Generalised anxiety disorder (GAD)
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.
What is generalised anxiety disorder?
Those with GAD will feel anxious most days and often catastrophise 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 when 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. According to the mental health charity Mind, in any given week in England, six in 100 people are diagnosed with GAD. While the NHS claims it affects more women than men, and is found to be more common in those aged 35-55.
In this video, counsellor Amanda MacDonald (MBACP, Dip.Couns) explores what generalised anxiety disorder is, its symptoms, and how counselling can support you.
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 more likely to experience 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.
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.
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.
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
- difficulty sleeping/insomnia
These physical manifestations of anxiety can often cause further worry in those with GAD, perpetuating the ongoing feeling of unease. If you're worried that your physical symptoms are not related to your anxiety disorder, please contact your GP.
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, including self-help, psychological therapies and medication, such as a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs).
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. For some people, it is a combination of approaches that work 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.
If you haven't found self-help options useful, you may benefit from therapy.
There are many different therapies available to those with generalised anxiety. The following have been found to be the most successful in clinical trials:
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.
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
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 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.
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 - they allow you to share your experiences with attendees and discover how others with the condition manage it.
Talking therapies will give you a confidential space to explore your thoughts, feelings and ideas, and work on ways to manage your GAD or anxiety. Therapy will give you space to explore the roots of your anxiety, and consider its components and triggers.
- Joshua Miles MBACP accredited psychodynamic psychotherapist
For many people dealing with anxiety, their first port of call is to try self-help methods. In some cases, this self-help is supported by a trained therapist with whom you speak on a regular basis.
There are many different books and courses available for those with anxiety, 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).
Tips for dealing with anxiety
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:
1. 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 your overall mood and make you feel less inclined to worry. Try the following exercises:
- walking or jogging
- team sports such as football or rugby
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.
2. 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 gentle exercises like yoga. Find something that works for you and try to dedicate some time every day to relaxation.
3. 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 effects on your anxiety levels. Try to cut down on your caffeine intake and try herbal teas instead.
4. 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 therapist?
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) has 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:
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