Generalized anxiety disorder (GAD) is a chronic condition whose central feature is excessive anxiety and worry. People with GAD worry about the same sorts of things as people who do not struggle with anxiety – relationships, doing well at work and at school, and health. The difference is that people with GAD report that they spend a lot of time worrying, particularly about problems that haven’t yet happened and about uncertain situations. They also report worrying more than other people they know. People with GAD experience problems concentrating and sleeping and have difficulty unwinding, even when things seem to be going well in life. This group is also at risk for many health problems, including depression, gastrointestinal conditions (like ulcers), and cardiac problems. People with GAD report challenges in their relationships that come about because of their worrying.

When people with GAD worry, their thinking can look a lot like an internal monologue of “what if?” questions. Notably, when people with GAD are caught in a spiral of worry, they can have a hard time articulating exactly what it is that they are afraid will happen (for example, What if something bad happens? What if I can’t handle it? What if things fall apart for me?). Indeed, research suggests that people with GAD avoid thinking clearly and concretely about their worst fear coming true, and that this avoidance actually maintains anxiety, because people are not confronting their fears head on. Fracalanza, Koerner, and Antony at Ryerson University in Toronto, Canada conducted a study to see if teaching people how to write concretely about their worries may have therapeutic effects. There is growing interest in writing interventions because they are inexpensive, easy to deliver, and have been shown to have important health benefits.

In the Ryerson University study, published in the Journal of Anxiety Disorders in 2014, 57 participants meeting criteria for a diagnosis of GAD were randomly assigned (like flipping a coin) to one of three conditions in the experiment. In one condition, participants were asked to identify their worst fear and to write a detailed “story” about this situation coming true in the here-and-now, for 20 minutes, 3 days in a row. In another condition, participants were also asked to write about their worst fear coming true according to the same instructions, but to write about a different scenario on each of the 3 days. Participants assigned to the neutral writing condition wrote on each of the 3 days about what they would do if they had the day off. They were instructed to write in a factual, nonemotional way. This was the “control” condition, designed to sort out whether it is writing concretely about one’s worst fears, or merely the act of writing, that leads to therapeutic benefits.

Before the first writing session, and one week after the third writing session, all participants completed questionnaires measuring worry and related features. They also did a brief exercise in which they were asked to close their eyes and spend 30 seconds imagining their worst fear coming true. The results showed that people who wrote repeatedly about the same worst fear coming true benefitted the most– after 3 days of writing, these participants reported a large decrease in worry, less negative attitudes toward uncertainty, and a greater willingness to bring to mind images of their worst fear coming true; whereas, people who wrote about a different worst fear on each day, or about what they would do if they had the day off, did not show these changes.

According to Fracalanza and colleagues, it may be that writing about the same worst fear coming true several times gave people the time and the opportunity to arrive at a new and possibly a less threatening understanding of their greatest fear. The research group at Ryerson University is continuing this line of research to determine the best way to deliver the writing intervention. Before it can be recommended as a treatment for people with GAD, the group wants to do more studies looking at, for example, the optimal number and duration of writing sessions, and the mechanism of action.