CBT for Generalized Anxiety Disorder After the Physical Symptoms Have Gone

Reader’s Question

I’m in my mid-twenties, and I live in Belgium. My psychiatrist diagnosed me with GAD (Generalized Anxiety Disorder) over a year and a half ago. At that time I did have physical symptoms, but for the last half a year, the physical symptoms seem to have gone. I still worry, however — day in day out. I worry about my mental health, about my relationship, about getting a job, etc. Is it possible to have GAD without obvious physical symptoms? I do feel irritable, restless, and on edge, and my thoughts race and sometimes get jumbled. I’ve got depersonalization and derealization, and my memory seems like it is declining, I can’t concentrate all too well, and my thoughts get stuck on past events and so on.

I feel like a failure in general and like I won’t be able to find a decent job that I’m good at. It makes me not even want to search for one, because I’m scared I wouldn’t be able to do a good job. My psychiatrist said I do have some depressive traits as well, along with obsessive thoughts and GAD. But is it really possible to have GAD without experiencing physical symptoms? Am I just totally messed up? I’ve always been a thinker and a perfectionist, and I know that’s working against me in recovery. Maybe I’m just a worrier and I will be like this forever? Or maybe I’m having a more serious mental illness without anyone but me noticing it?

Thanks for reading this. I’m really looking forward to an answer.

Psychologist’s Reply

A host of psychological problems often accompanies GAD, and some of those problems can exacerbate sufferers’ anxiety and depression. Hopefully, you and your doctor are not just taking a strictly medical approach to dealing with your difficulties. Medicines can be particularly effective in reducing the “physical” manifestations of anxiety. Combating the tendency to worry too much, to be overly hard on yourself, and some of the other tendencies that only fuel anxiety and impair performance is another matter entirely. Fortunately, there are some generally accepted and powerful treatment methods available to deal with these problems. Chief among these are the cognitive-behavioral techniques that help you recognize and change the kinds of thinking that fuels worrying behavior. If your psychiatrist is not well-versed in non-medical therapies, perhaps you can get a referral to a therapist who is and who will work in tandem with you and your psychiatrist to provide you with comprehensive care.