What Is Anxiety?
Anxiety is a very normal part of daily life. We get stressed and anxious at work, at home, in traffic and about our kids. But when the anxiety becomes too big and hard to manage (and doesn’t go away), it becomes a disabling disorder. When anxiety has increased to a level that affects your ability to participate in everyday life – your ability to leave your home, go to the grocery store, be with friends or drive/ride in a car – it’s gotten to a point where help is needed.
Anxiety is the umbrella term we use to generally describe a series of symptoms we feel when we are worried, stressed out, or are scared.
The word “anxiety” covers four aspects of experiences that a person may have: mental apprehension, physical tension, dissociative anxiety, and physical symptoms.
Anxiety comes in many different formats and may be experienced differently by everyone. It can be experienced in a mild manner, such as butterflies in your stomach, to severe and crippling anxiety.
Regardless of how you experience anxiety or anxiety-related issues, anxiety is something that is understandable and treatable.
What Is Generalized Anxiety Disorder?
As mentioned above, the term anxiety technically refers to the experience of any anxiety-related issues. Generalized anxiety is a particular subset of anxiety. Those with generalized anxiety often feel worried and tense, even when not instigated by a trigger of some sort. They worry excessively or assume and expect the worse, when there is no rational reason to do so. While everyone worries from time to time, generalized anxiety goes above and beyond everyday anxiousness.
Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive worry about a number of different things. People with GAD may anticipate disaster and may be overly concerned about money, health, family, work, or other issues. People who have GAD find it difficult to control their worry. They may worry more than seems warranted about actual events or may expect the worst even when there is no apparent reason for concern.
GAD is diagnosed when a person finds it difficult to control worry on more days than not for at least six months and has three or more symptoms. This differentiates GAD from worry that may be specific to a set stressor or for more limited period of time.
GAD affects 6.8 million adults, or 3.1% of the U.S. population, in any given year. Women are twice as likely to be affected. The disorder comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age. Although the exact cause of GAD is unknown, there is evidence that biological factors, family background, and life experiences, particularly stressful ones, play a role.
Sometimes just the thought of getting through the day produces anxiety. People with GAD don’t know how to stop the worry cycle and feel it is beyond their control, even though they usually realize that their anxiety is more intense than the situation warrants. All anxiety disorders may relate to a difficulty tolerating uncertainty and therefore many people with GAD try to plan or control situations. Many people believe worry prevents bad things from happening so they view it is risky to give up worry. At times, people can struggle with physical symptoms such as stomachaches and headaches.
When their anxiety level is mild to moderate or with treatment, people with GAD can function socially, have full and meaningful lives, and be gainfully employed. Many with GAD may avoid situations because they have the disorder or they may not take advantage of opportunities due to their worry (social situations, travel, promotions, etc). Some people can have difficulty carrying out the simplest daily activities when their anxiety is severe.
Unlike a phobia, where your fear is connected to a specific thing or situation, the anxiety of generalized anxiety disorder is diffused—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, 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.
To better understand generalized anxiety, we’ll break it down further.
A phobia is a fear and anxiety reaction to a specific target object. Generalized anxiety is having a fear and anxiety reaction from NO specific target.
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.
Chronic worrying can have a long-term impact on your body and your mind.
“Normal” Worries vs. Generalized Anxiety Disorder:
Normal: Your worrying doesn’t get in the way of your daily activities and responsibilities.
GAD: Your worrying significantly disrupts your job, activities, or social life.
Normal: You’re able to control your worrying.
GAD: Your worrying is uncontrollable.
Normal: Your worries, while unpleasant, don’t cause significant distress.
GAD: Your worries are extremely upsetting and stressful.
Normal: Your worries are limited to a specific, small number of realistic concerns.
GAD: You worry about all sorts of things, and tend to expect the worst.
Normal: Your bouts of worrying last for only a short time period.
GAD: You’ve been worrying almost every day for at least six months.
So how can you tell if you are just worried versus having generalized anxiety disorder? While we often all worry about similar things — money, family, kids, work, generalized anxiety takes it a step further.
