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What Keeps Generalized Anxiety And Worry Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, they provide an easy way for clients to understand at a glance why their disorders persist, and how they might be interrupted. What Keeps Generalized Anxiety And Worry Going? is designed to help clients experiencing GAD understand more about their condition.

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A PDF of the resource, theoretical background, suggested therapist questions and prompts.

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A PDF of the resource plus client-friendly instructions where appropriate.

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An editable Microsoft PowerPoint version of the resource.

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It is common to worry sometimes, but if you worry too much it can feel exhausting and may affect your health. Psychologists call this Generalized Anxiety Disorder (GAD). If you have GAD, you may feel:

  • Worried
  • Anxious
  • Nervous
  • Tension, aches, or pain in your muscles
  • Restless or sleepless
  • Distracted
  • Easily irritated
  • Easily fatigued
  • Unable to control your worries

Research studies have shown that Cognitive Behavioral Therapy (CBT) is one of the most effective treatment for GAD (Cuijpers et al, 2014). CBT therapists work a bit like firefighters: while the fire is burning, they aren’t very interested in what caused it, but are more focused on what is keeping it going. This is because if they can work out what keeps a problem going, they can treat the problem by ‘removing the fuel’ and interrupting this maintaining cycle. 

Psychologists Tom Borkovec, Michel Dugas, and Mark Freeston are among those who have identified key components that explain why some people keep suffering from GAD. The What Keeps Generalized Anxiety And Worry Going? information handout describes some of these key factors which act to maintain GAD. It illustrates them in a vicious flower format in which each ‘petal’ represents a separate maintenance cycle. Helping clients to understand more about these processes are an essential part of cognitive therapy for GAD. Therapists can use this handout as a focus for discussion, or as a template from which to formulate an idiosyncratic model of a client’s experiences.


“One interesting way of thinking about GAD is to look at why, for some people, it does not get better by itself. This handout shows some of the most common reasons why some people’s worry persists. I wonder if we could look at it together and think about whether it describes some of what is happening for you?”


  • Borkovec, T. D., & Inz, J. (1990). The nature of worry in generalized anxiety disorder: A predominance of thought activity. Behaviour Research and Therapy28(2), 153-158.