Generalized Anxiety Disorder - GAD (Episode 038)

SPEAKER_05 0:06

Gad, generalized anxiety disorder. Pervasive worry and rumination that you can't seem to stop or control. I worry, and so to combat worry, I worry more. I attack everything like a problem to solve or fix, or everything I have to worry about, think about, predict.

SPEAKER_01 0:23

But with Gad, a lot of these worries don't have a solution. And it is fueled by rumination.

SPEAKER_00 0:30

Oh no! It feels like there's a problem to solve. Someone called the ruminator!

SPEAKER_03 0:35

You think rumination is your ally. Because they love you.

SPEAKER_01 0:56

Welcome to Disorder. This is episode 38, entitled Generalized Anxiety Disorder, also known as GAD. I'm Joshua Fletcher, not the Ruminator, and I'm a psychotherapist and author specializing in anxiety disorders in the UK. I also go by the name Anxiety Josh on social media.

SPEAKER_05 1:18

I am Drew Linzolata, co-host of Disordered, also not the Ruminator. Actually, we're all the ruminator sometimes, I think. Anyway, I'm a uh grad student studying clinical mental health counseling on the way to being a licensed therapist in New York. In the US of A, I'm a former sufferer of anxiety disorders and depression for many years, podcaster and author, and I go by The Anxious Truth on social media. Hope you guys enjoyed our little theatrical intro there.

SPEAKER_01 1:40

Yeah, the production value of this podcast is plummeting. Uh GAD, big, big popular one in this community, isn't it?

SPEAKER_05 1:48

Oh, it is huge. Uh, I think, and most people that in our community think that are suffering with GAD or generalized anxiety. There's a lot of misconceptions about it. And they will always say, Yeah, but what about GAD? That's different. What are my exposures for GAD? What do I do for GAD? GAD, GAD, GAD. It will set itself up as its own special thing. So let's talk about it today.

SPEAKER_01 2:07

Yeah, we'll look at GAD, we'll look at how it presents, you know, which is really important. But as always, we like to celebrate our community uh with a did it anyway that are always submitted on disordered.fm. Um, have we got one, DJ Drew? We do. Let's cue it up right away.

SPEAKER_06 2:25

Hi, Drew and Josh. My name is Nicole. You can use my name. I've been listening to the podcast for a while. I suffer from generalized anxiety disorder. I'm in end stage recovery, but I still can encounter some really hard days just like everybody else. Um, I haven't did it anyway that I wanted to share. I was having a really rough week with some dizziness, a lot of DPDR, and symptoms that I hadn't experienced at that level for quite a while. Um and it was throwing me a bit off my game, and I was becoming fused with my thoughts instead of challenging them as I typically do. So after a really bad day, I was with my 18-month-old son and my husband, and we were in our playroom, and um I just decided to try and do something that we haven't done in a while, even though I was feeling really scared in a really bad place. So we put on some music and we had a dance party, um, and we did that for about three minutes. My son was giggling and laughing, and after that, it was like nothing was even wrong, and the symptoms just totally faded. So just wanted to share that did it anyway. Thank you guys for everything. Huge heroes to me, and I love listening to the show. Thanks, Mike.

SPEAKER_05 3:35

Great job, Nicole.

SPEAKER_01 3:37

Yeah, well done, Nicole. I love that. Really wholesome as well. Like it's um engaging in parts of your life, making memories, doing what non-anxious you would do. Uh and no, you're the hero in this. We're just the ruminators of this. We provide the content, you've got to apply the tricky stuff. Uh, and you did. Well done.

SPEAKER_05 3:56

Yeah, I think I love how she recognized being fused with her thoughts, a little technical thing there, and she used that and moved toward what was important to her. Anxiety didn't have to be the most important thing in the room. No, my my husband and my son are right now. Let's try it that way. And look how it turned out. Very good.

SPEAKER_01 4:12

Outstanding.

SPEAKER_05 4:14

Love it.

SPEAKER_01 4:15

GAD, generalized anxiety disorder. What does that look like, Drew?

SPEAKER_05 4:20

Well, I think a lot of people think that if you're anxious all day long, then that means that you have to call it GAD. So I would start by saying, not necessarily, but you know, a lot of anxious people that have other types of anxiety disorders, and we've done right what type of anxiety do you have is one of those early episodes we did here on Disordered. But uh GAD generally is is characterized by pervasive worry and rumination that you can't seem to stop or control. Sometimes it's about real life things, sometimes maybe things that aren't so rooted in real life. And I'm one of those people that feels like there's not a lot of operational difference between GAD and OCD sometimes.

