The ABCs of Anxiety & GAD

A Primer on the “What's” and “Why's” of Anxiety

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Whether you are beginning a course of cognitive behavioral therapy (CBT) or other type of talk therapy for generalized anxiety disorder (GAD), or working on your own to better manage your anxiety and worry, it’s important to familiarize yourself with the ABCs of anxiety.

Here is a review of some basic information that can help you on your way to improved well-being:

What is anxiety?

Anxiety is a totally natural state that everybody experiences.

It can be felt mentally – with worry or fearful thoughts – and physically – with increased muscle tension or an upset stomach, for example. Essentially, anxiety is the state in which your brain and body is anticipating things that can go wrong – future threats – and trying to determine how it’s going to cope with them.

Anxiety is similar, but distinct from, fear. Anxiety occurs in advance of perceived danger, while fear is the response that occurs when the threat is thought to be imminent. The presence of anxiety can certainly increase the likelihood that a fear response will be triggered.

For example, imagine that you are going on a bike ride with friends. In anticipation of the excursion, you are worried – anxious – about losing control as the bike goes downhill, about speeding up and then falling off the bike and injuring yourself. When you meet up with your friends on the day of your ride, you would be in a state of anxiety and your body would be gearing up to take action.

You might be especially attuned to the steep hills you see in the surrounding environment or even to the noise of car traffic on the roads. Once on the bike, anxiety is what builds as you pedal uphill; fear is what kicks in when you are actually experiencing the bike picking up speed as you head downhill.

How does anxiety manifest in GAD?

There are three aspects of any type of anxiety that tend to manifest in a particular way for people with GAD.  

  1. Physical sensations are a key part of anxiety. These sensations occur because when danger is perceived or anticipated, the brain sends this message to the sympathetic nervous system (which primes the body for action) and the parasympathetic nervous system (which restores the system back to a balanced baseline state). Studies have shown that the chronic worry and anxiety characteristic of GAD are associated with low levels of parasympathetic activity, rather than high levels of sympathetic activity. This could explain the sustained nature of commonly reported physical symptoms in GAD – headache, muscle tension, difficulty relaxing, chronic stomach distress.
  2. Thoughts are another component to anxiety. Worry thoughts present in individuals with GAD may be the mind’s way of creating an illusion of control (e.g., “Let me worry about this so that I am doing something about it.”). These thoughts can also take the form of images. Sometimes the thoughts are interpretations of physical sensations; in this way, physical symptoms can worsen worry thoughts and worry thoughts, in turn, may exacerbate bodily feelings. Anxious thoughts in people with GAD can be difficult to control. Therefore, a focus of a talk therapy like CBT might be to learn how to “turn off” or “turn down” the volume on the worry.
  1. Behaviors are the third aspect to the state of anxiety. Avoidant behaviors may be intended to prevent the chances of the anticipated negative outcome. Reassurance-seeking or checking behaviors are an attempt to make as sure as possible that everything will be OK. Unfortunately, these types of behaviors can create a strain on relationships and perpetuate the anxiety cycle. However, there are a number of ways that family members and friends of a person experiencing behavioral consequences of anxiety can help.

Why does it happen?

The purpose of anxiety is to protect and prepare you. It’s actually quite helpful in a number of ways. You can think of anxiety as your biologically built-in alarm system. Just like an alarm clock can signal and motivate you to get out of bed each morning, anxiety can motivate you to get things done. Anxiety, at reasonable levels, enhances performance in the classroom, on the baseball field, and at a business meeting. When actual danger is present, it triggers a “fight or flight response” that allows us to run away or face threats to stay safe.

The point at which worry and anxiety become a problem is somewhat subjective, but when you (or your clinician) feel that your anxiety has reached unreasonable levels, it is time to face that head-on.

Once you understand the purpose of anxiety and what it looks like for you (and whether or not this is a significant problem), you will put yourself in a better position to start working on coping with the sensations and thoughts, and challenging the behaviors, that perpetuate it.


Craske MG, Barlow, DH. Mastery of Your Anxiety and Worry Workbook (2nd Edition). In DH Barlow (Ed.) Treatments That Work. New York: Oxford University Press, 2006.

Eifert, G.H., & Forsyth, J.P. (2005). Acceptance and Commitment Therapy for Anxiety Disorders. Oakland, CA: New Harbinger Publications.

Newman MG, Crits-Christoph PF, Szkodny LE. Generalized Anxiety Disorder. In L Castonguay & T Oltmanns (Eds.), Psychopathology: From Science to Clinical Practice. New York: Guilford Press, 2013, p. 62-87.

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