How often do we ask the "What if…?" questions? How often do we end up with a chain of "What if…?" questions that we reach a point where we become so worried, anxious and fatigued?

Having excessive and uncontrollable worries about daily life events and experiencing physical symptoms such as muscle tension, fatigue, trouble concentrating and sleeping -- these might all be symptoms of Generalized Anxiety Disorder (GAD).

GAD is a common disorder, with one-year prevalence rates of 3 to 5  per cent, and lifetime prevalence rates of 7 per cent. GAD is one of the most common psychiatric disorders in primary-care settings in the world.

GAD is a chronic and disabling condition and associated with various health problems. It is characterized by excessive and uncontrollable worry about a range of situations, such as family, work, money, relationships, school, and health.

Some cognitive symptoms associated with GAD are “something bad is going to happen,” “I will go crazy because of my worries,” “I cannot control my worries.”

It is also associated with various physical symptoms, such as feeling restless or on edge, fatigue, difficulty concentrating, feeling irritable, muscle tension and difficulty falling or staying asleep.

Recent studies have shown muscular and stomach pain to be associated with GAD.  Muscle tension consisting of headaches, neck aches, backaches, and sore jaw are also found to be associated with GAD. Nausea or stomach distress is also found to be among the most frequently endorsed symptoms in individuals who suffer from GAD.

In addition, individuals suffering from excessive worry and anxiety tend to have more doctor visits and have gastric complaints than those with low anxiety and worry.  

Avoidance or seeking excessive reassurance represents common behavioural strategies that people use to cope with the excessive worries and anxiety. However, these behaviours paradoxically contribute to heightened anxiety. Common examples of avoidance include avoidance of news or newspapers or limiting activities due to excessive worries about what could happen.

It is important to note that we all have worries, fears and doubts. These are just a normal part of life. It is normal to be worried about your job when your company is experiencing layoffs. You might be worried about money when you have difficulty paying your bills. You might be worried about your upcoming exam.

The worries in GAD are not always different in content from the worries of people who do not suffer from an anxiety disorder. The worries in GAD differ mostly by their frequency, intensity, the distress and disruption that they could cause and the catastrophic nature of them.

In GAD, the worries tend to be excessive or perceived as being difficult to control. People might anticipate disaster or often expect the worst, even when there might be no apparent reason for concern. They might also tend to worry more about unlikely or remote future events, such as how to pay for an unborn child’s university education. As well, GAD worries are also often characterized by excessive worry about minor matters (e.g. "What book to read?”)

Unlike other anxiety disorders, people with GAD worry about a number of events such as work, relationships, health, school, and finance. The worry in other anxiety disorders is related to more specific issues or areas. For instance, individuals with panic disorder worry about having panic attacks and the subsequent physical symptoms of anxiety; individuals with social phobia worry about being judged or embarrassed in public; and those with obsessive-compulsive disorder worry about contamination or the fear of something bad happening if they do not engage in compulsions.

Intolerance of uncertainty, reflecting the tendency to believe that uncertainty has negative implications and is unfair, has been found to play a central role in GAD, by Dr. Michel Dugas, Professor at Concordia University, one of the leading experts and researchers in the area of anxiety disorders, in particular GAD. Dr. Dugas defined intolerance of uncertainty as a type of “psychological allergy” to uncertainty.

GAD tends to cause significant distress and impairment in overall functioning, in social life, academic life and/or at work. In addition, when compared with individuals without GAD, those who suffer from GAD are also more likely to report dissatisfaction with their present main activity, family life, and overall well-being. They tend to experience great difficulty living and enjoying the moment due to worries about future events. The question “what if?” also makes it difficult to stay in the moment and to enjoy that moment.  Studies have found that GAD is also associated with unemployment and chronic medical illnesses and with significant economic and health care costs.

Effective treatments for GAD are available, including evidence-based Cognitive Behavioural Therapy (CBT) and medications. CBT for GAD encompasses various components, including psychoeducation on anxiety and worry; monitoring worries, worry types and beliefs about worries; skills and strategies to better cope with distressing worry cycles; cognitive interventions focusing on identifying distressing thought patterns, perception of uncontrollability or danger in worry, intolerance of uncertainty and ways of developing healthier balanced thoughts; and exposure interventions to help gradually reduce any behaviours such as avoidance, to increase activities and overall functioning; other helpful components of treatment include, for example, problem-solving skills and relaxation techniques.