What Are The Symptoms of Generalized Anxiety Disorder?
- Excessive worrying: Worrying all day every day. Worrying about things that others would not worry about. Just getting through the day without provoking anxiety.
- Intrusive thoughts: Worry thoughts constantly or frequently come in to your head and you are unable to interrupt them or distract yourself from them.
- Persistent worry: Pacing, the inability to control your worrying.
- Interference: Your anxiety disrupts your day-to-day activities. You are distracted at work, you don’t go out, your friendships become troubled.
GAD develops slowly. It often starts during the teen years or young adulthood.
People with GAD may:
- Worry very much about everyday things
- Have trouble controlling their worries or feelings of nervousness
- Know that they worry much more than they should
- Feel restless and have trouble relaxing
- Have a hard time concentrating
- Be easily startled
- Have trouble falling asleep or staying asleep
- Feel easily tired or tired all the time
- Have headaches, muscle aches, stomach aches, or unexplained pains
- Have a hard time swallowing
- Tremble or twitch
- Be irritable or feel “on edge”
- Sweat a lot, feel light-headed or out of breath
- Have to go to the bathroom a lot
Adults with GAD are often highly nervous about everyday circumstances, such as:
- Job security or performance
- The health and well-being of their children
- Being late
- Completing household chores and other responsibilities
Both children and adults with GAD may experience physical symptoms that make it hard to function and that interfere with daily life.
GAD Symptoms in Children and Teenagers:
Children and teenagers may have similar worries to adults, but also may have excessive worries about:
- Their performance, such as in school or in sports
- Catastrophes, such as earthquakes or war
- Performance at school or sporting events
- Family members’ safety
- Being on time (punctuality)
A child or teen with excessive worry may:
- Feel overly anxious to fit in
- Be a perfectionist
- Redo tasks because they aren’t perfect the first time
- Spend excessive time doing homework
- Lack confidence
- Strive for approval
- Require a lot of reassurance about performance
- Have frequent stomachaches or other physical complaints
- Avoid going to school or avoid social situations
- Concentration issues in school
- Poor school performance
- Require a lot of approval and reassurance
There may be times when your worries don’t completely consume you, but you still feel anxious even when there’s no apparent reason. For example, you may feel intense worry about your safety or that of your loved ones, or you may have a general sense that something bad is about to happen.
What Are The Risk Factors For Developing GAD?
While the exact cause of developing generalized anxiety disorder are unknown, there are some risk factors that have been identified as being associated with generalized anxiety disorder.
Women are diagnosed with generalized anxiety disorder somewhat more often than men are. The following factors may increase the risk of developing generalized anxiety disorder:
- Personality. A person whose temperament is timid or negative or who avoids anything dangerous may be more prone to generalized anxiety disorder than others are.
- Genetics. Generalized anxiety disorder may run in families.
- Experiences. People with generalized anxiety disorder may have a history of significant life changes, traumatic or negative experiences during childhood, or a recent traumatic or negative event.
- Chronic mental illnesses or other mental health disorders may increase risk.
- Illness such as a chronic or serious illness can lead to constant worry about things such as the future, money, and treatment.
- Stress exacerbates the development of anxiety.
- Personality disorders such as borderline personality disorder may be associated with generalized anxiety disorder.
- Substance abuse can exaggerate the symptoms of anxiety.
How Is Generalized Anxiety Disorder Diagnosed?
Diagnosis is often made after a person with generalized anxiety disorder feels that his or her anxiety is interfering with his or her personal life. You may feel that you worry too much; you suffer from depression, substance abuse, or suicidal thoughts.
The DSM-5 outlines specific criteria to help professionals diagnose generalized anxiety disorder. Having a standard set of symptoms to reference when assessing clients helps them to more accurately diagnose mental health concerns and, in turn, create a more effective plan of care.
When assessing for GAD, clinical professionals are looking for the following:
- The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least 6 months and is clearly excessive.
