Understanding generalised anxiety
Understand how worry works, why uncertainty feels difficult, and what can help.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Understanding generalised anxiety
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Generalised anxiety and the worry habit
Generalised anxiety disorder (GAD) means frequent, hard-to-control worry across several areas of life. It can bring tension, tiredness, poor sleep or trouble concentrating. It is more persistent and disruptive than everyday concern, not a personal failing.
Problem-solving names a current difficulty and chooses an action. Worry follows one possible future problem with another: "What if that happens too?" Thinking continues without a useful next step. Real problems still deserve practical help.
Why worry keeps itself going
Worry may feel useful: preparing you or showing you care. If trouble does not happen, you may credit worrying. Yet it can feel uncontrollable, leading to worry about worry. Trying to force thoughts away keeps attention on them.
Uncertainty means not knowing for sure. If that feels unacceptable, you may check or seek reassurance. Brief relief gives way to fresh doubt. You miss chances to learn you can make choices with uncertainty.
Ways to change the pattern
With your therapist, separate practical problems from imagined possibilities, explore beliefs about worry, and try small steps with uncertainty. With your therapist, identify repeated checks or requests for reassurance that keep worry going, and agree gradual changes. Keep necessary medical checks, practical safety steps and support for disability in place. The aim is choice about responding, not eliminating worry.
When to seek support
Speak to your GP or therapist if worry disrupts daily life. If overwhelmed, pause and use your agreed therapist contact. Use local urgent care if help is urgent and they are unavailable.
This worksheet is for feelings you can manage. If you have urges to hurt yourself, or you feel unsafe, use your safety plan if you have one and tell your therapist. If you might act on the urges, call 999 or go to A&E. To talk to someone now, call Samaritans free on 116 123.
Your question
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When to use ‘Understanding generalised anxiety’
‘Understanding generalised anxiety’ is a psychoeducation handout based on cognitive behavioural therapy (CBT), most often used in CBT for generalised anxiety (GAD).
It is designed to be read within therapy rather than as a standalone self-help tool: a therapist introduces it and discusses it with the client. You can preview the full handout above, then assign it for clients to read between sessions on any device or download it as a print-ready PDF. Where a short reflection is included, it offers space to respond to the reading.
How it works
Most people work through it in around 10 minutes. It moves through five short sections to read:
- Generalised anxiety and the worry habit: Generalised anxiety disorder (GAD) means frequent, hard-to-control worry across several areas of life. It can bring tension, tiredness,…
- Why worry keeps itself going: Worry may feel useful: preparing you or showing you care. If trouble does not happen, you may credit worrying. Yet it can feel…
- Ways to change the pattern: With your therapist, separate practical problems from imagined possibilities, explore beliefs about worry, and try small steps with…
- When to seek support: Speak to your GP or therapist if worry disrupts daily life. If overwhelmed, pause and use your agreed therapist contact. Use local urgent…
- Your question
The handout can be read on a phone, tablet or computer, or downloaded as a print-ready PDF. If it includes a reflection, answers entered on the Formulate platform are saved automatically and shared back with the therapist for review before the next session.
The CBT approach behind it
‘Understanding generalised anxiety’ introduces a CBT approach that involves noticing the links between situations, thoughts, feelings, physical sensations and behaviour and finding practical ways to change unhelpful patterns. The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This handout is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Dugas, M. J. & Robichaud, M. (2007). Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice. Routledge.
- National Institute for Health and Care Excellence (2011). Generalised anxiety disorder and panic disorder in adults: management. NICE guideline CG113.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
More Generalised Anxiety (GAD) worksheets
View all Generalised Anxiety (GAD) worksheets →Generalised Anxiety (GAD)
GAD Metacognitive Formulation (Wells)
A formulation based on Wells' metacognitive model of GAD — mapping the role of positive and negative beliefs about worry in maintaining the worry cycle.
Generalised Anxiety (GAD)
Worry decision tree
Work through a worry tree, one question at a time, to decide whether a worry is practical, with something you can do now or later, or a "what if" worry to let go. Adapted from Butler, Grey and Hope (2018).
Generalised Anxiety (GAD)
Worry classification worksheet
Sort your worries into practical ones you can act on and hypothetical "what if" ones, then choose a response for each. Based on Dugas and Robichaud (2007): it adds a "now or later" test from the worry tree, a "both" option, and refocusing or a worry period for "what if" worries.
Generalised Anxiety (GAD)
Tolerating uncertainty practice
Practise noticing and living with everyday uncertainty, so it gets easier over time. Write down what you fear, practise without trying to resolve the uncertainty, then compare what happened. Based on Dugas and Robichaud (2007): it adds a written fear and belief rating before and after each practice.
Generalised Anxiety (GAD)
Worry diary with postponement record
Write down worries as they come, sort them into practical and "what if" worries, and put the "what if" ones off to a set worry period. Based on Borkovec, Wilkinson, Folensbee and Lerman (1983) and Dugas and Robichaud (2007): it adds a next step for practical worries and a second strength rating at the worry period.
Generalised Anxiety (GAD)
Positive meta-beliefs about worry
Spot the beliefs that keep you worrying because you think it helps, look at the evidence, and test one belief with an experiment. Based on Wells (2009): belief ratings, evidence and an experiment, with a prediction and a rating before the test added.
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