Generalized Anxiety Disorder

Generalised Anxiety Disorder, or GAD as it is commonly known, is a subtype of anxiety disorder. Anxiety is often described as a feeling of unease, worry, or fear that can range from a mild to severe feeling.  Anxiety is common and most people will experience some level of anxiety at stressful times in their life, for example when sitting an exam, going for a job interview, or having a medical test.

GAD is much more than ‘normal’ worry or anxiety and there are a number of key differences between experiencing GAD and the type of anxiety people experience day to day:

  • GAD is characterised by chronic worry for more than a six month period, in which you feel anxious in a wide range of situations, as opposed to a specific event/situation
  • If you have GAD, you are likely to feel anxious a lot of the time, and this may feel out of control
  • If you are suffering from GAD you may not always be clear about what the cause of the anxiety is
  • You may feel ‘on edge’ or more alert to your surroundings
  • You may also find it incredibly difficult to control your worries and symptoms of anxiety
  • Often when you resolve one anxious thought, it will quickly be replaced with another issue if you are experiencing GAD.  

Generalised Anxiety Disorder can cause both physical and emotional symptoms and people may feel that their thinking patterns and behaviour have changed.  When someone has anxiety, they often notice changes to their thoughts (for example noticing worried thoughts such as “something terrible has happened”), their emotions (for example feeling extremely fearful), and their behaviours (for example avoiding situations that may cause anxiety, or seeking reassurance from others). 

However, like with other anxiety disorders, symptoms of GAD can vary from person to person, but can include psychological, emotional and physical symptoms.

Psychological or Emotional Symptoms
  • Feeling restless or finding it difficult to relax
  • Feeling worried or on edge
  • A sense of dread
  • Racing thoughts
  • Difficulty concentrating or an inability to focus
  • Irritability.
Physical Symptoms
  • Difficulty falling or staying asleep
  • Tiredness or fatigue
  • A noticeable increase in strength or frequency of heart rate (palpitations) or an irregular heartbeat
  • Muscle aches or tension
  • Shaking or trembling
  • Stomach ache, feeling sick or loss of appetite
  • Excessive sweating
  • Shortness of breath.

As there is not always a clear cause of the anxiety and because people’s symptoms vary so widely, it can be difficult to diagnose GAD. Your doctor is might say that you have GAD if you have felt anxious most days over a period of around six months or may want to refer you to another service who specialise in understanding anxiety and other mental health conditions.

GAD is thought to be one of the more common anxiety disorders, with studies suggesting that around 1 in 50 adults will experience it at some point in their lifetime. As with many mental health conditions, the exact cause of GAD is not currently fully understood.  However, various risk factors may play a part. For example, genetic makeup may make people more likely to have an ‘anxious personality’ which can run in families and may put you at higher risk of developing GAD. Experiencing significant negative events in childhood may make you more prone to anxiety in your adult life. It may also be that a major stress in life could ‘trigger’ anxiety, for example, experiencing a significant health problem or bereavement, but unfortunately, the symptoms can persist after the trigger has gone.

What helps

As the symptoms associated with GAD are so uncomfortable and unpleasant, you might try to find ways of reducing the anxiety yourself. However, this might result in you avoiding situations that cause you to feel worry or dread.  It is common for people with GAD to withdraw from socialising, or only doing things in a certain way in order to feel safe. For example, you might withdraw from family and friends, or you might find work to be very stressful and then take some time off sick. Unfortunately, while this may reduce the anxiety in the short term, these actions can make you worry even more and can also lead to low self esteem and loss of regular ways of coping , which can have a negative effect on your emotional well-being in the longer term. For example, sometimes it might be helpful to take some time off work, however this is not a long-term solution, and you may find it even more difficult to go to work after a long time off.

The most helpful thing that you can do if you think you might be experiencing GAD is to talk to someone about how you are feeling.  Your General Practitioner (GP) is a good place to start and they will be used to talking to people experiencing similar symptoms.  Your GP should be able to can provide you with information about the various treatment options available for GAD if it is confirmed that this is what you are suffering from.  It is important to think about the pros and cons of each of these so that you know what to expect and are aware of any potential risks of side effects.

There are three main types of treatment for GAD:

  • Self-help resources
  • Talking treatments (psychological therapies)
  • Medications.

Self Help Resources

Your GP might direct you to an individual self-help course to help you to learn more about GAD and what you can do to help yourself feel better. This usually involves working from a book or a website with occasional contact with your doctor to monitor your symptoms and progress. Alternatively you may be offered a place in a group with other people who have similar problems where you can learn how to tackle your anxiety. There are lots of helpful resources available to support you through this process.  For some good examples, please see the links in the ‘find out more’ section.

Talking Treatments (Psychological Therapy)

Often people will try a type of self-help treatment for GAD in the first instance. However, if this approach does not work for you, or does not lead to an improvement in your symptoms, or if your symptoms are more severe, your GP may refer you for something called ‘talking treatment’. Talking treatments are a type of psychological therapy and offer some of the most successful treatment options for GAD. Talking therapy involves working through a process with a trained therapist to help you to understand the causes of your anxiety, and to help you to find strategies to help you to manage your symptoms. There are a number of different talking treatments available; however one of the most effective in treating GAD is Cognitive Behavioural Therapy (CBT).  This approach helps you to understand the connection between your thoughts, your behaviour, and your GAD symptoms. This type of psychological therapy involves meeting with a therapist for around one hour a week over a period of a few months. During talking therapy you will develop strategies to cope which are designed to help you to manage your anxiety symptoms independently in the future. It can be described as adding various tools to a toolbox that you can keep and use later.