- The worry is experienced as very challenging to control. The worry in both adults and children may easily shift from one topic to another.
- The anxiety and worry are accompanied with at least three of the following physical or cognitive symptoms (In children, only one symptom is necessary for a diagnosis of GAD):
- Edginess or restlessness
- Tiring easily; more fatigued than usual
- Impaired concentration or feeling as though the mind goes blank
- Irritability (which may or may not be observable to others)
- Increased muscle aches or soreness
- Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep)
Sometimes a person notices other physical ailments that are actually a symptom of generalized anxiety disorder. When the mind cannot or will not process certain feelings or situations, it may outlet the feelings in to a physical ailment. Common physical conditions include:
- Gastroesophageal reflux disease
- Heart disease
- Hypo- or hyper-thyroidism
- Menopause onset
Other issues include increasing the symptoms in other psychological or physical issues.
- Substance abuse
- Digestive issues
- Teeth grinding
What Is Excessive Worry?
Excessive worry means worrying even when there is no specific threat present or in a manner that is disproportionate to the actual risk.
Someone struggling with GAD experiences a high percentage of their waking hours worrying about something. The worry may be accompanied by reassurance-seeking from others.
In adults, the worry can be about job responsibilities or performance, one’s own health or the health of family members, financial matters, and other everyday, typical life circumstances.
In children, the worry is more likely to be about their abilities or the quality of their performance (for example, in school).
How is Generalized Anxiety Disorder (GAD) Treated?
A number of types of treatment can help with GAD. Supportive and interpersonal therapy can help. Cognitive behavioral treatment (CBT) has been more researched and specifically targets thoughts, physical symptoms, and behaviors including the over-preparation, planning and avoidance that characterizes GAD.
Mindfulness based approaches and Acceptance Commitment Therapy have also been investigated with positive outcome. All therapies (sometimes in different ways) help people change their relationship to their symptoms.
They help people to understand the nature of anxiety itself, to be less afraid of the presence of anxiety, and to help people make choices independent of the presence of anxiety. The adult CBT treatments for GAD have been modified for children and teens and show positive outcomes.
Cognitive-Behavioral Therapy (CBT)
The five components of CBT for anxiety are:
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. 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. CBT for GAD trains you in relaxation techniques to help decrease the physical over-arousal of the “fight or flight” response.
Cognitive control strategies teach you 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.
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 feel more in control and less anxious.
A well-established, highly effective, and lasting treatment is called cognitive-behavioral therapy, or CBT. It focuses on identifying, understanding, and changing thinking and behavior patterns. Benefits are usually seen in 12 to 16 weeks, depending on the individual.]]
In this type of therapy the patient is actively involved in his or her own recovery, has a sense of control, and learns skills that are useful throughout life. CBT typically involves reading about the problem, keeping records between appointments, and completing homework assignments in which the treatment procedures are practiced.
People learn skills during therapy sessions, but they must practice repeatedly to see improvement.
There are a number of medication choices for GAD, usually the SSRIs either alone or in combination with therapy.
Relaxation techniques, meditation, yoga, exercise, and other alternative treatments may also become part of a treatment plan.
Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone; co-occurring conditions must also be treated with appropriate therapies.
Medication – This is the other primary treatment method utilized. Medication may be used to treat symptoms of depression, with anti-depressants; anxiety, with anti-anxiety medications; or stronger-acting benzodiazepines to help calm anxiety.
Doctors may also prescribe medication to help treat GAD. Your doctor will work with you to find the best medication and dose for you.
Different types of medication can be effective in GAD:
- Antidepressants, including medications in the selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) classes, are the first line medication treatments. Examples o antidepressants used to treat generalized anxiety disorder include escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva).
- Buspirone. An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective.
- Benzodiazepines. In limited circumstances, your doctor may prescribe a benzodiazepine for relief of anxiety symptoms. These sedatives are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these medications aren’t a good choice if you have or had problems with alcohol or drug abuse.
