Managing worry in generalized anxiety disorder

Srini Pillay, MD
Srini Pillay, MD, Contributor

Follow me at @srinipillay

Everyone worries, but some people worry more than others. When worry is excessive, people may develop generalized anxiety disorder (GAD). In fact, close to a quarter of people who go to their primary care physicians with anxiety suffer from this.

In general, stressful events in childhood and adulthood, having strained economic resources, being divorced, and being female all put you at risk for GAD. But what do all of these different high-risk groups have in common psychologically? Why do they worry so much? And what can they do about this?

The surprising benefits of worry for people with GAD

A recent study explained why people with GAD worry so much — and the findings may surprise you. While many people think they are just worriers, they do not realize that they actually worry for a reason. Their worry is an attempt to protect themselves! If you’re wondering how such a nagging, persistent, annoying, and sometimes distressing psychological state can be helpful, you’re probably not alone. But the findings do in fact make some sense.

It turns out that worrying about something puts your mind into a negative state, but this helps, because when something negative does happen, you don’t feel that much worse. You’ve already been feeling bad. For people with GAD, it’s better to feel bad most of the time so that a negative event — someone being ill, sudden financial challenges, or rejection from a loved one — doesn’t have the power to create a massive emotional swing. It’s the sudden shift from a neutral or positive mood to a negative one that is of great concern to worriers. They will do anything to avoid this, include preparing to be miserable. They really hate the contrast of a situation unexpectedly going south. To people who aren’t worriers, this would sound counterintuitive, but they don’t have the same sensitivity to sudden emotional shifts. In fact, for them, worry is undesirable, whereas worriers find worry helpful.

This poses a dilemma for treatment, then. If someone has GAD, just asking them to lose the worry will not work. And if you have GAD, expecting your brain to simply stop worrying on command is a tall order. Another study has helped us understand that people who are prone to worrying are soft-wired to pay attention to threatening news, thereby building up a library of evidence in their brains that worrying is necessary. Think about it. On any given day, there are so many threatening things happening in the world — anything from new viruses, terrorist attacks, or political conflicts to a hostile email or upcoming storm are all real events. Yet, if you only pay attention to the threats, you have no space left in your brain to process anything else. Threat becomes your reality, and worry becomes your justifiable response. Anyone telling you to give up your worry will sound out of touch, to say the least.

What you can do to get your worry under control

As challenging as this sounds, there are things that you can do to retrain your brain to stop worrying. Cognitive behavioral therapy, a type of talk therapy where you simply revisit your assumptions in an attempt to reframe your thoughts, works according to some studies but not others.

It’s important to remember that you can benefit from other forms of talk therapy, though, and that you can benefit from medications as well. But if you want to try changing the way you think right now, prior to therapy or while you’re waiting, you might consider the following approach.

Rather than challenging yourself or someone else about worry, you can actually accept that the worry is serving a purpose — to avoid a sudden negative swing. Then, start to delve deeper so you can discover that the negative swing is probably less negative than you think. Giving up the struggle and control with worry, and accepting that it has not been helpful, is the next step. You can then re-examine your library of negative “proof” and swap out threatening realities for positive ones. In fact, this kind of deliberate optimism can protect you from GAD.

Worry in GAD can be debilitating, but there is an increasing amount of data that shows you can address this effectively.


  1. Manju

    Sir iam suffering from anxiety. And worried for simple reasons. I dont get sleep properly .and my body gets heated .and acidity gastric. Acid reflexses .chest infection .chest pain like heart attack. When consalted cordialogist they done angogram and told me there is a mid myocordial bridge in left arteries. Again and I visited doctor. He suggested to consult psychiatric .my psychiatric doctor has given tables. 1, Duvanta 40mg 1-0-1,2 Etilam 0.5mg 1-0-1,3 Felicita-OD 0-1-0, 4 Petril 0.5mg .do I should take medicine for lifelong .is there is any side effect by taking this medicine.

    • Srini Pillay

      I am sorry to hear of the medical challenges you are experiencing, but encouraged to hear that you have sought medical help.

      I am afraid that I cannot provide formal medical advice here as I do not have access to your full history and the site is meant to be informational.

      That said, I am also not familiar with the specific formulations of medication you mention as they are not marketed by those names in the US.

      Some general thoughts for our next discussion with your doctor:
      1. Always get clarification from your doctor. Get clarification on why each medication was prescribed for you and how they might interact with one another. Also discuss alternatives.
      2. Have him/her explain the side effects of each medication, especially those that could affect heart health or symptoms.
      3. It would also help to get clarification on any other things you can do to help your heart health/symptoms
      4. Ideally see if your cardiologist and psychiatrist could talk to each other to help optimize your care

      Hope this is helpful in your starting a helpful conversation with your doctor. Thanks for being a part of the “Harvard Health Publications” community.

