Generalized Anxiety Disorder, also known as GAD, is characterized by disproportionate anxiety and worry over everyday events when there is no obvious cause. Generally, people with GAD find themselves unable to control their sense of impending doom or rationalize their feelings of extreme worry over the smallest of things. This inability to cope often means that the anxiety trickles its way into everyday life and can have a great impact on jobs, school, social activities, and relationships.
It is common for those with GAD to worry about regular, everyday occurrences from work performance, their own health, the health of their loved ones, finances or even being late.
Common symptoms include:
- Excessive worrying
- An inability to control those worries
- Understanding that the anxiety is unnecessary but unable to prevent it
- Inability to relax
- Feelings of restlessness
- A lack of concentration
And while GAD is a condition of the brain, physical symptoms often accompany any psychological ones and can include:
- Increased heart rate
- Rapid breathing (hyperventilating)
- Trouble falling asleep
- Trouble staying asleep
- Easily startled
- Severe fatigue / being tired all the time
- Aches of the muscles and headaches
- Excessive sweating
What Causes GAD?
The exact cause of GAD is unknown; but environmental factors, genetics, and brain chemistry are believed to be major contributors to its development.
Research is also showing that family history may play a large part in determining a person’s chances of developing GAD. Similar to the inheritance of green eyes or blonde hair, it is believed that a person’s tendency to develop anxiety may be passed down from their parents.
In addition, the make-up of one’s brain may also contribute to their likelihood of developing GAD. The brain contains chemicals, called neurotransmitters, that are responsible for moving information from one nerve cell to another. Troubles regulating mood and anxiety can be a result of these pathways not functioning correctly.
Other factors to consider are those that are particular to an individual and their environment. Traumatic experiences such as physical, emotional, and verbal abuse, the death of a loved one or moving to a new school or city are major stressors that may trigger an anxious response..
When symptoms of GAD are noticed, the first step in diagnosis is seeing your physician – who may immediately refer you to a specialist (psychiatrist or psychologist).
The doctor will conduct an assessment by exploring your psychiatric and medical history through a series of questions. They may also order further (and seemingly unrelated) testing, including urine tests and blood work. This is an important step in order to rule out any physical ailments that may be causing the GAD symptoms.
Your doctor will take the following information into consideration when conducting their assessment:
- The intensity of your anxiety – your ability to function through the worry
- The duration of your symptoms – have you had these severe symptoms for at least 6 months?
- The level of interruption that this is causing your everyday life – are you able to keep a job? Does this prevent you from maintaining relationships? Etc.
The results of this testing will allow your doctor to either confirm your GAD diagnosis or put you on the right track to finding another condition to explain your symptoms.
Individuals who have been diagnosed with GAD will be presented with treatment options that the doctor feels are best suited for their needs. This may include psychotherapy, medication, or a combination of the two.
The most common psychotherapy used to treat GAD is Cognitive Behavioural Therapy (or CBT). CBT focuses on helping people assess the problems of everyday life and how these problems make them feel so they can better cope when upsetting situations arise.
It is a structured form of therapy that is solution focused, meaning that the program is limited (usually 6-20 sessions).
CBT therapists work with their clients to identify their way of thinking, understand that thoughts are only ideas about what is happening (not facts) and how to remove themselves enough from their thinking to see it all from different perspectives. This is done by recording a person’s thoughts during events that upset them, monitoring how this contributes to their anxiety and finding ways to reduce their reaction when these things happen.
While in-person CBT is one of the best options, there are often wait lists associated with the programs. In the meantime, there are many books and websites that are educational in terms of cognitive and behavioural principles. Research shows that in combination with therapy, these self-help methods can be useful to those requiring extra support.
Another form of therapy is called ACT, Acceptance and Commitment Therapy.
ACT is a combination of cognitive and traditional behavioural therapies. It’s key function is to help individuals learn to be accountable for their feelings and stop denying and avoiding the feelings that are causing them anxiety and learn how to keep moving forward.
This program teaches that self-talk, the internal voice used to talk to yourself, is crucial to navigating particularly traumatic experiences. The theory being that you interrupt your thought pattern by deciding if a particular problem requires immediate attention (and action) or if it is something that you must accept and learn how to live with.
Once they’re able to do this, clients are better equipped to handle the tough emotions and must commit to changing their behaviour accordingly to better align with their beliefs and what they want for their lives.