Medication

If you prefer not to try talking therapy approaches, or if you continue to struggle with symptoms of anxiety, your GP may offer you some medication.  A variety of different medications are available, however, it is important to discuss your symptoms fully with your doctor so that they can match a medicine to suit your individual needs.   If you decide to take medication you will need to see your doctor regularly to assess the impact of the medication.  As with all medications, there is the risk of side effects and it is important that you tell your GP if you experience side effects as they may be able to adjust your dose or prescribe an alternative.

The four main types of medication you may be prescribed to help you with your GAD symptoms are:

  • Antidepressants – these might help you to feel more calm, and may improve your sleep
  • Benzodiazepines – these medications will not deal with the cause of your anxiety, but they can help to reduce your symptoms until you are able to consider other treatment options.  They should only be used as a temporary measure as it is possible to become dependent on these medications
  • Pregabalin – this type of medication can be used to treat GAD. It is normally used to treat epilepsy but is also licensed to treat anxiety
  • Beta-blockers – these medications are used less frequently in GAD as they only treat the physical symptoms of anxiety by reducing your level of physiological arousal. They are often more helpful in treating short-lived anxiety, like phobias. They are short acting which means that you will need to keep taking them, and they will not reduce any of your psychological symptoms like worrying thoughts.
Living with...Generalised Anxiety Disorder

GAD is different from ‘normal worry’ and can difficult to live with as the anxiety is prolonged and the level of anxiety can be severe. People with GAD feel anxious much of the time and this can affect your ability to complete day-to-day activities or basic tasks.  Because GAD is not specific to a particular situation or as a result of a particular event, you may feel that there is little respite from it and as though it has taken over, making it difficult to think about anything else. The fact that there is often no clear trigger for the anxiety can mean that GAD is difficult for people to understand and often not knowing what is causing you to feel this way can make you feel worse.  You may think that “things are out of your control”, “there isn’t a solution” or “I might always feel this way”. As a result, GAD can have a major impact on your general well-being, your emotional health, your ability to work, and may also affect your relationships. It is also common to have other conditions, such as depression or other anxiety disorders if you have GAD.

Find out more

NHS Choices website has more information about anxiety disorders including GAD.

Well-being Services South Glasgow website has lots of information about anxiety and includes a self help booklet & also provides video and audio guided relaxation exercises, which you can also use for free.

MIND is a mental health charity which offers a range of helpful information, guides to support and services, and stories from people who have lived experience of anxiety.

Anxiety UK is a charity with over 40 years of supporting people with anxiety.  It offers information as well as telephone, email and text support.

The Centre of Clinical Interventions has workbooks about worry and generalised anxiety that you can work through yourself at your own pace.

Looking after someone with...a Generalised Anxiety Disorder

It is important to remember that whilst suffering from Generalised Anxiety Disorder your family member or friend is not themselves, and this means that you may need to adjust your expectations and the way you interact with them.  Although you might not understand how they feel, or why they are feeling this way, it is helpful to try to adopt a non-judgemental approach rather than trying to dispel the anxiety with ‘logical’ arguments. There are a number of specific things that you can do which may help a friend or family member when they are suffering from anxiety:

  • Try to find out more about anxiety so that you can learn more about the condition yourself. This might help you to be understanding and supportive. Let your friend or family member that you are there to support them, and ask them what you can do to help – they might already have ideas about how you can support them or what they need from you. This might be things such as talking to them calmly about how they are feeling or doing deep, slow breathing exercises with them.
  • Stay calm and listen to your family member or friend’s wishes.
  • Try not to pressure them – seeing a family member or friend suffer from anxiety can be distressing and make you want to ‘fix’ it for them or find practical solutions. However, it can be very distressing for someone with anxiety to feel under pressure and it could even make them feel more worried.
  • Encourage them to seek help from their GP or access self-help resources.  It may be helpful to ask if it would help to accompany them to a GP appointment, or even call to organise one.  
  • Look after yourself – it can be stressful supporting someone else and it is important to take care of your own well-being.  This can help you to be in the best position to help someone else.

Further information for carers is available on our Looking After Someone page and from the NHS Greater Glasgow and Clyde carers site

Real life stories

See Emily’s story about living with anxiety at University  

Hear Alex talk about the physical symptoms of anxiety and the impact they had on him 

Hear Zoe’s story about living with GAD after her Dad passed away 

BSL - Generalised Anxiety Disorder

NHSGG&C BSL A-Z: Mental Health - Anxiety

Anxiety is a feeling that we can all get but sometimes it can become excessive and stop you from doing the things you want to. These feelings can become a problem when they cause distress or make us feel uncomfortable. There are various types of anxiety disorders depending on how often they occur or if they are triggered by certain things. Examples might be when the feelings of anxiety can occur all the time for no apparent reason with lots of worrying thoughts and physical symptoms such as a racing heart, feeling breathless, knot in your stomach, increased sweating. This is called Generalised Anxiety. Sometimes these symptoms can occur without warning for short periods of time for no apparent reason. These are called Panic attacks. Sometimes the feelings of aniety can be brought on by specific things such as a fear of heights or crowded places or spiders etc. These are described as Phobias.

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde