Worry, worry, worry!

Generalised anxiety disorder (GAD)


Everyone gets worried sometimes, but if you have generalized anxiety disorder (GAD) then worries and fears are so constant that they interfere with your ability to function and relax. You may worry excessively about things that are unlikely to happen, or feel tense and anxious all day long with no real reason. This anxiety takes a physical toll, too. Your body aches, you can�۪t sleep, and you�۪re exhausted all the time. The good news is that generalized anxiety disorder is treatable. Many things can help, including self-help strategies and therapy.
What is generalized anxiety disorder (GAD)?
Carrie�۪s story
Carrie has always been a worrier, but it never interfered with her life before. Lately, however, shes been feeling keyed up all the time. She�۪s paralyzed by an omnipresent sense of dread, and worries constantly about the future. Her worries make it difficult to concentrate at work, and when she gets home she can�۪t relax.
Carrie is also having sleep difficulties, tossing and turning for hours before she falls asleep. She also gets frequent stomach cramps and diarrhoea, and has a chronic stiff neck from muscle tension. Carrie feels like she�۪s on the verge of a nervous breakdown.
Generalized anxiety disorder (GAD) involves anxiety and worry that is excessive and unrelenting. This high-level anxiety makes normal life difficult and relaxation impossible.
If you have generalized anxiety disorder (GAD) you may worry about the same things that other people do: health issues, money, family problems, or difficulties at work. But you take these worries to a new level.
A co-worker�۪s careless comment about the economy becomes a vision of an imminent pink slip; a phone call to a friend that isn�۪t immediately returned becomes anxiety that the relationship is in trouble. Sometimes just the thought of getting through the day produces anxiety.

Whether you realize that your anxiety is more intense than the situation calls for or believe that your worrying is protective in some way, the end result is the same. You can�۪t turn off your anxious thoughts. They keep running through your head, on endless repeat.
Sound Familiar?
� ���I can�۪t get my mind to stop��_it�۪s driving me crazy!"
� ���He�۪s late - he was supposed to be here 20 minutes ago! Oh my God, he must have been in an accident!�۝
� ���I can�۪t sleep ��� I just feel such dread ��_ and I don�۪t know why!�۝

The difference between "normal" worry and GAD

Worries, doubts, and fears are a normal part of life. It�۪s natural to be anxious about your upcoming test or your finances after being hit by unexpected bills. The difference between ���normal�۝ worrying and generalized anxiety disorder (GAD) is that the worrying involved in GAD is much more frequent and disruptive.
For example, after watching a news report about a terrorist bombing in the Middle East, the average person might feel a temporary sense of unease and worry. A person with generalized anxiety disorder, however, might be up all night afterwards, then continue worrying for days about a worst-case scenario in which his or her small hometown is attacked.
Most people with GAD don�۪t avoid workplace or social situations, but they go about their activities filled with exaggerated worry and tension, even though there is little or nothing to provoke them. For others, the anxiety and physical symptoms of generalized anxiety disorder interfere with everyday functioning.


���Normal�۝ Worry:

� Your worrying doesn�۪t get in the way of your daily activities and responsibilities.
� You�۪re able to control your worrying.
� Your worries, while unpleasant, don�۪t cause significant distress.
� Your worries are limited to a specific, small number of realistic concerns.
� Your bouts of worrying last for only a short time period. �

Generalized Anxiety Disorder:

Your worrying significantly disrupts your job, activities, or social life.
� Your worrying is uncontrollable.
� Your worries are extremely upsetting and stressful.
� You worry about all sorts of things, and tend to expect the worst.
� You�۪ve been worrying almost every day for at least six months.