SPEAKER_01 4:56

So yeah, uh no, as well in the UK in particular, um a lot of the diagnosed diagnostic process with anxiety, uh, and there's a lot of um not only anecdotal evidence, but I remember doing my master's thesis on this was when people go to their general practitioner, often I hear, you know, and they've only got a small window with their general practitioner, you know, and it's no blame here, it's a systematic flaw. But sometimes the doctor will say, Well, it sounds like you've got a lot of anxiety, and they often come out with a very quick diagnosis of GAD, or maybe it's um a diagnosis of GAD after um a consultation with um a psychologist or a health team. Um, some people have quite uh strong, severe GAD, and some people come out with a diagnosis of GAD because they had a 10-minute consultation with the doctor. Um, it's quite hasty and it's quite vague, in my opinion, in my experience over in the UK. So uh the opinions and and the advice I'll share is from my experience here. Um and yeah, we can talk about it today because it's something that that pops up. And what I've noticed as well is that each person's GAD is kind of subjective and individual to them.

SPEAKER_04 6:19

Yeah.

SPEAKER_01 6:20

Uh so let's kind of talk a bit about you know how it presents. Uh, you've mentioned then often it's characterized by you know having anxiety for a lot of the day.

SPEAKER_05 6:32

Well, that would be how it presents for sure. And I think people, again, they that the confusion of like, well, if I'm anxious, if I feel anxious all day long, then we'll call it GAD. Here it's sometimes a catch-all. Like, I can't diagnose you with with panic disorder or agoraphobia or OCD. So you're anxious all the time, it's what's GAD. But GAD doesn't mean that all the time. So don't sometimes I would start this conversation by saying, don't get too stuck on the label. Because we've talked about this, they all start to melt together anyway over time.

SPEAKER_01 6:59

Yeah, and and and with GAD as well, it's often that fear of fear. You know, if you scale anxiety from one to ten, people struggle with panic disorder and agrophobia and things like that. When they're in situations that are scary and they suffer from panic, you know, there are eights, nines, tens on on the anxiety scale. Uh, for me, I I mean I've I've had GAD as part of you know my anxious presentation, my fear of fear. And that would be anxiety presenting uh around at around a three to a six, maybe a seven on the scale, uh, with the odd panic attack now and then. Uh, I call it like that, just like medium simmering anxiety. Um the thing with GAD is that it's often more external. So and it can be mixed with a fear of fear. So people with GAD may fear anxiety itself and may experience things like panic, but also it could be things like external to them. Like I'm worrying about things that are outside of fear, and it's a misinterpretation. So you could be worrying excessively about something that's maybe out of your control, it might be conventionally not a big deal, but GAD will make you feel like it's a big deal. Um, I know people with GAD who don't realize they have GAD, uh, some of my family members, you know, and it's like you know, it's like excessive, intense worry and urgency to address all the time, and it is fueled by rumination.

SPEAKER_05 8:36

Yeah, 100%. That's why we started with the ruminator. I would, you know, I think GAD, there's fear of fear and GAD. I think there's also one thing we don't talk about all the time. There's worry of worry. Worrying about worrying is a big GAD thing too, because I know a lot of people who will say that they have GAD, whether they've self-diagnosed or they have been diagnosed, and they'll say, Yeah, but I'm not afraid of the anxiety. No, but you often worry that you have it. So you recognize that you're anxious all day long. You know that it shouldn't be that way, you don't want to be that way, and you're worried, you might be not afraid of it, but you're resisting it in the form of worrying about it and trying to fix it. And I can't seem to fix it. So now I'm gonna try harder to fix it. I'm gonna worry more than I'm anxious all day long. What do I do about that? What do I do about it is usually a clue to me, in my experience.

SPEAKER_01 9:20

Yeah, and it falls under the the I I don't want this label, something's wrong label. It's always like it's something's wrong. Maybe there's something wrong externally, and my what if thoughts are loud and convincing, or maybe it's something's wrong. It's just I don't feel 100% and I need to fix this. Um, it and it can be inwards, maybe there's something wrong with me, or it can be outwards, maybe there's something wrong with my work life, my personal life, whatever. But again, it sits between that three and six. Um, and it and it's it for a lot of people it presents as quite chronic.

SPEAKER_05 9:54

Yeah. People with GAD can have panic attacks sometimes. They're not, you know, this is not a mutually exclusive thing. Like, oh, if I have GAD, then I can't that I don't ever have panic attacks. Some people with GAD do occasionally have them. Some people with panic disorder might might also be diagnosed secondarily as having GAD. So again, they things start to bleed together sometimes. There's no hard edges here, no black and white definitions.

SPEAKER_01 10:21

No, there's no black and white definitions, and if we miss your presentation, you know, you know, sorry about that. Yeah, but you know, I you know spoken to so many people on the community with Gad, and it's different for each person, but it is always the worry and the rumination. Uh, and usually when we do worry, we end up in a cyclical cycle. Cyclical cycle? Well, we end up in a cycle of you know, I worry, and so to combat worry, I worry more. Yes, I may I may play through catastrophes in my mind, I may behave to stop the catastrophe in my mind, uh, I may seek reassurances to that these what ifs don't come true. And I might just have kind of worries just gatling gunned at me. What if this? What if my kid's not well? What if this happens? What if I lose my job? What if I have a panic attack? What if I never get better? What if I can't, what if I'm not doing the right things in my life? What if, what if, what if and they all feel loud and real because we're in that state.

SPEAKER_05 11:28

Yeah, highly sensitized, triggered state, and everything feels so important. By the way, that was an outstanding Gatling gun sound effect, by the way. Should you should use that more often. Oh, yeah. It was really good. Thanks. Yeah, very impressive. And I think sometimes the it feels so important because sometimes the often the themes are sort of real world oriented. You know, we might say sometimes people will say, well, the difference between OCD and GAD is OCD is completely irrational, whereas GAD is based on real life things that could actually happen or did actually happen. Again, very gray, might go back and forth, but uh that is what also what makes it feel special. But but something could happen to my children. I'm supposed to worry about that. But I don't want, I don't want to worry as much as I do, but I feel like I have to worry because that's what makes me a good parent. But I don't want to worry so much because it's making me crazy. And I think that presentation could sometimes be very physical because you have actual physical reactions to that agitated state you're in. Sometimes not so much. Some people are physically anxious all day. Some people will just say, I just can't get out of my head. I don't have big symptoms. I'm not afraid of those symptoms. I just feel like I can't get out of my head all day long. I'm in my head.

SPEAKER_01 12:36

Yeah, I can't get out of my head. That's very gad. Or the secondary fear to fear. Um, that's more of a concern and an annoyance and an irritation. Um, you know, this is something I can't quite fix. This feeling isn't something I can't quite fix. And yeah, uh this label is something I need to remove from me. This is a problem. Um and yeah, again, depending on it, like um, like if I if I see people uh in my practice, you know, I have this diagnosis of GAD, it's different because it's like, okay, well, often, like Drew said, it can be it can either be a catch all or it can be quite specific. Um some people's um GAD means you're just highly sensitive all the time. Um I know a lot of neurodivergent people that get um diagnosed with GAD because often with elements of neurodivergence, whether you're ADHD or autism, um you can be sensitive to certain things, uh like me and things like that. And that can often get um bumped in there as well.

SPEAKER_05 13:48

Yeah, that makes sense because sometimes I think that the the reaction in the neurodivergent community might not necessarily be recognized in the clinical community. So, oh, that's gat that's an anxiety GAD reaction. Maybe not. That just might be the way you perceive the world, which is important for us to validate and recognize for sure. But the it's funny because you said a thing before that I think really cuts to the heart of GAD in many instances. And I'm worried. And the way that I think I can fix my worry is to worry more. I I I'm thinking as a default way to interact with the universe, which most of us do anyway. But mine, I that's important for me. I think to solve and fix and scan and predict and be safe. And then I notice that thinking is not helping me, it's making my life worse. So I love to think, and then I hate that I think so much. Then I love to think again. So in in metacognitive therapy or theory, we have that, you know, it's a love-hate relationship with thinking and your thinking habits that are often underneath that that GAD thing. Love to think, then I hate that I think. Overthink, I'm an overthinker. Yeah.

SPEAKER_01 14:49

It's extremely cognitive and create symptoms of anxiety.

SPEAKER_05 14:53

Oh, sure. Yeah. If you're worried about a thing, worry will make a physical reaction. There's no doubt, that's not a mystery for sure. That can happen, no doubt.

SPEAKER_01 15:01

Yeah, it's also as well, like I've I've tend to find that it is for people who are very analytical and and and and intelligent. And in the past, these people have used their analytical skills and intelligence to solve problems, you know. But sometimes GAD can step in where all of that amazing brain power is then turned in on itself, uh, and there's nothing to explore sometimes.

SPEAKER_05 15:29

Where that's the default. I'm a problem solver or a fixer. But this isn't a either this isn't even a problem, but I'm just interpreting it as one, or this is a problem that cannot be solved and a question that cannot be answered. But I'm gonna try anyway, really hard, is what I do.

SPEAKER_01 15:45

Yeah, absolutely. And you've got um you're gonna remember as well, uh, and a disclaimer uh with GAD is that as we know, GAD is anxiety, anxiety is the amygdala, and the amygdala is your threat response. So some people, in my experience, only the minority of people, but uh they can get a diagnosis of GAD when actually because they're anxious all day, but sometimes, and this is where the disclaimer lies, like maybe there's something actually wrong in your life at the moment. So you might be anxious all day, and again, minority, but like you may be anxious all day because maybe someone's bullying you at work, maybe there's someone not being nice to you at home, you know. Um, maybe there's just a sit ongoing situation that's that's just worrying you. Maybe you're looking after someone who's chronically unwell, maybe there's someone in palliative care. But you actually what would happen there is that you would meet all the criteria for GAD if you were failed to separate that actually, no, this is something that is gonna cause me anxiety all day.

SPEAKER_05 16:51

Yeah, that's a good point.

SPEAKER_01 16:53

Yeah, yeah. Definitely when I was a carer for my for loved ones, it's a horrible situation to be in. And then I developed panic disorder. Um, but a lot of my worries were around that, and sometimes you can't stop that. You know, if you you're gonna turn into the ruminator if if something serious is happening like that, uh, that's okay. You you're human, but a lot of the time with GAD on the flip side is that people are like, actually, I quite enjoy my life. I live quite a happy life. I just can't access that because of this chronic worry.

