Generalized Anxiety Disorder (GAD)

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Generalized Anxiety Disorder (GAD)

            Do you worry excessively about things that are unlikely to happen, or feel tense and anxious 

all day long with no real reason? Everyone gets anxious sometimes, but if your worries and fears are so constant that they interfere with your ability to function and relax, you may have generalized anxiety disorder (GAD). GAD is mentally and physically exhausting. It drains your energy, interferes with sleep, and wears your body out. But you can break free from chronic worrying and learn to calm your anxious mind.

Generalized anxiety disorder (GAD) is a common anxiety disorder that involves chronic worrying, nervousness, and tension.

Unlike a phobia, where your fear is connected to a specific thing or situation, the anxiety of generalized anxiety disorder is diffuse—a general feeling of dread or unease that colors your whole life. This anxiety is less intense than a panic attack, but much longer lasting, making normal life difficult and relaxation impossible.

If you have GAD you may worry about the same things that other people do: health issues, money, family problems, or difficulties at work. But you take these worries to a new level.

A co-worker’s careless comment about the economy becomes a vision of an imminent pink slip; a phone call to a friend that isn’t immediately returned becomes anxiety that the relationship is in trouble. Sometimes just the thought of getting through the day produces anxiety. You go about your activities filled with exaggerated worry and tension, even when there is little or nothing to provoke them.

Whether you realize that your anxiety is more intense than the situation calls for or believe that your worrying protects you in some way, the end result is the same. You can’t turn off your anxious thoughts. They keep running through your head, on endless repeat.

Sound familiar?

“I can’t get my mind to stop… it’s driving me crazy!"
“He’s late—he was supposed to be here 20 minutes ago! Oh my God, he must have been in an accident!”
“I can’t sleep—I just feel such dread… and I don’t know why!”
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The difference between "normal" worry and GAD

Worries, doubts, and fears are a normal part of life. It’s natural to be anxious about your upcoming SAT test or to worry about your finances after being hit by unexpected bills.
The difference between “normal” worrying and generalized anxiety disorder is that the worrying involved in GAD is:

• excessive
• intrusive
• persistent
• debilitating

For example, after watching a news report about a terrorist bombing in the Middle East, the average person might feel a temporary sense of unease and worry. If you have GAD, however, you might be up all night afterwards, then continue worrying for days about a worst-case scenario in which your small hometown is attacked.

"Normal" Worry vs. Generalized Anxiety Disorder
“Normal” Worry:	Generalized Anxiety Disorder:
Your worrying doesn’t get in the way of your daily activities and responsibilities.	Your worrying significantly disrupts your job, activities, or social life.
You’re able to control your worrying.	Your worrying is uncontrollable.
Your worries, while unpleasant, don’t cause significant distress.	Your worries are extremely upsetting and stressful.
Your worries are limited to a specific, small number of realistic concerns.	You worry about all sorts of things, and tend to expect the worst.
Your bouts of worrying last for only a short time period.	You’ve been worrying almost every day for at least six months.

Signs and symptoms of generalized anxiety disorder

The symptoms of generalized anxiety disorder fluctuate. You may notice better and worse times of the day, or better and worse days in general. And while stress doesn’t cause generalized anxiety disorder, it can make the symptoms worse.

Not everyone with generalized anxiety disorder has the same symptoms. But most people with GAD experience a combination of a number of the following emotional, behavioral, and physical symptoms.

Emotional symptoms of generalized anxiety disorder

• Constant worries running through your head
• Feeling like your anxiety is uncontrollable; there is nothing you can do to stop the worrying
• Intrusive thoughts about things that make you anxious; you try to avoid thinking about them, but you can’t
• An inability to tolerate uncertainty; you need to know what’s going to happen in the future
• A pervasive feeling of apprehension or dread

Behavioral symptoms of generalized anxiety disorder

• Inability to relax, enjoy quiet time, or be by yourself
• Difficulty concentrating or focusing on things
• Putting things off because you feel overwhelmed
• Avoiding situations that make you anxious

Physical symptoms of generalized anxiety disorder

• Feeling tense; having muscle tightness or body aches
• Having trouble falling asleep or staying asleep because your mind won’t quit
• Feeling edgy, restless, or jumpy
• Stomach problems, nausea, diarrhea

Children and generalized anxiety disorder

In children, excessive worrying centers on future events, past behaviors, social acceptance, family matters, their personal abilities, and school performance. Unlike adults with GAD, children and teens with generalized anxiety disorder often don’t realize that their anxiety is disproportionate to the situation, so adults need to recognize their symptoms. Along with many of the symptoms that appear in adults with generalized anxiety disorder, some red flags for GAD in children are:

• “What if” fears about situations far in the future
• Perfectionism, excessive self-criticism, and fear of making mistakes
• Feeling that they’re to blame for any disaster, and their worry will keep tragedy from occurring
• The conviction that misfortune is contagious and will happen to them
• Need for frequent reassurance and approval

Generalized anxiety disorder treatment tip 1: Look at your worries in new ways

The core symptom of generalized anxiety disorder is chronic worrying. It’s important to understand what worrying is, since the beliefs you hold about worrying play a huge role in triggering and maintaining GAD.

