Generalized Anxiety Disorder (GAD)
Symptoms, Treatment, and Self-HelpIn This Article
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.
What is generalized anxiety disorder (GAD)?
Carrie has always been a worrier, but it never interfered with her life before. Lately, however, she’s been feeling keyed up all the time. She’s paralyzed by an omnipresent sense of dread, and worries constantly about the future. Her worries make it difficult to concentrate at work, and when she gets home she can’t relax.
Carrie is also having sleep difficulties, tossing and turning for hours before she falls asleep. She also gets frequent stomach cramps and diarrhea, and has a chronic stiff neck from muscle tension. Carrie feels like she’s on the verge of a nervous breakdown.
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, 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.
- “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!”
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:
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
Not everyone with generalized anxiety disorder has the same symptoms, but most people experience a combination of emotional, behavioral, and physical symptoms that often fluctuate, becoming worse at times of stress.
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, personal abilities, and school performance. Unlike adults with GAD, children and teens 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, 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
Do you have generalized anxiety disorder?
Take this quiz to find out:
Have you experienced:
- Excessive anxiety and worry on most days for at least six months?
- Worry that’s difficult to control?
- Anxiety or worry associated with three or more of the following:
- Restlessness or feeling on edge?
- Being easily fatigued?
- Difficulty concentrating or mind going blank?
- Muscle tension?
- Sleep disturbance (difficulty falling or staying asleep or restless, unsatisfying sleep)?
- Anxiety or worry that causes significant distress or interferes with your daily life?
- Anxiety that isn’t related to a health condition, substance abuse, or a medication?
- Anxiety that isn’t related to another mental health condition, such as panic attacks, social phobia, or post-traumatic stress disorder (PTSD)?
If you answered “yes” to all six of the above questions, you may have generalized anxiety disorder. Follow the self-help tips below or consult a mental health professional.
This questionnaire is not intended to replace professional diagnosis.
Source: Scientific America and the Diagnostic and Statistical Manual of Mental Disorders
Generalized anxiety disorder treatment tip 1: Look at your worries in new ways
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.
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: Get moving
Exercise is a natural and effective anti-anxiety treatment. It relieves tension and stress, boosts physical and mental energy, and enhances well-being through the release of endorphins, the brain’s feel-good chemicals. Any exercise that engages both your arms and legs—such as walking, running, swimming, or dancing—can be especially effective. Instead of continuing to focus on your thoughts as you exercise, though, try focusing 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.
By adding this mindfulness element, by really focusing on your body and how it feels as you exercise, you’ll not only improve your physical condition faster, but you may also be able to interrupt the flow of constant worries running through your head. Many people find weight training, rock climbing, boxing, or martial arts especially effective as these activities make it easier to maintain your focus on your body movements—after all, if you don’t, you could get hurt.
For maximum relief of generalized anxiety disorder (GAD), try to get at least 30 minutes of physical activity on most days—or three 10-minute sessions if that’s more convenient.
Generalized anxiety disorder treatment tip 3: 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.
- 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. 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 4: Learn to calm down quickly
Many people with generalized anxiety disorder don’t know how to quickly 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—or movement. Try the following self-soothing suggestions when your GAD symptoms are acting up:
- Sight – Take in a beautiful view. Look at treasured photos, works of art, or funny videos online. Close your eyes and picture a place that feels peaceful and rejuvenating.
- Sound – Listen to soothing music. Call an old friend. Sing or hum a favorite tune. 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. Spritz on your favorite perfume.
- Taste – Slowly eat a favorite treat, savoring each bite. Enjoy a hot cup of coffee or herbal tea.
- Touch – Pet your dog or cat. Wrap yourself in a soft blanket. Sit outside in the cool breeze. Give yourself a hand or neck massage.
- Movement – Go for a walk or run, dance around, jump up and down or gently stretch.
For more tips on using your senses to quickly calm yourself, see Stress Relief in the Moment.
Generalized anxiety disorder treatment tip 5: Connect with others
Support from other people is vital to overcoming generalized anxiety disorder. In fact, GAD only gets worse when you feel powerless and alone. 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—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. That person may be your significant other, a family member, or a friend.