SPEAKER_05 17:26

Yeah, and I think when it becomes pervasive and it spreads beyond certain themes or certain particular issues, I attack everything like a problem to solve or fix or everything I have to worry about, think about, predict. That's when you that becomes that like, okay, maybe this is more of a thematic thing that goes wider than just a one particular life circumstance or context. And from, I could tell you, as somebody who's being drilled in these diagnostic techniques now in my my training, yeah, we are trained to look at that first. Is this explainable by life so that we don't automatically pathologize things? So I really like that you brought that up.

SPEAKER_01 18:02

Yeah, definitely. And not to be too cynical, but with GAD as well. I know people that go to the doctor and say all these naturally anxious things and then and they're still given a GAD diagnosis anyway, without, you know, without common sense. Again, not bashing doctors, and not everyone does this, but you know, people are different, uh, and attitudes towards mental health are different, and doctors are gonna know a hell of a lot about your body and thousands and thousands of anxious, uh, I mean not anxious, but like physical presentations, and then expected in a 10-15 minute talk to get to the bottom of your mental health issues as well. I think it's unfair, but you know, and I just thought um I'd kind of make sure we mention that.

SPEAKER_05 18:41

Yeah, it's important. Why do you think the they we started with our little ruminator skit, which we just had so much fun making, by the way? Thanks for indulging us. But why do you think people worry and ruminate? What's the point of worry and rumination? What are you trying to get out of that?

SPEAKER_01 18:56

Well, it's a good tool for us. It's part of, you know, when we did the very early episode on the threat response, um, being analytical, scanning for threats, um, was really is advantageous for us all. You know, if I'm walking home at night and my anxious response kicks off and says, You don't really want to walk through that dark park in front of you. What if you get mugged? What if you're followed in there by a stranger? Well, actually, that's helpful. Actually, yeah, those are possibilities, albeit, you know, still maybe slim. Maybe it's sensible. I don't do that, and therefore it changes our behavior. You have an outlook for this executive function, which is okay, I take that into consideration. I've rationalized, yeah, I'll walk around the park, you know, and lo and behold, yeah, there was a weirdo waiting in there, you know, to steal my mobile phone. You know, really advantageous to have that worry as I'm walking up to the park. Um, but with GAD, a lot of these worries don't have a solution, you know, or it feels like there's a solution because that's what the mechanism in the brain says, but there isn't, you know, and you know it's GAD when you're worrying about the same thing for days, weeks, months on end, or it's just flitting with the same urgency, importance, and intensity. So it always starts with a what if, and that's gonna feel just as urgent, important, and in and intense as it was to a worry that you don't really care about that you had last year.

SPEAKER_05 20:25

Yeah, yeah. I think that I worry or I ruminate because is a way that I can start to feel safe. Like I think I think that gets me to safety, or more accurately makes me feel like I'm doing something to be safe, or it makes me feel like I'm controlling or predicting or keeping or being vigilant. And I think I'm supposed to be like that. I think a lot of times it it does start to you know mix in with that whole sort of uh personal identity thing. No, I'm I'm a fixer or I'm a loving parent, so I'm supposed to worry about my kids. Don't tell me not to worry about my kids. I hate that I do it so much, it's making me sick. But also don't suggest that I not do that because I'm a loving person, I'm supposed to. So sometimes people, those habits that you hate can also be worn as a bit of a badge of honor. It confirms that I'm capable and confirms that I'm the person in control, I'm the go-to, I'm the loving person, the good person. This gets really sticky and tricky sometimes.

SPEAKER_01 21:20

Yeah, it is sticky. And if you if you do struggle with GAD, you know, well done for getting through each day. It's courageous, it's brave. Uh, and Drew and I on this podcast, so we're here to to kind of talk you through it. I've been no stranger to GAD. Uh and I'll be the first to admit that and I'll ask pose this question to you, Drew. How much of GAD, how much does habit uh play a part in GAD?

SPEAKER_05 21:47

I I think a lot, because I think that these are cognitive habits that we develop that we think are good. And then I I know I keep saying this again and again again, but then once in a while we realize, oh no, this is not good. But the feeling that the habit is so ingrained and it's automatic and it that's what gets you safety and certainty and control. Yeah. And that's a hard habit to break. Really hard.

SPEAKER_01 22:09

And that's the moment you get the cape out. Yep. And you do the clock and you rip the shirt off and the the the big R. The ruminator is on the chest. Yeah. Like, don't get me wrong, that problem solving fixer part of you is always part of you. And it's done to you've done it thousands of times in the past to help you, to help loved ones, to help friends, to problem solve, to get through your career. Brilliant. But that's you. The ruminator steps in, your ruminative self steps in when there's an issue that deep down you know worrying about it doesn't help. Um, and I know it feels like you can to chase that illusion of control, but it doesn't, you know. And this you always see those memes, don't you? Like me when a friend says just don't worry about it. And and you're like, Well, I'm I'm cured.