Understanding worrying

You may feel like your worries come from the outside—from other people, events that stress you out, or difficult situations you’re facing. But, in fact, worrying is self-generated. The trigger comes from the outside, but an internal running dialogue maintains the anxiety itself.

When you’re worrying, you’re talking to yourself about things you’re afraid of or negative events that might happen. You run over the feared situation in your mind and think about all the ways you might deal with it. In essence, you’re trying to solve problems that haven’t happened yet, or worse, simply obsessing on worst-case scenarios.

All this worrying may give you the impression that you’re protecting yourself by preparing for the worst or avoiding bad situations. But more often than not, worrying is unproductive—sapping your mental and emotional energy without resulting in any concrete problem-solving strategies or actions.

How to distinguish between productive and unproductive worrying? If you’re focusing on “what if” scenarios, your worrying is unproductive.

Once you’ve given up the idea that your worrying somehow helps you, you can start to deal with your worry and anxiety in more productive ways. This may involve challenging irrational worrisome thoughts, learning how to postpone worrying, and learning to accept uncertainty in your life.

Generalized anxiety disorder treatment tip 2: Practice relaxation techniques

Anxiety is more than just a feeling. It’s the body’s physical “fight or flight” reaction to a perceived threat. Your heart pounds, you breathe faster, your muscles tense up, and you feel light-headed. When you’re relaxed, the complete opposite happens. Your heart rate slows down, you breathe slower and more deeply, your muscles relax, and your blood pressure stabilizes. Since it’s impossible to be anxious and relaxed at the same time, strengthening your body’s relaxation response is a powerful anxiety-relieving tactic.

If you struggle with GAD, relaxation techniques such as progressive muscle relaxation, deep breathing, and meditation can teach you how to relax.

The key is regular practice. Try to set aside at least 30 minutes a day. As you strengthen your ability to relax, your nervous system will become less reactive and you’ll be less vulnerable to anxiety and stress. Over time, the relaxation response will come easier and easier, until it feels natural.

• Progressive muscle relaxation. When anxiety takes hold, progressive muscle relaxation can help you release muscle tension and take a “time out” from your worries. The technique involves systematically tensing and then releasing different muscle groups in your body. As your body relaxes, your mind will follow.
• Deep breathing. When you’re anxious, you breathe faster. This hyperventilation causes symptoms such as dizziness, breathlessness, lightheadedness, and tingly hands and feet. These physical symptoms are frightening, leading to further anxiety and panic. But by breathing deeply from the diaphragm, you can reverse these symptoms and calm yourself down.
• Meditation. Many types of meditation have been shown to reduce anxiety. Mindfulness meditation, in particular, shows promise for anxiety relief. Research shows that mindfulness meditation can actually change your brain. With regular practice, meditation boosts activity on the left side of the prefrontal cortex, the area of the brain responsible for feelings of serenity and joy.

Generalized anxiety disorder treatment tip 3: Learn to calm down quickly

Many people with generalized anxiety disorder don’t know how to calm and soothe themselves. But it’s a simple, easy technique to learn, and it can make a drastic difference in your anxiety symptoms.

The best methods for self-soothing incorporate one or more of the physical senses: vision, hearing, smell, taste, and touch. Try the following sensory-based, self-soothing suggestions when your generalized anxiety disorder symptoms are acting up:

• Sight – Take in a beautiful view. Go to an art museum. Walk around a pretty neighborhood. Look at treasured photos or an interesting picture book.
• Sound – Listen to soothing music. Enjoy the sounds of nature: birds singing, ocean waves crashing on the beach, wind rustling through the trees.
• Smell – Light scented candles. Smell the flowers in a garden. Breathe in the clean, fresh air. Stop by a bakery. Spritz on your favorite perfume.
• Taste – Cook a delicious meal. Slowly eat a favorite treat, savoring each bite. Enjoy a hot cup of coffee or tea.
• Touch – Pet your dog or cat. Take a warm bubble bath. Wrap yourself in a soft blanket. Sit outside in the cool breeze. Get a massage.

