Generalised anxiety disorder

The word anxiety relates to a feeling of unease, worry or even fear. Most of us have experienced feelings of anxiety before - sitting an exam, attending a job interview or having a medical test can all instill feelings of anxiety that are perfectly normal. For some people however, feeling anxious is part of everyday life and controlling their anxiety is near impossible.

Anxiety is the primary symptom in several conditions, including panic disorder and phobias - however there is also a condition called generalised anxiety disorder. What makes generalised anxiety disorder different to 'normal worry' is that the sense of anxiety is ongoing and tends to be out of proportion to the risk.

On this page we will explore the characteristics of generalised anxiety disorder and how talking therapies can help.

What is generalised anxiety disorder?

Generalised anxiety disorder (also referred to as GAD) is a long-term condition that causes sufferers to feel anxious about a variety of situations/issues, rather than one specific situation. Those with GAD will feel anxious most days and often catastrophize situations - for example, if their partner is late home from work, someone with GAD may think that they have been in an accident, rather than any other likely scenario (e.g. stuck in traffic).

Other characteristics of GAD include an inability to focus, loss of concentration and racing thoughts. If you have GAD your day-to-day life will be affected by your anxiety, which may impact your sleeping habits, your relationships or even your ability to hold down a job. As soon as one issue has been resolved, another one will rear its head, making it difficult for you to feel relaxed and at ease.

The condition is persistent and there may be occasions where you don't understand why you are feeling anxious. When it comes to diagnosing GAD, it can be difficult to differentiate those with GAD and those who have a naturally nervous disposition. As a rule however, GAD is diagnosed if the symptoms of the condition are persistent and affect your day-to-day activities.

Who is affected?

GAD is considered a relatively common condition that affects around one in every 25 people in the UK. There are slightly more women than men diagnosed and the condition has been found to be more common in those aged 35-55.

What causes GAD?

The cause of GAD is largely unknown, although experts agree that there is likely to be a combination of factors at play. Research into the condition has revealed the following potential contributing factors:

  • overactivity in the parts of the brain associated with behaviour and emotion
  • an imbalance of mood-regulating brain chemicals serotonin and noradrenaline
  • genetics - if you have a close relative with GAD, you are five times more likely to develop it
  • suffering from a long-term health condition, such as arthritis or chronic fatigue
  • a history of major stress or trauma can trigger the condition
  • having a history of drug or alcohol misuse.

While the situations listed above may contribute to the development of GAD, many people develop the condition for no apparent reason.

Symptoms of GAD

Generalised anxiety disorder causes both psychological and physical symptoms. The severity of the symptoms experienced will differ from person to person - one may feel all of the listed symptoms, while another feels just one or two. Regardless of how many of the symptoms you relate to - if your symptoms are causing you distress and are affecting your everyday life, you are advised to seek professional support.

Psychological symptoms

GAD usually causes a change in the way you behave as well as the way you think and feel about things. This can result in the following symptoms:

  • a sense of dread
  • feeling 'on edge'
  • feeling restless or unable to relax
  • difficulty concentrating
  • feeling irritable
  • racing thoughts
  • intrusive thoughts about worrying scenarios.

These symptoms may cause you to avoid certain situations in order to prevent yourself from feeling anxious. This may see you withdrawing from your friends and family or from social contact altogether. Your symptoms may also make work difficult for you as it can trigger stress and anxiety, causing you to take time off. These actions can cause further worry and a low sense of self-esteem - continuing the cycle of anxiety.

Physical symptoms

Extreme anxiety can also lead to a number of physical symptoms, including the following:

  • feeling lightheaded or dizzy
  • feeling lethargic
  • heart palpitations
  • dry mouth
  • muscle aches
  • shortness of breath
  • tension headaches
  • digestive problems
  • nausea
  • difficulty sleeping/insomnia.

These physical manifestations of anxiety can often cause further worry from those with GAD, perpetuating the ongoing feeling of unease. If you are worried that your physical symptoms are not related to your anxiety disorder, don't hesitate to discuss your symptoms with your doctor.

While other anxiety disorders, like phobias, have a specific trigger for their symptoms - those with GAD may not be clear on what it is they feel anxious about. Not knowing your trigger for anxiety can intensify the feeling and may cause you to feel as if there is no way to stop feeling anxious.

Recognising that your anxiety is negatively affecting your life is the first step to seeking help. From here you can explore your treatment options.

Treatment for GAD

Generalised anxiety disorder is a difficult condition to live with and tends to weigh heavily on the sufferer's mind. It can feel as if you get no respite from the symptoms, especially as the anxiety is not linked to a specific trigger. GAD can cause difficulties in your relationships, job and ultimately your well-being, so seeking support and treatment is highly recommended.

There are several different treatment options available to help ease symptoms, these include:

  • self-help
  • psychological therapies
  • medication.

Speaking to your doctor will help to determine which avenue to explore further, and it is important to understand that no one treatment option is 'right'. Every person is unique and will respond differently to the available treatments, however your doctor is likely to suggest the following treatment options:

Self-help

For many people dealing with anxiety, their first port of call is to try self-help methods. This may involve working from a book or computer programme designed to help those with GAD. In some cases this self-help is supported by a trained therapist with whom you speak to on a regular basis.