SPEAKER_04 23:06

Yeah, thanks. Thanks for telling me to not worry about it. It doesn't work for you, guys.

SPEAKER_01 23:10

It doesn't matter. We understand and feel how strong that habit is. Because one, it is a habit, yeah. But but two, you've got the threat response and the adrenaline telling you that you know, there's be urgent, do this. You've got the symptoms that don't feel nice and the discomfort. But that's with God, that's the moment where you've got to go, nope, buttons are back up, cape's back in the garage. I'm not stepping in here. No, no one called the ruminator. I need to kind of work where my focus is and look what I'm doing with my behavior.

SPEAKER_05 23:43

Yeah, and there is, you know, we come back to willful tolerance all the time. In that situation, I think one of the reasons why a lot of people, and I'm in that camp for sure, can mix GAT an OCD, is the worry and the rumination are compulsive. It's not something where somebody says, Oh, just chill out, dude. Oh, thanks. I'll just chill out. You want to chill out, you just can't, because not worrying and ruminating feels risky and dangerous and uncomfortable and all of those things. So you will, when Josh says button back up, put the ruminator away, he doesn't get to show up right now. That's going to feel uncomfortable, risky, reckless, wrong, like all of those things. No, no, we need the ruminator. I like to use the fire department analogy sometimes. Imagine if you spilled a glass of water on your countertop in your kitchen. That's not a thing. But yet every time that happens, the entire fire brigade comes rolling up to your house with sirens and lights and ladders and you know, like uh hoses and axes. All right, we got this. And they push you out of the way and they mop up the spell and then they leave. Then they do it again. You're like, wait, I didn't need all that. But but there's such a hubbub around it that it feels like, well, maybe I did, and they keep barging in every single time there's a minor thing. We got this. That's your ruminative and worry habits. We got this. This is for us, we'll take care of it. No, no, no, no. It's just a that's what it's okay.

SPEAKER_01 24:58

Yeah, that's a great analogy. Also, it made me think about, especially with GAD, is that I'd ref if you got GAD, reflect on how how many of these situations would have kind of turned out okay without you ruminating. And it's usually the vast majority of them.

SPEAKER_05 25:18

Yeah, that's when that metacognitive awareness of the ruminating in worry, I'm aware I'm doing it and I don't like it, and I wish I could stop because I can see that it's not actually productive. It didn't do anything. Yet when you're triggered again, you will go back into that, and that's when you get the I can't get out of my head. Like I like I can't help it. I just do that automatically. True. That is a default reaction, but once you become aware of it, then what do you do?

SPEAKER_01 25:43

Yeah, yeah, yeah.

SPEAKER_05 25:44

And then what you do? That that's when it's the willful tolerance is I'm gonna have to leave that question unanswered or even unasked. I'm gonna leave that worry unattended to for a while. Oh boy, that's uncomfortable.

SPEAKER_01 25:58

That's the literal willful tolerance of uncertainty.

SPEAKER_05 26:01

Right there, exactly. And I think it needs to go again.

SPEAKER_01 26:04

So it feels like you've turned your back on high stakes.

SPEAKER_05 26:06

Right. It's it really does. Um, one of the old episodes I did of The Anxious Truth was called Learning to Live Recklessly, but in parentheses, but not really, because it feels super recklessly learning to live recklessly.

SPEAKER_01 26:17

Yeah, but not really 150 miles an hour to work, you know, drink bleach for breakfast.

SPEAKER_05 26:24

Yeah, for people that are dealing with GAD, I I think it feels that dangerous to them. Like it is a threat to their personal identity. I'm no longer the loving person if I don't actively worry. I'm I'm no longer the fixer if I don't stay on top of things. Who am I if I'm not the person that has the hotel reservations nailed down two years before the trip? Because I'm that person. I'm ahead of the game. I'm better than I did it better. I've heard all of those very specific examples in my community. I worry about we're going to the cinema in three days. I worry about parking before we in three days before we've even left. I'm thinking about where we're gonna park. You know, we're going on a family trip in eight months, and if I don't have the hotels nailed down today, I'm failing because I'm the person that nails that stuff down. Look, it's done. Look, I did it, it's done.

SPEAKER_01 27:14

Like that's a good because there's evidence, isn't it? Some kind of weird evidence, like I'm here, everyone's safe. Yep, nothing's fallen apart. Yeah, well, that means you know, I can't discount that all my worrying rumination, correct, which is uh is bad. Because look, ultimately I'm safe, and that's what the threat response your job's done. Correct.

SPEAKER_05 27:37

It looks like it worked, or looks like it worked in the family holiday, the family vacation, you know. I was actually in that conversation with somebody who was nice enough to share about that, and it was, you know, yeah, but everything went smooth. We didn't have stress, we didn't get delayed, we didn't have to think about where we were staying. Oh, so that's proof that if you hadn't driven yourself to near madness to get those hotel reservations nailed out today, if you hadn't done that, the whole trip would have fallen apart. Oh, yeah, yeah. Maybe it wouldn't have, maybe it would have worked out fine. If it would have taken me three more days to do the hotels, yeah. But it's like self-reinforcing. See, everything turned out great because I did that.

