Introduction to Anxiety

Generalized anxiety disorder (or GAD) is characterized by excessive, exaggerated anxiety and worry about everyday life events with no obvious reasons for worry. People with symptoms of generalized anxiety disorder tend to always expect disaster and can't stop worrying about health, money, family, work, or school. In people with GAD, the worry often is unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear, and dread. Eventually, the anxiety so dominates the person's thinking that it interferes with daily functioning, including work, school, social activities, and relationships.

What Are the Symptoms of GAD?

GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well. Symptoms of GAD can include:

• Excessive, ongoing worry and tension
• An unrealistic view of problems
• Restlessness or a feeling of being "edgy"
• Irritability
• Muscle tension
• Headaches
• Sweating
• Difficulty concentrating
• Nausea
• The need to go to the bathroom frequently
• Tiredness
• Trouble falling or staying asleep
• Trembling
• Being easily startled

In addition, people with GAD often have other anxiety disorders (such as panic disorder, obsessive-compulsive disorder, and phobias), suffer from depression, and/or abuse drugs or alcohol.

What Causes GAD?

The exact cause of GAD is not fully known, but a number of factors -- including genetics, brain chemistry and environmental stresses -- appear to contribute to its development.

• Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families.
• Brain chemistry: GAD has been associated with abnormal levels of certain neurotransmitters in the brain. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts in certain situations, leading to anxiety.
• Environmental factors: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol, caffeine, and nicotine, can also worsen anxiety.

How Common Is GAD?

About 4 million adult Americans suffer from GAD during the course of a year. It most often begins in childhood or adolescence, but can begin in adulthood. It is more common in women than in men.

How Is GAD Diagnosed?

If symptoms of GAD are present, the doctor will begin an evaluation by asking questions about your medical history and performing a physical examination. Although there are no laboratory tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for physical illness as the cause of the symptoms.

The doctor bases his or her diagnosis of GAD on reports of the intensity and duration of symptoms -- including any problems with functioning caused by the symptoms. The doctor then determines if the symptoms and degree of dysfunction indicate a specific anxiety disorder. GAD is diagnosed if symptoms are present for more days than not during a period of at least six months. The symptoms also must interfere with daily living, such as causing you to miss work or school.

How Is GAD Treated?

If no physical illness is found, you may be referred to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses like GAD. Treatment for GAD most often includes a combination of medication and cognitive-behavioral therapy.

• Medication: Drugs are available to treat GAD and may be especially helpful for people whose anxiety is interfering with daily functioning. The medications most often used to treat GAD in the short-term are from a class of drugs called benzodiazepines. These medications are sometimes referred to as "tranquilizers," because they leave you feeling calm and relaxed. They work by decreasing the physical symptoms of GAD, such as muscle tension and restlessness. Common benzodiazepines include Xanax, Librium, Valium and Ativan. Antidepressants, such as Paxil, Effexor, Prozac, Lexapro, and Zoloft, are also being used to treat GAD. These antidepressants may take a few weeks to start working but they're more appropriate for long-term treatment of GAD.
• Cognitive-behavioral therapy: People suffering from anxiety disorders often participate in this type of therapy, in which you learn to recognize and change thought patterns and behaviors that lead to anxious feelings. This type of therapy helps limit distorted thinking by looking at worries more realistically.

In addition, relaxation techniques, such as deep breathing and biofeedback, may help to control the muscle tension that often accompanies GAD.

Are There Side Effects of GAD Treatment?

Dependency on anti-anxiety medications (benzodiazepines) is a potential complication of treatment. Side effects of antidepressants vary by specific drug and the person taking them. Common side effects can include sleepiness, weight gain, and sexual problems.

What Is the Outlook for People With GAD?

Although many people with GAD cannot be cured and symptoms can return from time to time, most people gain substantial relief from their symptoms with proper treatment.

Can GAD Be Prevented?

Anxiety disorders like GAD cannot be prevented. However, there are some things that you can do to control or lessen symptoms, including:

• Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola and chocolate.
• Ask your doctor or pharmacist before taking any over-the-counter medicines or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
• Exercise daily and eat a healthy, balanced diet.
• Seek counseling and support after a traumatic or disturbing experience.
• Practice stress management techniques like yoga or meditation.

WebMD Medical Reference

Cognitive-Behavioral Therapy (CBT)

If we are serious about overcoming an anxiety disorder, we need to approach anxiety from every positive angle and perspective that we have available to us. Therefore, we focus on three main areas, all three of which must be addressed in therapy:

1. COGNITIVE

(thinking/belief processes)

Here we learn new methods and ways to change our old thinking patterns and habits. If we’re always thinking and expecting the worst, then we will continue to suffer. We train or condition our minds to think and respond differently than we have in the past. Or think of it this way – if we can be conditioned to think and feel negatively, then we can be reconditioned to think healthfully.

We have dozens of specific methods and techniques that we use -- and you only need to find several methods that work well for you. We usually start CBT (cognitive-behavioral therapy) at this stage.

Some effective techniques are:

Slow-talk/slow walk/slowing down

Stopping automatic negative thinking (ANTs)

The acceptance paradox: how we keep the fires burning and how to put them out

Rational and helpful self-statements that can become permanent and "automatic"

Continuing to move our self-statements up

Whose voice are you listening to, anyhow? Do we have to listen and believe all those old lies?

The determination factor: becoming more focused and gently determined

Focusing: What are you paying attention to?

Later, it’s important we address:

perfectionism, anger, frustration, setbacks, and our view of the world

2. BEHAVIORAL

(what we do)

The behavioral aspect of therapy is the part where we actually put everything into place in everyday, real-life situations where we are bothered by anxiety and depression.

This area is always handled at the same time or after cognitive therapy, because we need a strong foundation of cognitive and emotional skills/strategies so that we can begin living and acting differently before we confront real-life challenges.

This stage is essential for people with some of the anxiety problems (such as social anxiety disorder) and serves as a powerful adjunct to individual treatment for others.

3. EMOTIONAL

(relaxation/peaceful/strength and power strategies)

It is important to have some type of relaxation or "de-stress" strategy that is accessible whenever we need it.  In this area, calmness and peace are the goals.

The more your brain is quiet and relaxed, the easier therapeutic information can get into it and be processed. This is simply another way to let the therapy reach your brain and gently sink in.

Our focus is on peace and calmness here. We do not focus on decreasing anxiety by using these methods. Why? As peace and calmness become a little stronger, they tend to "crowd" out the anxieties and fears we have. Therefore, we never need to focus on the anxiety, the nervousness, or the fear. Our focus is on healing, healthiness, and inner peace.
 

-- Thomas A. Richards, Ph.D., Psychologist