Doctors commonly use SSRIs and SNRIs to treat depression, but they are also helpful for the symptoms of GAD. They may take several weeks to start working. These medications may also cause side effects, such as headaches, nausea, or difficulty sleeping. These side effects are usually not severe for most people, especially if the dose starts off low and is increased slowly over time.
Benzodiazepines, which are sedative medications, can also be used to manage severe forms of GAD. These medications are powerfully effective in rapidly decreasing anxiety, but they can cause tolerance and dependence if you use them continuously. Therefore, your doctor will only prescribe them for brief periods of time if you need them.
Don’t give up on treatment too quickly. Both psychotherapy and medication can take some time to work. A healthy lifestyle can also help combat anxiety. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends who you trust for support.
Therapy allows a mental health professional to examine and help you discover and manage the underlying causes for the anxiety and anxious feelings. Together you can use cognitive-behavioral techniques to focus on skill development to manage coping and thought patterns that lead to anxiety feelings.
Typically therapy and medication are used hand-in-hand to reduce the feelings of anxiety, and increase relevant coping skills.
How Do I Cope With Generalized Anxiety Disorder?
While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here’s what you can do:
Learn How To Calm Yourself:
While socially interacting with another person face-to-face is the quickest way to calm your nervous system, it’s not always realistic to have a friend close by to lean on. In these situations, you can quickly self-soothe and relieve anxiety symptoms by making use of one or more of your physical senses:
- Sight – Look at anything that relaxes you or makes you smile: a beautiful view, family photos, cat pictures on the Internet.
- Sound – Listen to soothing music, sing a favorite tune, or play a musical instrument. Or enjoy the relaxing sounds of nature (either live or recorded): ocean waves, wind through the trees, birds singing.
- Smell – Light scented candles. Smell the flowers in a garden. Breathe in the clean, fresh air. Spritz on your favorite perfume.
- Taste – Slowly eat a favorite treat, savoring each bite. Sip a hot cup of coffee or herbal tea. Chew on a stick of gum. Enjoy a mint or your favorite hard candy.
- Touch – Give yourself a hand or neck massage. Cuddle with a pet. Wrap yourself in a soft blanket. Sit outside in the cool breeze.
- Movement – Go for a walk, jump up and down, or gently stretch. Dancing, drumming, and running can be especially effective.
Find and Build A Support System
Support from other people is vital to overcoming GAD. Social interaction with someone who cares about you is the most effective way to calm your nervous system and diffuse anxiety, so it’s important to find someone you can connect with face to face on a regular basis—your significant other, a family member, or a friend. This person should be someone you can talk to for an uninterrupted period of time, someone who will listen to you without judging, criticizing, or continually being distracted by the phone or other people.
Know who to avoid when you’re feeling anxious. Your anxious take on life may be 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.
Be aware that having GAD can get in the way of your ability to connect with others. Anxiety and constant worrying can leave you feeling needy and insecure, causing problems in your relationships. Think about the ways you tend to act when you’re feeling anxious, especially 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. But 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, meet with a trusted family member or friend. Just talking about your worries can make them seem less threatening.
Get Out And Move Yourself:
Keep physically active. Develop a routine so that you’re physically active most days of the week. Exercise is a powerful stress reducer. It may improve your mood and help you stay healthy. Start out slowly and gradually increase the amount and intensity of your activities.
Exercise is a natural and effective anti-anxiety treatment. It relieves tension, reduces stress hormones, boosts feel-good chemicals such as serotonin and endorphins, and physically changes the brain in ways that make it less anxiety-prone and more resilient.
For maximum relief of GAD, try to get at least 30 minutes of physical activity on most days. Exercise that engages both your arms and legs—such as walking, running, swimming, or dancing—are great choices.
For even greater benefits, try adding mindfulness element to your workouts.
Mindfulness is a powerful anxiety fighter—and an easy technique to incorporate into your exercise program. Rather than spacing out or focusing on your thoughts during a workout, focus on how your body feels as you move. Try to notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of the wind on your skin. Not only will you get more out of your workout—you’ll also interrupt the flow of worries running through your head.
