Therapy for generalised anxiety disorder when worry never clocks off
Generalised anxiety disorder (GAD) is more than being a worrier. Therapy for generalised anxiety disorder in New York can help you loosen worry's grip on your days, your body and your sleep.
If you have spent months or years moving from one worry to the next, carrying tension in your shoulders and bracing for problems that rarely arrive, you are not overreacting and you are not alone. I offer trauma-informed care for GAD that combines psychotherapy, somatic work and medication support when it is useful, paced so you can build understanding and steadiness rather than simply white-knuckling through.
“Worry often feels like preparation, as if thinking through every disaster keeps you safe. In reality it keeps your body living in emergencies that have not happened.”
Therapy helps you notice when worry is doing the job of control, and find steadier ways to feel prepared.
Understanding generalised anxiety disorder, beyond everyday worry
GAD is defined by worry that is excessive, hard to control and spread across many areas of life, usually lasting for months rather than days.
Most anxiety has a recognisable focus: a feared situation, a specific trigger, a looming event. Generalised anxiety disorder is different because the worry moves. One day it is your health, the next your partner's silence, then work, money, a parent's ageing or a vague sense that something is about to go wrong. Solve one concern and another arrives to take its place. People with GAD often describe the feeling as a background radio that is never quite switched off.
GAD is also profoundly physical. Long-term worry keeps the body in a low-level state of threat, which can bring muscle tension, headaches, jaw clenching, fatigue, restlessness, digestive upset and unrefreshing sleep. Many people see several doctors for these symptoms before anyone connects them to anxiety. Recognising that the body and mind are part of one pattern is often a relief in itself, and it opens up ways of working that address both.
Because GAD tends to develop gradually, it can feel like personality rather than something treatable. You may have been called a worrier since childhood, or praised for being responsible and thorough when, underneath, you were simply frightened of getting things wrong. Generalised anxiety disorder is a recognised and treatable condition, and with the right support many people find that worry becomes quieter, less frequent and far easier to set down.
The 'what if' loop
A hallmark of GAD is the chain of 'what if' questions: what if I get ill, then what if I cannot work, then what if I lose the flat. Each link feels logical, so the chain is hard to interrupt. Underneath it there is often an intolerance of uncertainty, a deep discomfort with not knowing, and a belief that worrying is the responsible thing to do. In therapy we look gently at those beliefs, because loosening them often does more than arguing with any single worry.
Why a trauma-informed lens matters
For many people, chronic worry began as an intelligent adaptation. If your early environment was unpredictable, if you had to anticipate other people's moods, or if you have lived with discrimination or instability, constant vigilance once made sense. A trauma-informed approach respects that history. Rather than treating worry as irrational, we explore where it learned its job, and help your nervous system discover that it can now stand down.
Could this be generalised anxiety?
Only a proper assessment can tell you whether what you are experiencing is generalised anxiety disorder, but these are some of the patterns people with GAD most often describe. If they have been present most days for several months, it is worth exploring them with someone who can look at both the psychological and the physical side.
- Worry that jumps between topics
- Months of feeling keyed up
- Tight shoulders, neck or jaw
- Tiredness that rest does not fix
- Mind going blank under pressure
- Difficulty tolerating uncertainty
- Over-preparing and over-checking
- Lying awake rehearsing problems
- Feeling unable to switch off
- Worrying about worrying itself
Collaborative, paced care for chronic worry
My approach to generalised anxiety disorder is collaborative and unhurried. We work at a pace that builds genuine understanding and regulation, combining several methods so that both the worrying mind and the tense body receive attention.
Mapping your worry
We start by charting how your worry works: its favourite topics, the times it peaks, what it promises you and what it costs. Seeing the pattern laid out often reduces its power and shows us where to intervene first.
Exploring worry's purpose
Using psychoanalytic and relational approaches, we explore what worry has been doing for you, perhaps keeping you a step ahead of disappointment or holding feelings that are harder to face. Understanding its function makes it easier to let it rest.
Living with uncertainty
CBT-informed exercises help you notice catastrophic leaps, experiment with postponing worry and gradually build tolerance for not knowing. The aim is not perfect certainty, which nobody has, but a calmer relationship with uncertainty.
Releasing held tension
Chronic worry is stored in the muscles and breath. Somatic work helps you locate where you brace, soften it and develop daily practices that lower your baseline level of arousal, so you are not starting each day already halfway to overwhelm.
Medication review and prescribing
Some people with GAD find medication helpful, particularly when worry is severe or long-standing. I can assess, prescribe and monitor it, or review what you already take. Any change is gradual, carefully monitored and decided together.