How GAD can get in the way of connecting with others
While the more connected you are to other people, the less vulnerable you’ll feel, but the catch-22 is that having 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.
- 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. 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 face to face about your worries can make them seem less threatening.
- 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.
Generalized anxiety disorder treatment tip 6: Change your lifestyle
A healthy, balanced lifestyle plays a big role in keeping the symptoms of GAD at bay. In addition to regular exercise, try these other lifestyle choices to tackle chronic anxiety and worry:
Adopt healthy eating habits
Start the day right with breakfast, and try to eat regularly to avoid getting too hungry between meals. 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 at least 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. But sweet foods are only part of the problem: a lot of processed and convenience foods are packed with sources of hidden sugar. Read the labels and focus more on eating “real food”: unprocessed fruit and vegetables and healthy sources of protein.
Avoid alcohol and nicotine
Alcohol temporarily reduces anxiety and worry, but it actually makes anxiety symptoms worse as it wears off. While it may seem like cigarettes are calming, nicotine is actually a powerful stimulant that 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. Improve your sleep at night by changing any daytime habits or bedtime routines that can contribute to sleeplessness.
When to seek therapy for generalized anxiety disorder treatment
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. To get an accurate diagnosis and appropriate treatment, it’s best to see a mental health professional. 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.
Professional treatment for GAD
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. CBT 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. 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.
Medication for generalized anxiety disorder
Medication for GAD 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. 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), but 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 – 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.
More help for generalized anxiety disorder
Self-help strategies for chronic worriers. Have fears and “what ifs” taken over your life? Is your worrying out of control? The good news is that chronic worrying is a mental habit you can learn how to break. You can teach yourself to stay calm and collected and to look at your fears from a more balanced perspective. Read: How to Stop Worrying
- How to Stop Worrying: Self-Help Strategies for Anxiety Relief
- Therapy for Anxiety Disorders: Cognitive Behavioral Therapy, Exposure Therapy, and Other Options
- How to Sleep Better: Tips for Getting a Good Night’s Sleep
- Relaxation Techniques for Stress Relief: Finding the Relaxation Exercises That Work for You
- Anxiety Medication: What You Need to Know About Anti-Anxiety Drugs
- Benefits of Mindfulness: Practices for Improving Emotional and Physical Well-Being
Resources and references
General information about generalized anxiety disorder
When Worry Gets Out of Control: Generalized Anxiety Disorder – Booklet on generalized anxiety disorder, including its symptoms and treatment. (National Institute for Mental Health)
Generalized Anxiety Disorder – Harvard Medical Schoo-endorsed guide to the signs, symptoms, and treatment of generalized anxiety disorder. (Aetna InteliHealth)
Self-help tips for generalized anxiety disorder
What? Me Worry!?! – Series of self-help modules for generalized anxiety disorder. Includes step-by-step tips for dealing with anxiety and worry. (Centre for Clinical Interventions)
Generalized anxiety disorder in children and adolescents
Generalized Anxiety Disorder – Learn what generalized anxiety disorder looks like in children. Includes red flags to watch out for. (WorryWiseKids.org)
Generalized Anxiety – Guide for parents on the signs and symptoms of generalized anxiety disorder in children and teens. Includes a video and story examples. (AnxietyBC)
What other readers are saying
“Thanks for the article on GAD. I've struggled with it all my life and sometimes it's so overwhelming it scares the crap out of me. I started practicing some of the techniques . . . and they do work.” ~ Massachusetts
“I struggle with anxiety . . . commingled with panic attacks, making me miserable and frightened and feeling like I’m slowly going bonkers. It is a lonely, scary feeling—wondering what is wrong with me and why I cannot function like “normal” people. . . . As I was reading the article about GAD, I started crying. In a perfectly nice, friendly, and calming way it discussed EXACTLY how I felt. I just sat there bawling my eyes out because it was just so straightforward, so positive, and so precisely what I needed.” ~ Canada