To Cope with Anxiety, Remember A-W-A-R-E

The key to switching out of an anxiety state is to accept it fully. Remaining in the present and accepting your anxiety cause it to disappear.
A: Accept the anxiety. Welcome it. Don’t fight it. Replace your rejection, anger, and hatred of it with acceptance. By resisting, you’re prolonging the unpleasantness of it. Instead, flow with it. Don’t make it responsible for how you think, feel, and act.
W: Watch your anxiety. Look at it without judgment – not good, not bad. Rate it on a 0-to-10 scale and watch it go up and down. Be detached. Remember, you’re not your anxiety. The more you can separate yourself from the experience, the more you can just watch it.
A: Act with the anxiety. Act as if you aren’t anxious. Function with it. Slow down if you have to, but keep going. Breathe slowly and normally. If you run from the situation your anxiety will go down, but your fear will go up. If you stay, both your anxiety and your fear will go down.
R: Repeat the steps. Continue to accept your anxiety, watch it, and act with it until it goes down to a comfortable level. And it will. Just keep repeating these three steps: accept, watch, and act with it.
E: Expect the best. What you fear the most rarely happens. Recognize that a certain amount of anxiety is normal. By expecting future anxiety you’re putting yourself in a good position to accept it when it comes again.
Adapted from: Anxiety Disorders and Phobias: A Cognitive Perspective by Aaron Beck and Gary Emery

Generalized anxiety disorder treatment tip 4: Connect with others

Generalized anxiety disorder gets worse when you feel powerless and alone, but there is strength in numbers. The more connected you are to other people, the less vulnerable you’ll feel. The catch-22 is that GAD can lead to problems in your relationships.

For example, anxiety and constant worrying about your close relationships may leave you feeling needy and insecure. Perhaps you tend to read into what people say or assume the worst when a friend or partner doesn’t respond the way you expected or hoped. As a result, you may need lots of reassurance from others or become paranoid and suspicious. These things can put a huge strain on your relationships.

• Identify unhealthy relationship patterns. Think about the ways you tend to act when you’re feeling anxious about a relationship. Do you test your partner? Withdraw? Make accusations? Become clingy? Once you’re aware of any anxiety-driven relationship patterns, you can look for better ways to deal with any fears or insecurities you’re feeling.
• Build a strong support system. Human beings are social creatures. We’re not meant to live in isolation. Connecting to others is vital to your emotional health. A strong support system doesn’t necessarily mean a vast network of friends. Don’t underestimate the benefit of a few people you can trust and count on to be there for you.
• Talk it out when your worries start spiraling. If you start to feel overwhelmed with anxiety, call a trusted family member or friend. Just talking out loud about your worries can make them seem less threatening. It’s helpful to bounce your worries off someone who can give you a balanced, objective perspective.
• Know who to avoid when you’re feeling anxious. Remember that there is a good chance that your anxious take on life is something you learned when you were growing up. If your mother is a chronic worrier, she is not the best person to call when you’re feeling anxious—no matter how close you are. When considering who to turn to, ask yourself whether you tend to feel better or worse after talking to that person about a problem.

Generalized anxiety disorder treatment tip 5: Change your lifestyle

A healthy, balanced lifestyle plays a big role in keeping the symptoms of GAD at bay. Read on for a number of ways you can stop chronic anxiety and worry by taking care of yourself, and commit to making any necessary anxiety-reducing lifestyle changes.

Adopt healthy eating habits

Start the day right with breakfast, and continue with frequent small meals throughout the day. Going too long without eating leads to low blood sugar, which can make you feel anxious and irritable. Eat plenty of complex carbohydrates such as whole grains, fruits, and vegetables. Not only do complex carbs stabilize blood sugar, they also boost serotonin, a neurotransmitter with calming effects.

Limit caffeine and sugar

Stop drinking or cut back on caffeinated beverages, including soda, coffee, and tea. Caffeine can increase anxiety, interfere with sleep, and even provoke panic attacks. Reduce the amount of refined sugar you eat, too. Sugary snacks and desserts cause blood sugar to spike and then crash, leaving you feeling emotionally and physically drained.

Exercise regularly

Exercise is a natural and effective anti-anxiety treatment. For maximum relief for generalized anxiety disorder (GAD), try to get at least 30 minutes of aerobic activity on most days. Aerobic exercise relieves tension and stress, boosts physical and mental energy, and enhances well-being through the release of endorphins, the brain’s feel-good chemicals.

Avoid alcohol and nicotine

Alcohol temporarily reduces anxiety and worry, but it actually causes anxiety symptoms as it wears off. Drinking for generalized anxiety disorder relief also starts you on a path that can lead to alcohol abuse and dependence. Lighting up when you’re feeling anxious is also a bad idea. While it may seem like cigarettes are calming, nicotine is actually a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety.