Sleep and daily rhythm
GAD and poor sleep feed each other. We look at evening routines, caffeine, screens and the habit of problem-solving in bed, and build realistic changes that give your nervous system a better chance to recover overnight.
How generalised anxiety differs
Everyone worries. The difference with GAD lies in how much, how often and how hard it is to stop.
Ordinary worry
- Linked to a specific, real problem
- Eases once the issue is resolved
- Can be set aside when needed
- Proportionate to the situation
- Little lasting effect on the body
Generalised anxiety disorder
- Moves restlessly between many topics
- Persists most days for months
- Feels impossible to put down
- Larger than the situation warrants
- Brings tension, fatigue and poor sleep
Your path through GAD treatment
Each stage is shaped around you, and nothing moves faster than feels right.
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1
Free consultation 15 minutes
A brief call to talk about the worry you have been carrying, how long it has been present and what you hope will change. It is also your chance to ask about my approach and see whether working together feels right.
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2
Thorough assessment 90 minutes
We look at your worry in depth alongside your physical health, sleep, history, relationships and any previous treatment. This helps clarify whether GAD is the best description of what you are experiencing, or whether something else is also involved.
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3
Shared treatment plan
Together we decide which combination of psychotherapy, somatic practice, lifestyle changes and, if wanted, medication makes sense for you. I explain my reasoning clearly, and you are free to question any part of it.
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4
Steady, regular work 60 or 90 minutes
Over time we practise new responses to worry, release held tension and explore the roots of your vigilance. We review progress together and refine the plan as your worry begins to loosen its hold.
Francesca Rome-Marie, PMHNP-BC
I bring together psychiatry, psychotherapy, somatic work and whole-body health, informed by years in primary care and further study in gender theory, feminist thought, culture and visual art.
I keep a deliberately small caseload so that every client receives consistent, unhurried and genuinely attentive care, held within one relationship rather than split across several providers.
Clear, upfront rates
I don't accept insurance. Modern Holistic Psychiatry is an out-of-network provider, so sessions are paid for directly. Depending on your plan, you may be able to claim reimbursement through your out-of-network benefits.
Find out how much your insurance may coverNeed urgent support? If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.
Therapy for Generalised Anxiety Disorder FAQs
What is the difference between generalised anxiety disorder and normal anxiety?
Normal anxiety is usually tied to a particular situation and settles once it passes. Generalised anxiety disorder involves worry that is persistent, difficult to control and spread across many areas of life, typically present on most days for several months. It often brings physical symptoms such as muscle tension, fatigue and disturbed sleep. A careful assessment can help clarify which description fits your experience best.
Can you diagnose generalised anxiety disorder?
Yes. As a board-certified psychiatric nurse practitioner I can carry out a full psychiatric assessment and, where appropriate, diagnose GAD. I see diagnosis as a useful map rather than a label that defines you. It can help guide treatment choices and support out-of-network reimbursement claims, but our work always centres on your lived experience rather than on a category.
What does therapy for generalised anxiety disorder in New York involve with you?
It usually blends several elements: understanding how your worry operates, exploring where it came from, practising CBT-informed skills for uncertainty, and using somatic work to release the tension GAD leaves in the body. Where it may help, we can also consider medication. Sessions are 60 or 90 minutes, which gives us time to move beyond symptom lists and into the patterns underneath.
Is medication necessary for GAD?
Not necessarily. Many people improve significantly with psychotherapy and somatic work. For others, especially when worry is severe, long-standing or affecting sleep and functioning, medication can make other work more accessible. I can talk you through the options, potential benefits and side effects so you can make an informed choice. Any medication is started, adjusted or tapered gradually, collaboratively and with careful monitoring.
I have worried my whole life. Can that really change?
Long-standing worry can feel woven into who you are, and that is understandable. Yet many people find that, with time and the right support, worry becomes less constant and less convincing. The aim is not to turn you into someone who never thinks ahead, but to give you choice: the ability to plan when planning is useful, and to set worry down when it is not.
Why do my GAD symptoms feel so physical?
Persistent worry keeps your stress response partly switched on, which affects muscles, digestion, breathing and sleep. Over months this can lead to aches, headaches, fatigue and stomach trouble. These symptoms are real, not imagined. It is still sensible to rule out other medical causes, and we can talk about that together. Somatic work then helps your body learn to return to rest more easily.
Let worry take a back seat
Book a free 15-minute consultation to talk about living with generalised anxiety and how we might approach it together.