Signs and symptoms of generalized anxiety disorder (GAD)
The symptoms of generalized anxiety disorder (GAD) fluctuate. You may notice better and worse times of the day, or better and worse days in general. And while stress doesn�۪t cause generalized anxiety disorder, it can make the symptoms worse.
Not everyone with generalized anxiety disorder has the same symptoms. But most people with GAD experience a combination of a number of the following physical and psychological symptoms:
Physical symptoms of generalized anxiety disorder (GAD)
� Muscle tension, aches, or soreness
� Trouble falling asleep or staying asleep
� Stomach problems, nausea, diarrhea
� Jumpiness or unsteadiness
� Edginess or restlessness
� Tiring easily
Psychological symptoms of generalized anxiety disorder (GAD)
� Irritability
� Feelings of dread
� Inability to control anxious thoughts
� Inability to relax
� Difficulty concentrating
� Fear of losing control or being rejected
Children and generalized anxiety disorder (GAD)
In children, excessive worrying centers on future events, past behaviors, social acceptance, family matters, their personal abilities, and school performance. Unlike adults with GAD, children and teens with generalized anxiety disorder often don�۪t realize that their anxiety is disproportionate to the situation, so adults need to recognize their symptoms. Along with many of the symptoms that appear in adults with generalized anxiety disorder, some red flags for GAD in children are:
� ���What if�۝ fears about situations far in the future
� Perfectionism, excessive self-criticism, and fear of making mistakes
� Feeling that they�۪re to blame for any disaster, and their worry will keep tragedy from occurring
� The conviction that misfortune is contagious and will happen to them
� Need for frequent reassurance and approval
Self-help for generalized anxiety disorder (GAD)
If you have generalized anxiety disorder (GAD), there are many things you can do to make yourself feel better. For some, self-help strategies are enough to get anxiety symptoms under control. For others, additional therapy and support is needed. But in either case, self-help coping techniques will only help reduce your overall anxiety levels.
Effective self-help techniques for generalized anxiety disorder (GAD) include:
� Dealing with your worry and anxiety in more productive ways. This may involve challenging irrational worrisome thoughts, learning how to postpone worrying, and learning to accept uncertainty in your life.
� Make any necessary anxiety-reducing lifestyle changes, such as eliminating caffeine, starting an exercise program, improving your diet, and drawing on the support of family and friends.
� Learn and practice relaxation techniques, such as meditation and deep breathing. As you strengthen your ability to relax, your nervous system will become less reactive and you�۪ll be less vulnerable to anxiety and stress.
Self-help strategies for chronic worriers
Learn how to reduce your anxiety levels by challenging negative thoughts, making healthy lifestyle choices, and de-stressing using your senses.
Another effective approach to self-help for generalized anxiety disorder (GAD) involves learning how to self-soothe. Many people with generalized anxiety disorder don�۪t know how to calm and soothe themselves. But it�۪s a simple, easy technique to learn, and it can make a drastic difference in your anxiety symptoms.
The best methods for self-soothing incorporate one or more of the physical senses: vision, hearing, smell, taste, and touch. Try the following sensory-based, self-soothing suggestions when your GAD symptoms are acting up:
� Vision ��� Take in a beautiful view. Go to an art museum. Walk around a pretty neighborhood. Look at treasured photos or an interesting picture book.
� Hearing ��� Listen to soothing music. Enjoy the sounds of nature: birds singing, ocean waves crashing on the beach, wind rustling through the trees.
� Smell ��� Light scented candles. Smell the flowers in a garden. Breathe in the clean, fresh air. Stop by a bakery. Spritz on your favorite perfume.
� Taste ��� Cook a delicious meal. Slowly eat a favorite treat, savoring each bite. Enjoy a hot cup of coffee or tea.
� Touch ��� Pet your dog or cat. Take a warm bubble bath. Wrap yourself in a soft blanket. Sit outside in the cool breeze. Get a massage.
To Cope with Anxiety,
Remember A-W-A-R-E

The key to switching out of an anxiety state is to accept it fully. Remaining in the present and accepting your anxiety cause it to disappear.
A: Accept the anxiety. Welcome it. Don�۪t fight it. Replace your rejection, anger, and hatred of it with acceptance. By resisting, you�۪re prolonging the unpleasantness of it. Instead, flow with it. Don�۪t make it responsible for how you think, feel, and act.
W: Watch your anxiety. Look at it without judgment ��� not good, not bad. Rate it on a 0-to-10 scale and watch it go up and down. Be detached. Remember, you�۪re not your anxiety. The more you can separate yourself from the experience, the more you can just watch it.
A: Act with the anxiety. Act as if you aren�۪t anxious. Function with it. Slow down if you have to, but keep going. Breathe slowly and normally. If you run from the situation your anxiety will go down, but your fear will go up. If you stay, both your anxiety and your fear will go down.
R: Repeat the steps. Continue to accept your anxiety, watch it, and act with it until it goes down to a comfortable level. And it will. Just keep repeating these three steps: accept, watch, and act with it.
E: Expect the best. What you fear the most rarely happens. Recognize that a certain amount of anxiety is normal. By expecting future anxiety you�۪re putting yourself in a good position to accept it when it comes again.
------Adapted from: Anxiety Disorders and Phobias: A Cognitive Perspective, by Aaron Beck and Gary Emery