SPEAKER_01 28:15

Yeah. Yeah. Yeah, it's almost almost like it's a safety object in itself, isn't it? Where you don't you don't get the credit, yeah, because that behavior, the mechanism of ruminating, was kind of lost in the whole process. So we invite you to be like, well, let's see if things happen well without me doing that. Small experiments a little bit at a time to start to prove that actually, you know, this leap into uncertainty still led to a positive outcome.

SPEAKER_05 28:47

I love that you use the word experiment because EX starts with EX, so does exposure. How many times a day do you hear? But my problem is GAD. What are exposures for GAD? I get asked every single day. What is the exposure for GAD? But Josh used the term experiment and they're almost interchangeable. What do you what would an exposure for GAD be?

SPEAKER_01 29:07

Uh an exposure for GAD is whatever you're doing, and I always uh say do commit to what non-anxious you is doing, but whilst parking the need to worry and ruminate on something. Now, with GAD, you're gonna be pulled back in through habit. So you might catch yourself worrying and ruminating, and that's the point where you can passionately and kindly say, Well done, I don't need to worry about this now. I'm gonna park it for as long as I can. Yes, my brain will flip back to the worry maybe 30 seconds later. Keep catching, keep redirecting. Because what you're doing is that you are lowering the amount of time you're ruminating. You can't just stop worrying, you can't just stop ruminating. Nope. But you can a little bit at a time start to change these habits. And it's a double win because you don't get to worry all the time, and you're practicing the skill, you're creating new neuropathways, you're doing lots of um good things, and you are changing the association with stopping and going inwards and stopping and going straight into your head. Oh wow. And the brain and the amygdala starts to go, right? Yeah, actually, things get done without this cognitive intervention that we've done for years, maybe all our life.

SPEAKER_05 30:22

Yeah, that's a good point. I I I always like to say grossly oversimplified, but GAD health anxiety OCD is usually the exposure is not doing, whereas maybe somebody with panic disorder agoraphobia is doing. I have to drive, I have to walk, I have to no, no, for GAD and for GAD, it's not doing. And it's people will say, Well, I I don't have to worry about this, just stop worrying. Well, you can't, you will be worried. But that's like an MCT. What can you do while you're worried? You know, what behaviors can engage in? What else can you engage with in the world? Preferably something that has had value of you while value for you while you are worried, you will be worried. You can't not just you can't turn off worry, but you can take it with you instead of trying to fix it. What would happen if you did that for today?

SPEAKER_01 31:05

Yeah, and you can't stop habit as well, correct. You know, if you if you're a lifelong passionate line dancer and someone's asked you to do the waltz, you're gonna, you know, you start doing the waltz of someone, but the habit will make you suddenly fall into line dancing again. Trust the analogy, and uh, and yeah, you're like your footsteps are gonna be wrong because how long have you been doing that type of dancing for? And now you've been taught to glide and do this and move in a different way. It would be impossible for you to try something new when you're on the dance floor, as opposed to, you know, because it's uh a lot of it's mechanical, a lot of its habit, the neuropathways are there. What you're doing is actually I can learn both. So you know, I uh you know, I might be doing good at doing the salsa, but now I'm going to do the American smooth, you know, and it's because and it's learning and teaching your feet. And while you're doing the American smooth, you might find yourself popping into salsa dancing again. Yeah, yourself. No, I'm doing the American smooth. See, I made something out of this analogy.

SPEAKER_05 32:12

Yeah, I think you pulled that out of the fire really well. That was the best recovery we've had on disordered in a long time that worked out really great.

SPEAKER_01 32:18

It was a great line dancing.

SPEAKER_05 32:20

And you know, it speaks to because you know me and my line dancing, it's all I do. As soon as mic goes off, boom, I'm line dancing. I can't help myself. But uh, and that's tough because that's habit. You're breaking, you're you're oh you're basically building a habit in parallel to the old habit and practicing the new one until it becomes a little bit more natural than the old habit, which is freeze, sit still, stop, and make my thoughts the most important thing. My worry, my fear, my uncertainty has to become the most important thing. What if it's not?

SPEAKER_01 32:50

It's that mechanism. There's proof in the pudding. That mechanism, I mean, think about it. Every time you're fully immersed or distracted by something, maybe it's something at work, maybe it's something you're doing a fun activity, maybe you're completely distracted by your friends and family. Something where you're entirely immersed. How anxious are you? You know, and this goes back to the distraction episode that we did early on. How anxious are you? Oh, actually, I wasn't really anxious at all. Well, look what happened when you're fully engaged and immersed in something, you suddenly weren't doing the habit that you did throughout the day. And I say that to show you that actually look how much our own attention and volition plays a part in GAD.