  2. carol beene

    I am guessing that a narcissistic person would never have an anxiety attack because they have no emotions and don’t care! That would explain why my husband lacks empathy and shows no concern when I have an attack! Am I correct?

  3. Rhonda Walker

    Thank you for presenting the research in a way wherein we can understand and apply beneficial techniques immediately!

  4. Dr Premilla Devi Naidoo FCP(SA)

    Dear Srini
    Thanks for a very insightful article. I used to be a worry-wort but have since learned to live in the present.
    A quote from a religious magazine
    ” Yesterday is history
    Tomorrow is a mystery
    Today is a gift- therefore it is called the present”

    Once again Thank you
    Dr Prem Naidoo

  5. Srini Pillay

    Joanne—Thanks so much for your comment. Just to clarify, I don’t think that worrying is good for you. This study that I reported on found that beneath the clearly disruptive and very difficult symptom of worry in GAD, is the unconscious psychology of worrying, making people feel worse, and therefore “protected” against huge negative swings when something goes wrong. In essence, this is not protective, but there is an unconscious fear of large negative swings that is even greater than the problems related to worry. Of course, more studies would need to be done to replicate this. I definitely don’t underestimate GAD because I have seen how many people suffer terribly from it. That said, CBT is controversial because several studies have found it to be ineffective. I would suggest speaking to your/a therapist to see if other forms of therapy e.g ACT (Acceptance and Commitment Therapy)—there are a few others—might be helpful. So just to reiterate, I do not feel that worry makes you stronger or is better. I was simply reporting on a study that shows why it is so problematic and difficult to control. Hope that clears things up. Thanks again for expressing what I know many will resonate with. We are increasingly finding out what helps worry, so I am optimistic that certain therapies be helpful.

    • Joanne Brown

      Thank you so much for taking the trouble to reply. What you have said is truly appreciated. I like your suggestions – I will try anything.

      • Elisa Merva

        @ Joanne Brown I come from a family with worriers anxiety, Oct etc. At one point I to was diagnosed with GAD and know that it is extremely uncomfortable and unbearable at times especially being a high achiever as well because I tend to over analyze everything especially those things that can possibly go wrong this so.etimes leads to a perfectionist mindset and if it’s not perfect I’m completely wretched with worry. On that note I have been through CBT however have spent the last 2 years in Acceptance and Commitment Therapy ACT and it has done wonders for me. Instead of using so many cognitive tools that can be overwhelming to manage at all times of the day ACT allows for a more mindful and progressive way of thinking. It’s more suited to the here and now. Learning to accept what is true helps ease the suffering and then lowers anxiety for me. The commitment to using these new tools and not go back and ruminate on old ways and accepting that through mindfulness and living in the present day has helped me not let my mind wander of to places that can instigate fear or worry. It really showed me how to observe my thoughts and gently bring them back to a place of acceptance or a place that is safe and grounded. I highly recommend it again as it has done wonders for me and changed my life for the better.

      • Srini Pillay

        You’re welcome, Joanne. Hope you took a look at Elisa’s comments above. That was great case evidence of what the research is now showing. Here’s an interesting link:
        All the best!

  6. Joanne Brown

    The physical and mental pain experienced with this disorder can be extreme. It is for me. I don’t want this. Worrying may be “good” for a person but not to the extent where simply giving up on life is periodically considered as an option as (for myself) it becomes exhausting continually applying CBT (which I do) and managing the physical symptons (head feels like it is in a vice, muscle pain and extreme sensitivity). Please don’t underestimate it. I am 52 years old and have battled to manage this most of my life. The phrase “what doesn’t kill makes you stronger” doesn’t apply. Over time one is worn down. I spent 2 years in therapy (bi-weekly), learning to manage this. I have ADHD which exaccerbates it and in today’s world of information overload it is very difficult. I have been very successful in my life as I am an “overachiever” and have great mental strength and thus I have always persevered. Underlying guilt and fear is unfortunately the major driving force. I don’t want this. Thus the therapy. But sometimes I feel that it is gradually killing me as. If you told a person who gets migraines that they can be good for them they would probably punch you in the nose! That’s how I feel. I believe GAD eventually can lead to chronic fatigue and ultimately a breakdown in functioning. your article simply doesn’t come close to communicating the pain that this condition causes.