When to seek professional help for generalized anxiety disorder
If���despite trying out the self-help coping strategies above���your anxiety is still getting in the way of your life or your emotional well-being, it�۪s time to seek professional help.
First, it�۪s important to make sure that your symptoms are truly due to generalized anxiety disorder (GAD). If you�۪ve struggled with anxiety and fears your whole life, it�۪s likely that your anxiety symptoms are due to GAD. However, if your anxiety symptoms are relatively new, this could be a sign of a different problem. For example, many medical conditions and medications can cause anxiety. Traumatic experiences can also cause symptoms similar to that of generalized anxiety disorder.
To get an accurate diagnosis and appropriate treatment, it�۪s best to see a mental health professional. Generalized anxiety disorder is often accompanied by other problems, such as depression, substance abuse, and other anxiety disorders. For treatment to succeed, it�۪s important to get help for all of the problems you�۪re dealing with.
Treatment options for generalized anxiety disorder (GAD)
A number of treatments can help reduce the symptoms of generalized anxiety disorder (GAD). Most effective treatment plans will incorporate both self-help measures and therapy. In more severe cases of GAD, medication may also be used.
Therapy for generalized anxiety disorder (GAD)
Therapy is a key component of treatment for generalized anxiety disorder. Many studies show that therapy is as effective as medication for most people. And best of all, therapy for generalized anxiety disorder (GAD) is side-effect free.
Cognitive-behavioral therapy (CBT) is one type of therapy that is particularly helpful in the treatment of generalized anxiety disorder (GAD). Cognitive-behavioral therapy examines distortions in our ways of looking at the world and ourselves. You therapist will help you identify automatic negative thoughts that contribute to your anxiety. For example, if you catastrophize���always imagining the worst possible outcome in any given situation���you might challenge this tendency through questions such as, ���What is the likelihood that this worst-case scenario will actually come true?�۝ and ���What are some positive outcomes that are more likely to happen?�۝.
Cognitive-behavioral therapy for GAD involves five components:
� Education. CBT involves learning about generalized anxiety disorder (GAD). It also teaches you how to distinguish between helpful and unhelpful worry. An increased understanding of your anxiety encourages a more accepting and proactive response to it.
� Monitoring. In CBT for generalized anxiety disorder (GAD), you learn to monitor your anxiety, including what triggers it, the specific things you worry about, and the severity and length of a particular episode. This helps you get perspective, as well as track your progress.
� Physical control strategies. Deep breathing and progressive muscle relaxation help decrease the physical over-arousal of the ���fight or flight�۝ response that maintains the state of fear and anxiety. CBT for generalized anxiety disorder (GAD) trains you in these techniques.
� Cognitive control strategies. Through CBT, you learn to realistically evaluate and alter the thinking patterns that contribute to generalized anxiety disorder (GAD). As you challenge these negative thoughts, your fears will begin to subside. CBT also teaches you to test the beliefs you have about worry itself, such as ���Worry is uncontrollable�۝ or ���If I worry, bad things are less likely to happen.�۝
� Behavioral strategies. Instead of avoiding situations you fear, CBT teaches you to tackle them head on. You may start by imagining the thing you�۪re most afraid of. By focusing on your fears without trying to avoid or escape them, you will begin to feel more in control and less anxious. Time management and problem-solving skills are also effective behavioral techniques for generalized anxiety disorder (GAD).

Melinda Smith, M.A., and Ellen Jaffe-Gill, M.A., created this article with contributions from Jeanne Segal, Ph.D. Last reviewed: May 2010.