SPEAKER_05 33:33

Yeah, and I think a lot of people with GAD will do the old like, okay, well, I understand like other people have to get out and do things. My problem is when I stop, because sometimes you recognize that if my brain gets occupied by something else, a shiny thing, then I get some relief from my worry and my rumination and that discomfort. So I will try to load my days up completely with activity to distract myself because if I have to sit quietly for an hour on a Sunday afternoon, oh boy, here comes the gad, here comes the thinking, I can't get out of my head. So but you'll see it as accidental. If I can just load things up and not give myself a choice, I get some relief. Okay, well, this is the experiment that Josh was talking about. What if I do that intentionally? And I say, well, while I'm feeling all this way, let me do some things that the other things that's in MCT, like they there's behavioral activation as an alternative to just thinking by default. And it's, you know, there's a lot of good research on MCT. I mean, and you know, we use bits and pieces of different modalities, but metacognitive therapy is shown to be really effective in lessening GAD symptoms and worry and rumination over time because you replace the thinking with other stuff that seems like you shouldn't do. But lo and behold, you learn that, oh, it's okay. Look at that.

SPEAKER_01 34:45

Yeah, I I I love metacognitive therapy uh as a principle. I think sometimes it's if I've heard anecdotal could be quite dry and robotic, but the principle and theory behind it is fantastic because it teaches you how much of an effect your own cognitive processes um uh have on you and have on how you on how you feel. Um a note as well with Gad is that it can often be tied to other things, so like productivity anxiety, which we'll definitely do an episode on. Yeah, uh feeling guilty when we're not feeling productive, it can tie into our self-esteem, it can tie into conventional anxieties about our identity, um, when our stress builds up and up and up, that threat response will not just fire off for no reason. And sometimes GAD can tie into those things as well, um, which is often where I find when people with GAD, if they go to almost like conventional talking therapy, just having someone to talk about their problems with and their stresses with, you find that the symptoms of GAD can often come down because it's less stresses, less triggers, uh, and often their sense of self may change, particularly if there's esteem issues.

SPEAKER_05 35:56

Yeah, sometimes talking about that stuff out loud, and this is tough because you know, we often talk about like, well, the habit of always bringing your worry to the forefront is not so good. But if you can be open enough to talking about what you're worried about with somebody and let that reflection come back at you, the person who can say, Oh, I understand why you're worried about that, but there's I have no answer for you, or there's nothing we can do about that. Sometimes just putting that out in the open as opposed to leaving it silently in your own head. So you just keep going back and back. I've heard people say, Oh, that helps me a lot, or I keep a worry journal. I I indulge my worries for 15 minutes every night in my journal, and sometimes that helps alleviate that. I got it out, I saw that there was nothing I could do about this, and I gave myself permission to move on for a while. Got sucked back in the next morning, but okay, I'm learning. Yeah, so there's a lot of different ways to do that.

SPEAKER_01 36:45

Yeah, and if that works for you, it's great. If you're doing it compulsively, don't that's a problem. Yeah, yeah, yeah. And and again, it's it's quite like GAD is a big umbrella, and we'll do more stuff on GAD and particular and sending you questions as well. If you do have questions about GAD, um, because if it's specific to you and your worries, then we can answer more on them. But because it's such a wide umbrella, um, you know, we we have to do kind of you know to discuss it in quite general terms.

SPEAKER_04 37:12

Yeah, that's true.

SPEAKER_01 37:13

Yeah, I'm looking at the time now. We like to again engage the community a bit more.

SPEAKER_02 37:19

Yeah.

SPEAKER_01 37:20

Um, shall we have a question?

SPEAKER_05 37:22

Okay, so the question that I had is interested. It's a question about uh interest interesting question about projected anxiety. And the question is, I'm 32 years old and I've been living with GAD as long as I can remember. This is perfect for this episode. Over the past year, I've been trying to understand this disorder and identify with my triggers are. Tell me you have GAD without telling me you have GAD. During this journey, I have been entertaining the idea that my anxiety is not actually my anxiety at all, but my mother's anxiety that has been projected on me over the years. I'm still trying to understand my thoughts and emotions, so I can't tell if this is real or me just coming up with an explanation for why I feel the way I do. Are there any steps that I could take that will help give me more clarity on this? Also, if the anxiety I harbor is in fact my mother's anxiety that she is making me hold, what exposures can I do to help me overcome this? Then he goes on to thank us for her work. Thank you. You're welcome. Glad it's helpful. What do you think about this one?

SPEAKER_01 38:14

Uh, it's a good question. The first piece of advice I do is to not compress your anxiety into a singularity. You know, oh, it's something that my mother gave me, like, you know, and I'm now I'm holding it. Uh, I know a lot of therapists kind of use that speak, and if you want to do that, that's okay. But if you have an anxiety disorder, I will find that those narratives are quite difficult. Um, could it play a part in your anxiety? Yeah. I mean, and obviously we genetics plays a part, you know, you inherit nervous systems from your parents, and yes, there's evidence to suggest that we that we copy uh some behaviors, you know. Um, if your parents are anxious, then more likely than you're going to be anxious. But I just be I just be aware of how you're formulating it. You know, you're trying to put it into one small neat box because when something's in one small neat box, you can fix it and throw it out. Whereas with Gad, you know, uh you're a ruminator. And it may be, just maybe, and I don't know too much about it, but maybe, even through the question, a lot of what's going on has encouraged this rumination. What if it's my mother that's doing this? What if it's something that my mother's passed down to me? What if I've inherited it? What if it's not that? What if it's something else? What if it's this? What if it's stored emotions I'm holding? What if that? Yes, definitely like kind of talk that through in therapy if you need to, but just be careful not to try and compress it into one thing to fix. When actually a lot of what GAD is is the rumination keeps us ticking over and ticking over and ticking over.

