AnxietyFor yourself55 min read

Constant worry: generalised anxiety disorder

Worrying about work, about the health of those you love, about money, about a message that has gone unanswered, and starting again the next day with another subject. This guide explains why worry takes hold and feeds on itself, how to tell the worry that serves a purpose from the worry that spins on the spot, and offers the method that has proved itself: worry time, problem solving, and learning to live with uncertainty.

In short

This guide is for adults who worry almost every day, about several areas at once, and who cannot manage to stop. It describes what research has established about this way of functioning: the intolerance of uncertainty that drives it, the beliefs about the usefulness of worrying that keep it going, and the quiet avoidance it organises. It then offers concrete tools, week after week, and says frankly when outside help becomes necessary.

Topic: Anxiety
Who it's for: For yourself
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The programme

This guide is psychoeducational content. It does not replace a consultation. If the worry is accompanied by chest pain, breathlessness, faintness or any new physical symptom, have these assessed by a doctor before concluding that they are due to anxiety. If you are thinking about dying, call your doctor the same day or, in immediate danger, the emergency services. Never stop a prescribed treatment on your own. Allow fifty-five minutes to read.

1. Before you begin

It is eleven at night. You are in bed, the day has gone well, and yet the machine starts up. Your son has not answered the message you sent at six. You think of an accident, then you tell yourself that is absurd, then you think of it again. You move on to the test results your doctor is due to go through on Thursday. Then to the reorganisation announced at work. Then to the car, which is making a noise. By around one in the morning you have solved none of these four problems, but you have examined every one of them in detail.

The next day, someone says to you: "don't worry." You already know that this is no use at all.

Three things, straight away.

Worrying is not a character flaw. It is a mental activity, learned, kept going by precise mechanisms, and those mechanisms can be changed. It is not a matter of willpower, and it is not an inevitability either.

Excessive worry is the symptom of a common and well-treated disorder. What clinicians call generalised anxiety disorder affects a substantial part of the population over the course of a lifetime. It is often identified late, because the people concerned consult for headaches, tiredness, tension, sleep that will not come — rarely for the worry itself, which they regard as their nature.

The aim is not never to worry again. Worry is useful when it leads to an action. The aim is to get the choice back: to use it when it helps, to drop it when it spins on the spot.

Who this guide is for

For you if you worry almost every day, about several subjects at once, and if the subject changes but the worry does not.

For you if you are permanently tense, tired for no clear reason, irritable, and if your sleep suffers for it.

For you if you need to be reassured often, if you check, if you anticipate everything, and if this weighs on those close to you.

For you if you are supporting someone who functions in this way, and you no longer know what to answer.

2. What constant worry is

A chain of sentences, not an image

Worry is almost always verbal. It comes in the form of linked sentences: "what if...", "I ought to...", "maybe that means that...". It resembles thinking, and that is what makes it so hard to interrupt: it has every appearance of serious mental work.

This is an important observation, and it has practical consequences. What is said in words produces fewer physical reactions than what is seen in images. A person who worries in words about the illness of someone close feels the dreaded scene less intensely than if they truly pictured it. In other words: worry is already, in itself, a way of keeping fear at a distance.

What distinguishes it from ordinary concern

Everybody has concerns. What characterises worry that has become a problem:

It is almost daily and has been going on for months.
It jumps from one subject to another. Solving a problem does not stop it: another takes its place, often within the hour.
It is difficult to stop deliberately. This is the point the people concerned describe first.
It often concerns things that are unlikely or already under control.
It is accompanied by lasting physical tension.
It costs: time, sleep, concentration, patience.

The usual themes

Family and the health of those close to you. Your own health. Work, possible mistakes, the judgement of others. Money. Domestic and administrative tasks. Delays, journeys, the unforeseen. And, in many people, an additional layer: worrying about minor things and blaming yourself for worrying about them.

What it is not

It is not reasonable anticipation. Planning a budget, taking out insurance, having a medical check-up requested by your doctor are actions; worry, by contrast, leads to nothing.

