Generalized Anxiety Disorder (GAD)
Do you worry excessively or feel tense and anxious all day long? Learn about the signs, symptoms, and treatment of GAD.
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 a common anxiety disorder that involves constant and chronic worrying, nervousness, and tension. Unlike a phobia, where your fear is connected to a specific thing or situation, the anxiety of GAD 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. Generalized anxiety disorder is mentally and physically exhausting. It drains your energy, interferes with sleep, and wears your body out.
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. But no matter how overwhelming things seem now, you can break free from chronic worrying, learn to calm your anxious mind, and regain your sense of hope.
Worries, doubts, and fears are a normal part of life. It's natural to be anxious about an upcoming 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:
|“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.|
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.
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:
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, perhaps. 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.
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.
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.
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.
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 particularly good 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 constant worries running through your head.
The core symptom of GAD is chronic worrying. It's important to understand what worrying is, since the beliefs you hold about worrying play a huge role in triggering and maintaining GAD. 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 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 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.
If you're focusing on “what if” scenarios, your worrying is unproductive.
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 stop worrying, and learning to accept uncertainty in your life.
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:
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. Try the Ride the Wild Horse meditation, part of HelpGuide's free Emotional Intelligence Toolkit.
A healthy, balanced lifestyle plays a big role in keeping the symptoms of GAD at bay. In addition to regular exercise and relaxation, try adopting these other lifestyle habits to tackle chronic anxiety and worry:
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.
Limit caffeine. Stop drinking or at least cut back on caffeinated beverages, including soda, coffee, and tea. Caffeine is a stimulant that can trigger all kinds of jittery physiological effects that look and feel a lot like anxiety—from pounding heart and trembling hands to agitation and restlessness. Caffeine can also make GAD symptoms worse, cause insomnia, and even trigger panic attacks.
Avoid alcohol and nicotine. Having a few drinks may temporarily help you feel less anxious, but alcohol 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.
Eat right. Food doesn't cause anxiety, but a healthy diet can help keep you on an even keel. Going too long without eating leads to low blood sugar—which can make you feel anxious and irritable—so start the day right with breakfast and continue with regular meals. Eat plenty of fruits, and vegetables, which stabilize blood sugar and boost serotonin, a neurotransmitter with calming effects. Reduce the amount of refined carbs and sugar you eat, too. Sugary snacks and desserts cause blood sugar to spike and then crash, leaving you feeling emotionally and physically drained.
If you've given self-help a fair shot, but still can't seem to shake your worries and fears, it may be time 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
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?”.
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 GAD is generally recommended only as a temporary measure to relieve symptoms at the beginning of the treatment process, with therapy as 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 or other side effects.
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).
Helpline (India) – Provides information and support to those with mental health concerns in India. Call: 1860 2662 345 or 1800 2333 330.
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