Generalised anxiety disorder

Dr Elaine Ryan

Retrain Your Brain®

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Table of Contents

What is generalised anxiety disorder?

Generalised anxiety disorder, GAD, is a type of anxiety disorder where the person worries about many things. For most people, worrying is just a normal part of life. It’s that nagging feeling in the back of your mind that something might go wrong, and it can be helpful in some ways—it can motivate us to take action and avoid potential problems. But for people with generalised anxiety disorder (GAD), worry becomes excessive and debilitating, causing tremendous stress and interfering with daily life.

The primary feature of GSD is chronic worry, and it is important to distinguish GAD from normal worry.

The difference between “normal” worry and GAD

What is worry?

Worry occurs when you expect and plan for potential negative events that may or may not happen in the future. For example, if you approach your bank for a loan to buy your dream house. You might worry that you will not get the loan. What if the bank turns me down? What if my credit score is not good enough? I can check my credit score and improve it if needs be, check if I can afford the loan repayments before approaching the bank manager.

The type of worry has two parts; one where the person predicts all the things that could go wrong, and the second part solves the problem.

The key to distinguishing between productive and unproductive worrying is understanding the function that it serves for you.

Productive worrying is when you worry about something, then take action to resolve the issue. For example, if you’re worried about an upcoming presentation, you might rehearse your speech or researching the topic.

Unproductive worrying is when you worry about taking no action to resolve the issue. This type of worrying can be very harmful because it leads to stress and anxiety, providing no solutions.

GAD, image shows woman with many worries above head
Characteristics of worry

Worry is not a problem. We all worry when presented with a situation where the outcome is not clear. For example, during the last job interview, I attended, worry helped me to prepare. I did not know what they would ask me beforehand so predicted all plausible scenarios and prepared answers for them. Read more on worry.

When do worries become a mental health problem?

If you worry and run through all negative outcomes, use this information to problem solve, and move on. You do not have a problem. For worry to become clinical, it has to:

  • Affect your ability to problem solve, i.e. you worry so much, or feel so much stress that you cannot concentrate on the task at hand. For example, cancelling appointments as you worry so much.
  • The worry interferes with your daily life, for example, your sleep is affected.
  • When your daily life is affected and this continues for at least six months, meet with a mental health professional for assessment.

What does GAD look like?

Content of worry

The hallmark of GAD is excessive worry about many things. A person could worry about one or two things and not be given a diagnosis of generalised anxiety disorder. For example, if the content of a person’s worry is solely focused on health-related issues, the person might have health anxiety as opposed to GAD. It is called generalised anxiety disorder for a reason, in that the content of the worries is general. Not that a person with GAD cannot worry about their health, they can. But they can spiral into worrying about non-related things.

 

What do people with GAD worry about?

They worry about the same things as the rest of the population; work, health, life money, but the difference is the worry is uncontrollable and affects their day-to-day functioning.

The future


Because of the nature of GAD, i.e. chronic worry, people with the condition live in their heads, worrying about the negative consequences of imagined future events. This means that they miss most chances to feel okay, for example, you could be on holiday, that you planned last year, but not be able to enjoy it, as you are stuck in your head worrying about future events, the only difference is that you are doing it sitting on a beach.

How do I know if I have GAD?

If you suspect you have generalised anxiety disorder, it is important to get a diagnosis from a licensed mental health professional. Before discussing diagnosis, GAD has certain signs and symptoms that you might recognise in yourself.

 

Intolerance of uncertainty

People with GAD have negative beliefs about uncertainty and this proves difficult, as worry is about something that may occur in the future where the outcome is uncertain. For example, you can worry about passing an exam, as the outcome is uncertain. You would not worry if you knew beforehand that you will pass.

In order for someone to worry, there has to be a situation where the outcome is uncertain. Most people do not relish uncertainty but can cope with it better than someone who has a high intolerance of uncertainty where they make catastrophic predictions about the uncertain future outcome.

For example, if two people are interviewed for a job, the first might worry about how they did in the interview, but could carry on with life until they find out how they did. The second person, besides catastrophically predicting they won’t get the job, have difficulty tolerating not knowing the outcome for certain. They feel stressed, and agitated and could have difficulty sleeping. In other words, they are finding it difficult to cope with the feelings of uncertainty.

What are the symptoms of generalised anxiety disorder?

  • Feeling restless or on edge

  • fatigued

  • difficulty concentrating

  • irritability

  • muscle tension

  • sleep disturbance

  • worrying about everyday problems

 

How is generalised anxiety disorder diagnosed?

GAD is diagnosed when a person experiences uncontrollable worry that is present more days than not, lasts for at least six months and also has at least three of the following symptoms.

restlessness/nervousness, being easily fatigued, poor concentration, irritability, muscle tension, or sleep disturbance.

How is generalised anxiety disorder treated?

If you have been diagnosed with GAD, there are different treatment options open to you depending on the severity of your symptoms. I shall present the following using a stepped-care approach, where you start the least intensive treatment and move up to the next step if your current treatment was ineffective.

Self-help

The HSE recommends books or online courses to help with GAD as well as exercise and life-style changes. There is a lot of evidence to suggest that exercise can be an effective way to manage symptoms of generalised anxiety disorder. Exercise has been shown to help relieve tension, reduce stress hormones, boost feel-good chemicals such as serotonin and endorphins, and change the brain in ways that make it less anxious. Whether you choose books or a course, the model of therapy should be cognitive behavioural therapy, as this type of treatment lends itself well to self-help and working on your own.

Read more articles on how to use CBT to help with anxiety.

Psychological (talking) therapy

You can seek professional help from a mental health professional, or your GP may refer you for talking therapy. Like self-help, the model of therapy will be CBT.

CBT for GAD

People with GAD worry about and predict, the future in catastrophic ways. CBT shows people how to reappraise these catastrophic interpretations and manage uncertainty better. Read more on CBT.

Mindfulness.

Mindfulness. because the practice of focusing on the present moment, with no judgement, can help with worry associated with GAD.

Medication

If self-help and talking therapy did not work, your doctor may discuss medication options with you, which could be selective serotonin reuptake inhibitors and beta-blockers

Outlook
People with GAD can learn to manage their worry and change their faulty catastrophic thinking styles with CBT and thus increase their quality of life.

Dr Elaine Ryan

Dr Elaine Ryan

Dr Elaine Ryan is a Counselling Psychologist with 20 years experience. She specialises in OCD and anxiety related conditions. She worked in the National Health Service before setting up private practice. Dr Ryan obtained her PsychD from The University of Surrey.