Learn To Let Go:
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.
Effective relaxation techniques for relieving anxiety include:
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, starting at your toes and moving upward, slowly. 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.
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.
Meditation. 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.
Change Your Perspective:
The core symptom of GAD is chronic worrying. It’s important to understand what worrying is, as what you believe about worrying play a huge role in triggering and maintaining GAD.
You may feel like your worries come from the outside – other people, events that stress you out, or challenging situations you’re facing. However, worrying is self-generated. The trigger does come from the outside, but your internal running dialogue keeps it going.
When you’re worrying, you’re talking to yourself about things you’re afraid of (or negative events) that possibly could happen – not a certainty. You run over the feared situation in your mind and think about all the ways you might deal with it. Basically, you’re trying to solve problems that haven’t happened yet, or worse, 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.
Make Healthy Choices:
Make sleep a priority. Do what you can to make sure you’re getting enough sleep to feel rested. If you aren’t sleeping well, see your doctor. Anxiety and worry can cause insomnia, as anyone whose racing thoughts have kept them up at night can attest. A 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. Improve your sleep at night by changing any daytime habits or bedtime routines that can contribute to sleeplessness.
Use relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety.
Eat healthy. Healthy eating — such as focusing on vegetables, fruits, whole grains and fish — may be linked to reduced anxiety, but more research is needed.
Avoid alcohol and recreational drugs. These substances can worsen anxiety.
Quit smoking and cut back or quit drinking coffee. Both nicotine and caffeine can worsen anxiety.
Stick to your treatment plan. Take medications as directed. Keep therapy appointments. Practice the skills you learn in psychotherapy. Consistency can make a big difference, especially when it comes to taking your medication.
Take action. Work with your mental health professional to figure out what’s making you anxious and address it.
Let it go. Don’t dwell on past concerns. Change what you can in the present moment and let the rest take its course.
Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus your mind away from your worries.
Socialize. Don’t let worries isolate you from loved ones or enjoyable activities. Social interaction and caring relationships can lessen your worries.
Join a support group for people with anxiety. Here, you can find compassion, understanding and shared experiences. You may find support groups in your community or on the internet, for example, The Band Back Together Project..
See also Coping with Anxiety Disorders
Can We Prevent Generalized Disorder?
There’s no way to predict for certain what will cause someone to develop generalized anxiety disorder, but you can take steps to reduce the impact of symptoms if you experience anxiety:
- Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
- Keep a journal. Keeping track of your personal life can help you and your mental health professional identify what’s causing you stress and what seems to help you feel better.
- Prioritize issues in your life. You can reduce anxiety by carefully managing your time and energy.
- Avoid unhealthy substance use. Alcohol and drug use and even nicotine or caffeine use can cause or worsen anxiety. If you’re addicted to any of these substances, quitting can make you anxious. If you can’t quit on your own, see your doctor or find a treatment program or support group to help you.
Additional Resources About Generalized Anxiety Disorder:
Anxiety Disorders Association of America – This is a website dedicated to understanding and living with anxiety disorders. There is information about multiple anxiety disorders, as well as treatment options.
Support Groups – List of support groups in the U.S., Canada, Australia, and South Africa. (Anxiety and Depression Association of America)
NAMI Helpline – Trained volunteers can provide information, referrals, and support for those suffering from anxiety disorders in the U.S. Call 1-800-950-6264. (National Alliance on Mental Illness)
Find a Therapist – Search for anxiety disorder treatment providers in the U.S. (Anxiety Disorders Association of America)
Support Groups – List of support groups in the U.S., Canada, Australia, and South Africa. (Anxiety and Depression Association of America)
Anxiety UK – Information, support, and a dedicated helpline for UK sufferers and their families. Call: 03444 775 774. (Anxiety UK)
Anxiety Canada – Provides links to services in different Canadian provinces. (Anxiety Disorders Association of Canada)
SANE Help Centre – Provides information about symptoms, treatments, medications, and where to go for support in Australia. Call: 1800 18 7263. (SANE Australia).