The most effective medications used to help in the treatment of GAD include:
Selective Serotonin Reuptake Inhibitors (SSRIs)
These medications are antidepressants that increase levels of serotonin in the brain. Serotonin is best known as the feel good hormone and is a neurotransmitter that moves messages between brain cells and promotes good moods, contributes to your appetite and regulates your internal clock (what helps your body know when to sleep and when to wake up).
SSRIs prevent nerve endings from absorbing more serotonin, leaving more of the hormone available to help transmit messages. These are also used to relieve the symptoms of depression.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Unlike the SSRIs mentioned above, SNRIs also increase the levels of norepinephrine in the brain in the same manner. Norepinephrine is another neurotransmitter that aids in the regulation of thoughts and emotions. It mobilizes the brain and prepares it for alertness, focus and memory retrieval.
These can be used for short-term treatment of GAD. This is because the longer they are used the more likely a tolerance to the drug will be built – subsequently, this can lead to long term dependence. For this reason, benzodiazepines are used for shorter periods of time.
Other Methods of Managing Anxiety
In addition to psychotherapy and medication (or both) is engaging in activities that naturally produce the same effects of relaxation and calm.
Food is essential to overall well being and can help you cope with GAD. There are a few general suggestions to help minimize anxiety and its effects:
Start your day with some protein and try to eat balanced meals throughout your day. Eating a protein packed breakfast can help you feel full for longer periods of time which will keep your energy high throughout the day. Also aiming to include fresh, whole foods (fruit, vegetables, fish etc.) in your daily diet will contribute to your overall health.
Eliminate simple starches and opt for complex carbohydrates instead. Simple starches such as white bread, contain a lot of sugar which will cause your blood sugars to spike and then crash quickly. By swapping this for whole grains, such as quinoa, your brain is thought to create more serotonin (remember, the feel-good hormone!) thus helping to alleviate anxious feelings.
Increase your water intake and limit alcohol and caffeine. Alcohol is often thought to be a calming substance. However, as it is processed in your body it not only dehydrates you but it also causes interrupted sleep patterns. The same can be said for caffeine – similar to simple starches, caffeine causes a spike, a quick crash which will leave you feeling unmotivated and drained. Increasing your water intake, especially if you’re going to be drinking, can help avoid this.
Exercise contributes to more than just physical wellbeing. In fact, it has been found that regular exercise (specifically aerobic exercises) can help release serotonin and keep anxiety levels down.
It is recommended to engage in at least 30 minutes of moderate exercise per day.
If you’re unsure about your level of fitness or your ability to do a specific exercise, start slow and work your way up.
Some examples of aerobic exercises include:
- Running or jogging
- Skipping (jumping rope)
- Jumping jacks
The aim of this exercise is to get your body moving, help create and release serotonin and decrease anxious energy – and to do it without sustaining injury.
Meditation works to ground the mind by re-aligning its focus to the present moment.
There are several forms of meditation that can help those looking to cope with their anxiety. Some of the more popular meditation practices include:
Mindfulness meditation consists of focusing energy on your breathing, body and mind. There are no special tools required to practice mindful meditation, just a comfy and quiet place to sit and a small window of time.
If you’re brand new to mindfulness, you may find it helpful to find a program that works for you. There are apps and videos available on the internet – many that require less than 10 minutes of your time.
Metta (or loving-kindness) meditation is just as it sounds. It is used to bring forth feelings of compassion and love towards yourself.
Using kind self-talk allows you to focus on accepting love, kindness and grace from within.
In addition to easing anxiety or anxious thoughts, one of the biggest benefits to this form of meditation is that continuous practice of kindness also helps to lessen other negative feelings (sadness, resentment, and anger).
Meditation can be practiced whenever it is convenient for you. Pick a time when you know you’ll be able to focus on yourself without unwanted distractions.
A Generalized Anxiety Disorder diagnosis can be scary. However, so can the cycle of persistent untreated anxiety. The good news is that while it may seem impossible to move past the anxiety and into a more fulfilling life – it isn’t.
There are many resources and tools available to help treat GAD; these tools and the effort you put in will help you move forward and achieve substantial relief.
The most important thing to remember is: do NOT give up on treatment. Whether you’re prescribed psychotherapy, medication or both, it may take several weeks before any changes are noticed. This doesn’t mean that treatment isn’t working.
Stick with it, work with your doctors and therapists, and put in the work to help manage your GAD – you won’t regret it.