Overview of Generalized Anxiety Disorder (GAD)
Stress and anxiety are a normal part of life. It’s what helps keep us safe and alive. Too much, however, can also make us sick.
Anxiety is the physiological feelings of tension, nervousness, racing heart, sweating, and feelings of dread that can be triggered by worried thoughts.
Anxiety can be a worry and apprehension about something in the future and anxiety can be experienced in the moment during stressful events.
A buildup of daily stress or stress from life events such as losing a job, death of a loved one, or divorce can cause symptoms of anxiety. Our bodies experience a physiological response to these stresses that could lead to more prolonged anxiety.
Generalized anxiety is experienced by both adults and children.
To overcome and conquer your anxiety you begin by transforming your beliefs, identifying your "What if thinking," create more powerful thoughts, and learn to manage the physical symptoms of anxiety.
Generalized Anxiety Disorder is excessive anxiety and worry about multiple events and activities.
Persistent worry and apprehension that is out of proportion to what would actually happen
Difficulty controlling worried thoughts
Worries over routine daily activities and experiences (Job, health, finances, family, household chores, being late)
Difficulty making decisions
The worry and apprehension goes well beyond normal daily worries and is associated with significant physical symptoms of:
Restlessness or feeling on edge
Difficulty concentrating or mind going blank
Muscle tension or muscle soreness
Frequent urination and/or diarrhea
Children typically experience worry about their competence or performance with school or sports.
Children’s worries usually shift from one concern to another. They may seek more reassurance and approval from parents.
Children may also conform more and lack confidence. Children will usually have more physical complaints such as stomach aches or feeling ill and may avoid going to school.
Who’s at Risk?
Females are 2 times more likely than males to experience generalized anxiety disorder. 2.9% of adults and 0.9% of adolescents experience generalized anxiety disorder
Temperament: People with personalities that are shy, negative, behaviorally inhibited, and avoidant may be at risk.
Environmental: Having a difficult childhood and over-protective parents could be associated with generalized anxiety disorder.
Genetic and physical factors: Genetics accounts for approximately one-third of the risk for developing generalized anxiety disorder and is shared with depression and other anxiety disorders.
Worrying takes up a lot of time and energy. It interferes with sleep and feeling well physically.
Generalized anxiety disorder will have an affect on:
Social and interpersonal relationships
Following through with other daily activities and events
Physical health (High blood pressure etc.)
Generalized Anxiety Disorder occurs with other anxiety disorders
People who experience generalized anxiety have beliefs about themselves and the world that cause them to interpret a range of situations as threatening and dangerous.
Within your family environment, you may have learned negative beliefs from your parents that you apply to yourself, other people, and the world.
These subconsciously programmed beliefs influence how you think, how you behave, and how you feel.
If you believe that the world is basically a dangerous place, then your thoughts, behavior, and feelings will follow and lead you to fear and avoid those places that you believe are dangerous.
Common core beliefs include:
I must always be competent
I am responsible for other people’s feelings and actions
I must be in control at all times
I must have certainty at all times
You may have also learned ineffective ways of dealing with worries and stressful situations. You may feel inadequate at solving life’s problems or accomplishing your goals.
Early stressful life experiences such as being bullied in school, for example, could have instilled a sense of uncertainty and helplessness.
These experiences contribute to the development of your beliefs and attitudes about the world and your ability deal with stressful circumstances.
Our beliefs and attitudes directly affect how we perceive and interpret events and situations.
Our beliefs influence how we think and deal with life events.
Negative beliefs and attitudes are reflected in our thoughts and lead us to misinterpret situations. Some thoughts are deliberate and within our awareness, and some of our thoughts are automatic.
Thoughts can be so automatic that we are not fully aware of their impact on our emotions. This can leave us feeling out of control over events and our emotions.
David Burns, MD identified that thinking can be irrational and cause us to make errors. These errors are often called Cognitive Distortions.
All or Nothing Thinking: Also called “black and white thinking.” This is when you see only extremes and don’t appreciate that most things fall somewhere in between or the “grey areas.” Things are either all bad or all good. Examples include, “Either I cope with anxiety right or not at all” and “If I don’t do it perfectly, I’ve failed.” This type of thinking causes feelings of disappointment, frustration, and fear.
Overgeneralization: We overgeneralize when we conclude that one single event is evidence of all future events. We use a lot of “Always” and “Never” statements. This causes feelings of helplessness and feeling overwhelmed.
Labeling: You assign a label to yourself or other people that uses both all or nothing thinking and overgeneralization. “I made a mistake, so I’m a defective person.” This creates feelings of hopelessness and an inability to change.
Jumping to Conclusions: Mind Reading - we imagine we know what others are thinking and Catastrophizing - we know what will happen in the future without sufficient evidence. We make assumptions that create anxiety, anger, and depression.
Mental Filtering: You minimize positives and only pay attention to negative information, causing you to magnify and exaggerate your fear and negative outcomes.
Discounting the Positives: You reject positive qualities and experiences and conclude that they don’t count.
Magnification and Minimization: You exaggerate the importance of your failures (or someone else’s success) and minimize any evidence personal achievement.
Personalization: You assume and take on all the responsibility for a situation or another person’s behavior causing you to feel guilty and shameful.
Should and Must Statements: These are a ridged set of rules that when not followed also create feelings of guilt and fear of failure.
Emotional Reasoning: You assume that because you feel this way something must be true. “I’m anxious, so there must be danger.” Emotional reasoning creates a self-fulfilling prophecy and you end up worrying more and feeling anxious even though there really is no danger.
If you believe you could have Generalized Anxiety Disorder it will be helpful and important to seek consultation with a mental health professional to first verify the diagnosis and then receive appropriate treatment.
Generalized Anxiety Disorder (GAD) can be successfully treated with psychotherapy, and in some cases, a combination of psychotherapy and medication.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is a well-researched and highly effective form of talk therapy that focuses on learning more helpful ways of thinking and behaving.
You learn ways of improving your communication skills and different ways of responding to social situations and to your feelings of anxiety.
CBT helps challenge and change your unhelpful beliefs that cause the anxiety.
After you learn to master the anxiety, you will be encouraged to approach more social situations that trigger the anxiety. This is where you apply your new CBT skills within a feared situation and have the experience of feeling less anxious and more confident.
This is when your beliefs really begin to change and the social anxiety becomes non-existent.
Please consult with your primary care physician or a psychiatrist regarding the use of medication.
Medication can help reduce the physical symptoms of anxiety. Commonly prescribe medications include benzodiazepines, anti-depressants, and beta blockers.
Benzodiazepines are quick acting sedatives that are generally safe and effective for short term use. However, the long term use of benzodiazepines is associated with the risk of developing tolerance, dependence, and possible other adverse effects.
Commonly prescribed benzodiazepines are:
Anti-depressant medications are also effective at reducing symptoms of anxiety on a daily basis. This helps dampen the physical and emotional effects of anxiety and increases a person’s capacity to cope with stressful situations.
Commonly prescribed anti-depressants are:
Beta Blockers are used to treat high blood pressure, heart arrhythmias, and migraines. They are also prescribed for off-label use by physicians to help reduce the physical symptoms of anxiety.
Beta blockers have the ability to control rapid heartbeat, shaking, trembling, and blushing in response to anxiety.
Commonly prescribed Beta Blockers:
Metoprolol (Lopressor, Toprol-XL)