Get enough sleep

Anxiety and worry can cause insomnia, as anyone whose racing thoughts have kept them up at night can attest. But lack of sleep can also contribute to anxiety. When you’re sleep deprived, your ability to handle stress is compromised. When you’re well rested, it’s much easier to keep your emotional balance, a key factor in coping with anxiety and stopping worry.

When to seek professional help for generalized anxiety disorder treatment

Self-help strategies are enough for many people with generalized anxiety disorder. Others need additional therapy and support to get anxiety under control.
If you can’t seem to shake your worries and fears, despite trying the self-help treatment tips, it may be time to seek professional help. But remember that professional treatment doesn’t replace self-help. In order to control your GAD symptoms, you’ll still want to make lifestyle changes and look at the ways you think about worrying.

Is it really generalized anxiety disorder?

When seeking professional treatment, it’s important to make sure that your symptoms are truly due to generalized anxiety disorder. If you’ve struggled with anxiety and fears your whole life, it’s likely that your anxiety symptoms are due to GAD.
However, if your anxiety symptoms are relatively new, this could be a sign of a different problem. For example, many medical conditions and medications can cause anxiety. Traumatic experiences can also cause symptoms similar to that of generalized anxiety disorder.
To get an accurate diagnosis and appropriate treatment, it’s best to see a mental health professional. GAD is often accompanied by other problems, such as depression, substance abuse, and other anxiety disorders. For treatment to succeed, it’s important to get help for all of the problems you’re dealing with.

Therapy for generalized anxiety disorder

Therapy is a key component of treatment for generalized anxiety disorder. Many studies show that therapy is as effective as medication for most people. And best of all, therapy for generalized anxiety disorder is side-effect free.
Cognitive-behavioral therapy (CBT) is one type of therapy that is particularly helpful in the treatment of GAD. Cognitive-behavioral therapy examines distortions in our ways of looking at the world and ourselves.
Your therapist will help you identify automatic negative thoughts that contribute to your anxiety. For example, if you catastrophize—always imagining the worst possible outcome in any given situation—you might challenge this tendency through questions such as, “What is the likelihood that this worst-case scenario will actually come true?” and “What are some positive outcomes that are more likely to happen?”.

Cognitive-behavioral therapy for GAD involves five components:

• Education. CBT involves learning about generalized anxiety disorder. It also teaches you how to distinguish between helpful and unhelpful worry. An increased understanding of your anxiety encourages a more accepting and proactive response to it.
• Monitoring. In CBT for generalized anxiety disorder, you learn to monitor your anxiety, including what triggers it, the specific things you worry about, and the severity and length of a particular episode. This helps you get perspective, as well as track your progress.
• Physical control strategies. Deep breathing and progressive muscle relaxation help decrease the physical over-arousal of the “fight or flight” response that maintains the state of fear and anxiety. CBT for generalized anxiety disorder trains you in these techniques.
• Cognitive control strategies. Through CBT, you learn to realistically evaluate and alter the thinking patterns that contribute to generalized anxiety disorder. As you challenge these negative thoughts, your fears will begin to subside. CBT also teaches you to test the beliefs you have about worry itself, such as “Worry is uncontrollable” or “If I worry, bad things are less likely to happen.”
• Behavioral strategies. Instead of avoiding situations you fear, CBT teaches you to tackle them head on. You may start by imagining the thing you’re most afraid of. By focusing on your fears without trying to avoid or escape them, you will begin to feel more in control and less anxious. Time management and problem-solving skills are also effective behavioral techniques for generalized anxiety disorder.

Medication for generalized anxiety disorder

Medication can be effective for generalized anxiety disorder. However, it is generally recommended only as a temporary measure to relieve symptoms at the beginning of the treatment process, with therapy the key to long-term success.
There are three types of medication prescribed for generalized anxiety disorder:

• Buspirone – This anti-anxiety drug, known by the brand name Buspar, is generally considered to be the safest drug for generalized anxiety disorder. Unlike the benzodiazepines, buspirone isn’t sedating or addictive. Although buspirone will take the edge off, it will not entirely eliminate anxiety.
• Benzodiazepines – These anti-anxiety drugs act very quickly (usually within 30 minutes to an hour). The rapid relief the benzodiazepines provide is a major benefit, but there are serious drawbacks as well. Physical and psychological dependence are common after more than a few weeks of use. They are generally recommended only for severe, paralyzing episodes of anxiety.
• Antidepressants – A number of antidepressants are used in the treatment of generalized anxiety disorder. However, the relief antidepressants provide for anxiety is not immediate, and the full effect isn’t felt for up to six weeks. Some antidepressants can also exacerbate sleep problems and cause nausea.

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