Generalized Anxiety: The Logic of Unending Gloom

I am sure there is a reason why things keep going the wrong way. Once my grandmother told me that I looked like someone who would never be happy. I still remember her saying that, her tone of voice was so… matter of fact. All I have to do to believe her is to look at my relationships: it’s like looking at a trailer park after a tornado. (…) Oh my so-called career… let’s not even go there. (…) I had so many dreams when I was a kid. Where have they gone? I can’t even dream anymore. Heck, I can’t even sleep. (…) And my health! Every bone in my body screams bloody murder… I panic just thinking about going somewhere. (…) Why can’t I just be happy?

These statements (taken from a variety of similar cases) are representative of the way of thinking that is characteristic of individuals suffering from a stress disorder. They are so categorical–and, in the patient’s view, so logical–that anything anyone could say or do would appear to be just another futile attempt at fixing the irretrievably broken. The gloom can be so palpable and real that it falls over the therapy room like a cloak.

vanGogh_1889_StarryNight_MOMANY The apparent logic of these statements requires the experienced therapist to apply a judicious dosage of empathy and attunement while gently challenging their validity, in order to establish a positive therapeutic relationship.

Unfortunately, this type of personal narrative is not uncommon. In fact, most individuals who come in for help on issues of depression, anxiety, and stress disorders have a similar presentation. In some cases, the symptoms are focused on a specific stressor, but in many cases

there is a generalized pessimism that pervades the patient, such as in the compilation of quotes from different cases that I cite here.

Current models on this type of psychopathological self-assessment identify two core cognitive factors, i.e. two types of thoughts, that appear to be formulated very frequently. The first type of thought is a consistently negative appraisal of life’s events and their aftermath. The second type of thoughts are produced by disturbances in autobiographical memory, which means that the individual preferentially (albeit without explicitly choosing to do so) stores and retrieves negative memories more frequently than positive ones.

There is ample research to indicate that individuals who suffer from stress disorders routinely exaggerate both the probability of future negative events occurring and the adverse effects of these events on their general well-being. To add to the misery of this condition, they also frequently display cognitive biases (expectations) for events related to external harm (“I see danger in just about everything and anyone”), pain and illness (“Yesterday I had this new pain…”), and social concerns (“I don’t think people really like me”).

What can be done to help? Individual psychotherapy using a cognitive behavioral approach appears to produce excellent result, as it is designed to address both cognitions (the individual’s way of thinking) and behaviors. Clearly, a change in thinking is necessary and a sine qua non of producing any lasting change. It is a delicate and complex therapeutic approach, as it must penetrate below the surface (top-of- mind thoughts) and go to the deeper beliefs of the individual (“here’s who I think I really am”).

The outcome of treatment with this type of condition is generally quite good. In one particularly challenging case, it took approximately five months and twenty plus sessions to introduce the idea that what was needed was a healthier dose of skepticism—not about whether life could be better (there was enough skepticism about that to begin with), but that the individual’s personal narrative may not have been entirely accurate. After that, the prognosis became significantly better.

“Doc, you’ve made me doubt my ability to think clearly about what’s going on in my life. You make me think that maybe I’m wrong thinking this way about me.”

Yes, that was exactly the idea.