout Questionnaire
PASS Perinatal Anxiety Questionnaire Scale 2
The Perinatal Anxiety Screening Scale 2 (PASS-2) is a tool used to assess anxiety symptoms in pregnant and postpartum individuals. It helps identify potential mental health concerns during the perinatal period, including generalized anxiety, panic, and obsessive-compulsive symptoms. The scale aids healthcare providers in screening for anxiety disorders, enabling early intervention and support for individuals at risk.
The Perinatal Anxiety Screening Scale 2 (PASS-2)