They are not obsessions. In obsessive-compulsive disorder, the thoughts arrive as abrupt intrusions, often absurd or shocking to the person themselves, and are accompanied by rituals. Worry, by contrast, remains plausible and presents itself as reasoning. If your thoughts have that intrusive form, see OCD: the eight-step exposure programme.

They are not panic attacks. Those rise within a few minutes, peak, and make you dread feeling unwell immediately. See Panic attacks and agoraphobia.

They are not depressive ruminations, turned towards the past and towards yourself — "why am I like this", "why did I say that". Worry looks ahead. The two often coexist: see Stop overthinking: getting out of rumination.

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Frequently asked questions

Am I going to have to live with this all my life? No. Generalised anxiety tends to last if it is not treated, but it responds well to psychological treatments. Many people keep a rather anxious temperament while recovering their days, their sleep and a normal peace of mind. The realistic aim is not zero worry, it is a worry that no longer decides your timetable.

What is the difference between worrying and ruminating? Worry looks ahead, in "what ifs", and anticipates possible misfortunes. Rumination looks back, in "whys", and replays what has happened. Both are forms of repetitive thinking, they share the same mechanisms and often coexist. See Stop overthinking: getting out of rumination.

Will worry time not make me think more? That is the usual fear, and the opposite is what happens. By giving worry a specific slot, you reduce the total time it occupies, and you discover that a good proportion of the subjects have evaporated by then. Allow two weeks before judging.

I have had every test, nothing is found, and I still worry about my health. What should I do? This pattern is typical of health anxiety, where tests reassure for shorter and shorter periods. The work then consists of stopping the checking rather than looking for one more confirmation. See The fear of being ill: health anxiety.

Is it hereditary? Part of the tendency to anxiety is passed on, and another part is learned in the family, by example. Neither of the two determines your future: what counts in practice is what you do with the worry when it arrives.

Should I take medication? That depends on the severity, on your preference, on what you have already tried and on what your doctor observes. The guidelines place psychological approaches and certain medicines as first-line options. The decision is taken with a doctor, and this guide does not replace that advice.

Is meditation enough? It helps, especially with the relationship to thoughts and with tension. Used on its own and with the aim of making anxiety go away, it becomes one more form of control and disappoints. What changes things deeply is exposing yourself to uncertainty, and that requires actions in real life.

My partner tells me I am impossible to live with. Am I overdoing it? Worry does indeed spill over onto those around you: repeated questions, control, refusal of certain outings, irritability. It is not a moral failing, it is a symptom. The reassurance contract in section 19 is often the first visible change for a couple.

I worry mainly at night. Can I do the worry time in bed? No, and this matters. The bed must stay associated with sleep. The slot goes in the late afternoon, and at night you confine yourself to writing three words in a notebook and postponing to the next day.

How long before I see a result? The first effects of worry time often appear within two weeks. For intolerance of uncertainty, allow more like six to twelve weeks of regular practice. Regularity weighs more than the length of the sessions.

I am afraid that if I let go, something will happen to my children: what do I do? This is the central belief, and it is too important to be brushed aside. It is tested gently, on minor situations, by observing what actually happens when you are not supervising. What people discover is that their worry was not what protected their children — their actions were, and those continue.

Can alcohol or cannabis help me relax in the evening? They relax you in the moment and increase anxiety afterwards, as well as disorganising sleep and exposing you to dependence. This is one of the most frequent and most damaging combinations. See Drinking less, or stopping and Cannabis: taking stock.

worrygeneralised anxietyruminationuncertaintyreassurancecbtsleepcontrol

Emotions

Stop overthinking: getting out of rumination

Replaying Tuesday's conversation, analysing why you are the way you are, wondering what he meant, and going to bed at midnight with the same questions you had at six in the evening. This guide explains the difference between thinking and ruminating, why rumination gives the illusion of being useful, and what actually gets you out of it.

50 min readMembers only

Anxiety

The fear of being ill: health anxiety

A lump under the skin, a headache that keeps coming back, a reassuring test result that only reassures for three days. This guide explains how the fear of being seriously ill takes hold and keeps itself going: the body checks, the online searches, the reassurance that brings relief and then evaporates. It offers the method that has proved itself and the way to set a frame for your medical consultations.