There are many different books and courses available for those with anxiety, however it is worth noting that the National Institute of Health and Care Excellence (NICE) currently only recommends trying self-help treatments based on the principles of cognitive behavioural therapy (CBT).

Psychological therapies

If you haven't found self-help options useful, or your doctor believes you would benefit from more support, you are likely to be offered a psychological therapy. There are many different therapies available to those with generalised anxiety, however the following have been found to be the most successful in clinical trials:

Cognitive behavioural therapy (CBT)

This form of therapy has been found to be incredibly helpful for a range of concerns, including anxiety. Studies into CBT's effect on anxiety show that the benefits last longer than those of medication.

The aim of cognitive behavioural therapy is to help you to understand how your thoughts, feelings and behaviour affect each other. Having this clarity can help you to question negative and anxious thoughts, giving you the courage to do things you may ordinarily avoid as they make you anxious.

This therapy usually involves meeting with a qualified therapist on a regular basis (normally once a week) and often requires you to carry out 'homework' outside of your sessions. You can find out more about this treatment on our cognitive behavioural therapy page.

Applied relaxation

Applied relaxation is an alternative form of therapy that has been found to be as effective as cognitive behavioural therapy in treating GAD. The technique of applied relaxation involves relaxing muscles in a particular way when you feel anxious, and is best learnt through a trained therapist. They will teach you how to:

  • relax your muscles
  • relax your muscles quickly
  • relax your muscles when you hear a trigger word (such as "relax")
  • relax your muscles when you begin to feel anxious.

By teaching your body to relax in these situations, your mind will learn by association to relax too.

Problem-solving therapies

Some forms of counselling that are solution-focused can be useful for those with extreme anxiety. These therapies will help you devise coping strategies for when you feel anxious and can be a useful tool for reducing everyday symptoms.

Mindfulness

Mindfulness therapy is gaining steam and has been shown to help people with anxiety and depression. Helping you to focus on the here and now – rather than ruminating on past events or worrying about the future – mindfulness uses meditation and breathing techniques to help ground you in the present. Find out more on our mindfulness page.

Group therapy

Some people with GAD may find it helpful to speak to others who have similar issues. Group therapy offers you the opportunity to receive treatment for your anxiety alongside fellow GAD sufferers. Facilitated by a trained therapist, these sessions encourage you to share your experiences while teaching you relaxation techniques and coping strategies.

Alternatively, you may find it useful to attend a support group. In contrast to group therapy, support groups are rarely facilitated by a trained therapist - however they do allow you to share your experiences with attendees and discover how others with the condition manage it.You can read more about these options on our group therapy page.

Medication

If you have tried psychological therapies and they have not eased your anxiety, or your doctor thinks you would benefit from further help, you may be prescribed medication. There are several different types of medication to help treat GAD and your doctor should talk you through your options before choosing one. Once you have been prescribed a medication, you are advised to attend regular follow-up appointments with your doctor to monitor your progress.

One of the options for those with extreme anxiety is antidepressant medicine. While this medication is usually given to those with depression, it can also help to ease symptoms of anxiety. They work by interfering with the brain chemicals responsible for causing your anxiety symptoms.

For some people it is a combination of approaches that works best for them - but as you can see, there are several options available, so don't lose heart if you try one and it doesn't help. The important thing is to communicate with your doctor or therapist and ask about different approaches to try.

Dealing with anxiety - tips

As well as the above treatments for anxiety, there are some things you can do yourself to help ease symptoms of GAD, mostly to do with self-care. Try the following tips during your treatments to give yourself the best possible chance of overcoming your anxiety:

Exercise regularly

Regular exercise has a variety of benefits for both your physical and mental health. Research shows that regular aerobic exercise can help to release tension and encourages the brain to release serotonin - the 'feel-good' hormone. This can improve you overall mood and make you feel less inclined to worry. Try the following exercises:

  • walking or jogging
  • cycling
  • hiking
  • swimming
  • team sports such as football or rugby
  • aerobics.

Recommended guidelines state that you should aim to do a minimum of 150 minutes of moderate-intensity exercise a week - this intensity should raise your heart rate.

Make time to relax

Another key part of self-care is giving yourself time to relax and unwind. There are several ways you can do this, from breathing exercises and meditation to a gentle exercise like yoga. Find something that works for you and try to dedicate some time every day to relaxation.

Avoid caffeine

Having too much caffeine in the system is known to disrupt sleep and speed up your heart rate. Both of these can have adverse affects on your anxiety levels. Try to cut down on your caffeine intake and try herbal teas instead.

Avoid drinking and smoking

Alcohol and smoking have been known to make symptoms of anxiety worse. To improve your physical health and your anxiety levels, aim to cut down on your alcohol consumption and look to quit smoking.


What should I be looking for in a counsellor or psychotherapist?

There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat generalised anxiety disorder. However, the National Institute for Health and Care Excellence (NICE) have developed a set of guidelines that provide advice about the recommended treatments.

In the first instance those suffering with anxiety should be offered access to a support group and self-help information recommendations by their doctor. If this doesn't help, or the anxiety is more severe, psychological treatments such as cognitive behavioural therapy and/or applied relaxation are recommended. Further treatment may require medication.

Read the full NICE guidelines:

Treating generalised anxiety disorder and panic disorder in adults: information for the public

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