What is GAD (general anxiety disorder), and is change possible?

In primary care services, generalised anxiety disorder (GAD) is one of the most common disorders encountered, with its main defining trait being excessive anxiety and worry, lasting over at least six months.  

This anxiety and worry would be over a range of different environmental factors and cause serious interference with a person’s functioning on more days than not.

Approximately 5% of the UK population is affected by GAD, and it is more commonly recognised in people between 35 and 59 years old. Symptoms of GAD will vary from mild to more intense and severe.

GAD and normal anxiety have no clear dividing line, but they do differ in duration and extent of symptoms.  

GAD is often treated earlier due to the symptoms being more visible. Research shows that GAD is generally seen in those with a personality predisposed by genetic factors and childhood environmental influences on anxiety, and their response to persistent stressors. Stressful events could be those characterised by loss or danger. Using worry as a coping strategy when planning for potential threats, can then become uncontrollable and harmful, causing a person to move from excessive but normal worrying to GAD. The good news is that change is possible!   

How can GAD impact someone?

Physical

The extensive physical power anxiety can have when it provokes an unconscious biochemical reaction from the autonomic nervous system (ANS) can cause an increase in adrenalin which is responsible for various physiological symptoms. These could include irregular breathing, sweating, churning stomach, racing heart, trembling, and the need to visit the toilet more frequently. The adrenaline increase can activate the fight, flight, or freeze responses; triggering defensive or adaptive behaviours aimed at escaping the source of anxiety.

An individual’s ability to do things quickly and efficiently is impaired by excessive worry. Worrying takes energy and time, and the related symptoms would be muscle tension, feeling on edge, tiredness, disturbed sleep, and difficulty concentrating. 

Please speak to your doctor if you can relate to some of the able symptoms as they may also be explained by another condition or disorder.

Emotional

Painful feelings result when desirable goals are blocked or fail, which can cause troubling emotions. Anxiety is one of these and includes feelings of fear and discomfort, or terror in its extreme form, suggesting a person is striving towards a goal but has come to believe it is unobtainable due to their self-doubt. GAD sufferers often struggle with low self-esteem.

Painful emotions may be repressed; pushed into the subconscious, suppressed; consciously held at a distance, or projected onto others. While some people may have an uninhibited expression of their emotions, with no end or direction. If someone is often close to tears, this can reflect the general apprehensive state of GAD.

Choice

A person may be unaware of strategies they have put in place to reach their known or unknown goals, goals that will drive their choices and behaviour. GAD sufferers may avoid situations they are anxious about, either by not going into the situation or getting out of it as quickly as possible. However, this maintains the anxiety.  

Unhelpful strategies could include avoidance and escape; a natural reaction to flee or avoid perceived danger, seeking reassurance; excessively causing a reliance on it, or using social maintenance cycles; having people do things for them that mean they do have to move on or challenge their anxieties.

Thinking

The vicious circle of anxiety is maintained by thoughts and beliefs about what will happen in a feared situation becoming distorted and exaggerated, causing the anticipation that something bad will happen.  

Anxious thoughts are oriented toward the future and often forecast a negative outcome. Thoughts frequently start with “what if…” and predict catastrophe.

Irrational thoughts maintain anxiety, causing catastrophic thinking by misinterpreting bodily symptoms and anticipating disaster. These would include thoughts of anticipation; leaping ahead and replaying what might happen till overwhelmed with fear, can’t cope thoughts; negative statements related to both symptoms and situation, thoughts misinterpreting bodily symptoms; attributing bodily symptoms to something more serious, or escape thoughts; an avoidance strategy that in the long term maintains anxiety.

Core needs

A human’s basic core needs are security, self-worth, and significance.  

It has been suggested that early adverse experiences in childhood, and insecure attachment figures (your early caregivers) are causes of GAD in adults, affecting how they relate to others as adults if they cannot learn to build secure relationships. There is a close link between a person’s self-critical messages and self‐worrying. Negative self-directed messages can show low self-worth and significance. A person’s confidence is eroded by anxiety when it causes someone to avoid or fail situations.

How is change possible?

NICE guidelines (2019) would recommend self-help as a first-line intervention when treating GAD, followed by seeing a professional for cognitive behavioural therapy (CBT) and applied relaxation (AR), if self-help is not enough. If psychological treatment is not helpful, NICE then recommends that a doctor prescribe medication in the form of a selective serotonin reuptake inhibitor (SSRI).

Self-help

Here are some suggestions of places to support you with self-help.

Get Self Help

Anxiety UK

Recent studies comparing the self-reported change in GAD symptoms after using self-help material showed a significant reduction in self-reported worry, general anxiety, and anxiety. Digital CBT (self-help) has been found to be a safe and effective way to help reduce symptoms of GAD.

Counselling

CBT suggests that flawed thinking (influencing mood and behaviour) is typical in all psychological disorders. That when people learn to appraise their thinking more pragmatically and flexibly, it will result in a reduction of negative emotions and behaviours. CBT has shown good results in helping those suffering from GAD.  

AR treatment includes learning to be aware of early signs of anxiety, being educated in relaxation techniques, and then applying these techniques to the first signs of anxiety.

It is important to find a counsellor who can help you understand the underlying cause, as well as seeking symptomatic relief. The initial contact with a counsellor is a time for you both to see if the counsellor can help with your needs.

Change is possible, and you do not have to deal with GAD on your own.