Generalised Anxiety Disorder in Adults
Generalised Anxiety Disorder (GAD) can be described as excessive worry that is not necessarily focused on anything specific, but rather there is a general feeling of being on edge or feeling tense about a variety of things in life (e.g. finances, health, family, future, etc.).
The exaggerated worry is usually not provoked or triggered by a particular event or stressor, although the anxiety may be heightened by certain situations. That is what makes this Anxiety Disorder so tricky for people to deal with on their own because a person may believe they are just experiencing “normal” everyday concerns, yet somehow these worries seem to affect them more than the next person. When it comes to GAD, a person may feel like they cannot switch off the worrying thoughts. People with GAD often say things like: “I thought I was just a worrier”; “I worry about everything all the time”; “I often can’t sleep because the worries keep going around and around in my mind”; “my mind is constantly working through every possible scenario and preparing for all the negative outcomes.”
Aspects of GAD that distinguish it from regular everyday worries, are the symptoms that accompany the worry, and the intensity and frequency of the worry. People with GAD usually experience a consistent feeling of threat, racing thoughts, fear of future consequences, restlessness, irritability, sleep issues, and symptoms similar to panic, which include; heart palpitations, dry mouth, sweating or hot flashes, trembling or tense muscles, and upset stomach (or butterflies in the stomach).
Having GAD feels like walking around with a brain that is always switched “ON” to analysing any possible threat there may be during every moment of the day, and thinking of every possible consequence or solution to each of those threats. The problem though, is that most of the consequences do not happen and most of the solutions are not required. Therefore, the mind is constantly being over-used for things that will never occur.
Anxiety is a normal human process; in fact, it is necessary for our survival as it alerts us to threat. The problem with GAD is that the anxiety system has become over-active and much more sensitive to threat which means the anxiety system is activated by “perceived” threat or possible future threats rather than actual danger in the present moment. This can cause the anxiety system to be activated on and off for the majority of the day, leaving the person feeling constantly tense and worried. Although there is some agreement amongst researchers that there is a genetic component involved in developing GAD, there is no certainty about why certain people develop GAD and why others do not. The most likely explanation is that GAD develops due to a combination of things such as genetic, behavioural, and developmental factors.
Psychological intervention can be very useful in treating GAD. Therapy will typically involve an assessment session where you and your psychologist work out what the problematic symptoms are, the triggers for these symptoms (both thoughts and situations), and how these issues impact you. Your psychologist will then use this information to figure out which evidence-based intervention will suit you best and will be most effective for your specific difficulties. Cognitive-Behaviour Therapy (CBT) is a common and useful intervention for many anxiety disorders, including GAD. The cognitive part involves dealing with unhelpful thinking patterns (such as the excessive worry that occurs with GAD) and the behavioural part aims to deal with a person’s reactions to anxiety-provoking situations or other triggers. One main aspect of the behavioural component is exposure therapy; this aims to help the person gradually face feared situations to help the person recognise that the threat that leads to ongoing worrying thoughts is usually only a “perceived” threat and is not actually dangerous. This, in turn, decreases the sensitivity of the anxiety system so that it is activated less frequently.
There are other forms of therapy that are also very useful in treating GAD, such as, Acceptance and Commitment therapy (ACT) and Mindfulness- Based CBT that focus on managing the worrying thoughts by changing the relationship a person has to their thoughts and how much importance they place on them. Specifically, ACT and mindfulness approaches provide a person with the skills to separate and distance themselves from their thoughts, and accept that thoughts can be present without having a negative impact on their life.
Author: Ea Stewart (DPsych (Clin); BSc [Hons])