SPEAKER_05 39:45

Yeah, I agree with that. I I think there's a lot of clues here. Again, we can't, we don't know you personally. Of course, we can have a general answer to this, but sometimes I think it some of the clues could be in the nature of the question, too. I've been trying to figure this out. Now that's a thing that I hear from the GAD crowd, ground ground people all the time. Like, I can't figure out why I'm like this, you know, and I need to know. If I if I know why, then then it'll all go away. I'll be able to fix it. That's how I solve the problem. But but does that look like the way you approach everything in your life? And maybe it is related to your mom. That's certainly possible. And we're not saying that it's not, but what would be different if you discovered that yes, this is your mom's anxiety that she has given you to hold? Okay, so you what are you gonna do with it now?

SPEAKER_01 40:26

Yeah, yeah, okay. I've we we've got to that now. What you know, what do we do? Right. Do we resent mom? Do we kind of do that? What what do we do? You know, and and again, it's just another this is just a uh uh kind of cautionary uh advice for me. It's just be careful of some of the narratives out there as well. Uh, we've spoken about other narratives as well, because that can kind of get sucked into this whole fixing perfectionist. I need to completely rid myself of things which which for people with disordered cyclical anxiety can be can just feed rumination.

SPEAKER_05 41:04

I think that the the use of the language, just to add one more thing here, she gave it to me to hold. That has that sort of very, you know, again, you pick whatever therapy you like, but that speak we hear all the time. Okay, so let's say she did. My mother gave me this to hold. So what are you gonna do? Drop it. And if you are gonna try and drop it, it it looks a whole lot like what Josh and I were talking about 10 minutes ago. I'm going to drop that worry on the floor, but you're still probably gonna feel it. That's become a habit. So maybe you can conceptualize it as I'm gonna drop the anxiety that my mother gave me to hold, but you're still probably gonna go through the same process that we've been talking about. Yeah, it's gonna look very similar.

SPEAKER_01 41:44

So or you could do keep Ps with it. How many can you do? Like a foot, right foot, you know, around the world. Um, yeah, I mean it's it's up to you. Thank you for the question. Thank you for um how open and honest you were about that as well. It's a really good question. Uh I I have well uh I've got a did it anyway to share to share where at a time. Um hi Josh and Drew. I recently discovered disordered after having listened to many of Drew's Anxious Truth podcast episodes, and I've been really enjoying the new podcast and getting so much out of it. Thank you very much. I have a did it anyway to share. That's not from me, but my 10-year-old son. The other day, while we were driving home, he wanted to stop at our local small grocery store to buy one of his favorite drinks. I gave him some cash and asked him to go in and purchase it on his own. While this filled him with fear and anxiety, I stood outside watching while he went into the store. He picked up his drink, stood in line, paid the cashier, and walked out. He was shaken up afterwards, but I told him he was very brave because even though he was afraid, he did it anyway.

SPEAKER_05 42:56

Oh, if that if anybody needs a superhero music, it's this.

SPEAKER_01 43:00

Oh yeah, that's so good.

SPEAKER_05 43:02

Total superhero stuff right there.

SPEAKER_01 43:04

Love it. Very courageous. Well done, young man. Well done.

SPEAKER_05 43:08

Yeah, yeah, very good. And you know what, mom, good on you for being proud of your son and advocating for him and sharing that win.

SPEAKER_01 43:13

I appreciate it. Oh, yeah, excellent. And you're almost almost encouraging him to be anxious for it doesn't become a thing.

SPEAKER_05 43:19

Yeah, that's such a great lesson to teach a kid, especially if you're out there and worried. A lot of gad people worry about this sort of stuff. You know, am I gonna pass it on to my kid? That's a great way to respond to that fear. Go do something scary. I know you can handle it, son. And he did. Outstanding. Very good. All right, guys. Thanks for hanging in there with us today and letting us be silly with the ruminator skin in the beginning and sending in your questions and listening to us talk about Gad. We'll definitely do more on this for sure.

SPEAKER_01 43:43

Yeah, yeah. Got any questions? Send them into disorder.fm. And he did it anyways. Same website. You can record voice notes and stuff. We'd really appreciate any podcast reviews as well, particularly on Apple or Spotify. And yeah, we'll catch you soon. Yeah, thanks for listening, guys.

SPEAKER_05 43:58

We're going out with dramatic music today. See you next week.