Generalised anxiety disorder (GAD)

The normal worries of everyday life can usually be controlled or 'switched off'. Worrying can be constructive if it helps you to work out possible solutions to a problem. However, some people are troubled by excessive worry and anxiety that seems difficult to control. This type of excessive worrying is known as generalised anxiety disorder (GAD).

Worries associated with GAD are distressing, last a long time and may appear for no apparent reason. GAD is characterised by a feeling of apprehension and constant irrational worrying about potential threats to the person and their loved ones.

The main feature of GAD is excessive anxiety and worry, occurring more days than not for at least six months. Worries are often about a variety of minor issues and events that are unlikely to occur. Generally, the worries are future oriented -– about what might happen rather than what is happening. Even when there is no cause for alarm, a person with GAD might worry about health, finances, family issues, and work or study performance.

Generalised anxiety disorder affects about five per cent of the population and onset can be at an early age – one third of people with GAD experience onset in childhood or adolescence. GAD may occur following a stressful life event or a period of high stress. It is more likely to develop if a person is predisposed to high anxiety due to a combination of genetic factors and environmental influences.

Generalised anxiety disorder is often chronic (ongoing), but may have only a moderate impact on a person’s ability to function in daily life and so can often remain undetected and undiagnosed. There are various self-help strategies you can use to reduce your tendency to worry. You can also seek professional treatment.

Symptoms of generalised anxiety disorder

People with generalised anxiety disorder experience several mental, emotional and physical symptoms, including:

• excessive and unreasonable worry over events or activities, such as work, school or health
• excessive worry about their capacity and confidence to deal with situations
• inability to control or stop their worrying
• feelings of apprehension
• muscle tension
• restlessness or feeling keyed up or on edge
• being easily fatigued
• tension headaches
• problems with concentration or having their mind go blank
• irritability
• shallow, uneven breathing
• increase in heart rate and blood pressure
• sweating
• feeling nauseous or sick
• trembling and shaking
• sleep disturbance (such as difficulty falling or staying asleep, or restless unsatisfying sleep).

Causes of generalised anxiety disorder

Biological, psychological, social and cultural factors all appear to influence the development of GAD. The contributing factors may include:

• personality – research suggests that people who were inhibited or reserved as children may be more likely to develop GAD as adults. Personality traits such as emotional sensitivity and shyness also make worrying more likely
• learned behaviour – our habitual ways of thinking are learned over many years and are influenced by a range of environmental, social and family influences. A tendency to be preoccupied with imaginary worries can train our mind, over time, to habitually worry
• family – anxiety (as a trait) may be inherited and the family environment (including the role models provided by parents) may influence the development of GAD
• brain chemistry – some research indicates that anxiety is associated with altered brain chemistry. However, it is unclear whether anxiety causes the physical changes or whether the physical changes cause the anxiety.

Self-help strategies for generalised anxiety disorder

Self-help strategies that can help a person to control or reduce their worrying include:

• structured problem solving
• relaxation and mindfulness meditation
• exercise.

Structured problem solving can help with generalised anxiety disorder

Structured problem solving is a way of turning fruitless worrying into strategies to find solutions. It is best to practise first on small worries or problems, and limit yourself to working on one problem at a time. As you become proficient at the technique, you can tackle larger, more complex problems. Write down all the steps as you work through them. The steps of structured problem solving include:

• step one – identify the problem and be precise. For example, 'I am afraid of being alone in the house at night.'
• step two – brainstorm every possible solution you can think of, without censoring any idea at this early stage. Give yourself permission to list even absurd or outlandish possibilities
• step three – evaluate the solutions one at a time, noting the advantages and disadvantages of each
• step four – decide on the most appropriate solution(s). It is sometimes better to choose a solution that can be implemented immediately, even though it might not be 'the best'. Avoid choosing solutions that are too ambitious or hard to fulfil
• step five – make a plan for how you intend to implement the solution. Include factors such as the required resources (like money), help required from other people, time limits or deadlines, possible difficulties that may be encountered along the way, coping strategies for those anticipated difficulties, rehearsal (such as practising what to say during a job interview), and methods of monitoring and reviewing the effectiveness of the plan
• step six – review the plan as necessary, perhaps adding or deleting points.

Relaxation and mindfulness meditation for generalised anxiety disorder

Many people who experience excessive worry report that they don't know how to relax. Regular practice of a relaxation technique, such as progressive muscle relaxation (systematic tensing and relaxing of the various muscle groups), can help to reduce the physical symptoms of anxiety.

Mindfulness meditation, the practice of focusing our attention on the present moment, involves both physical relaxation and creating a calm and peaceful state of mind. During meditation, the brain's activity – when mapped by a device called an electroencephalograph (EEG) – is different to any other measurable state of consciousness, including sleep. The brain waves produced are called alpha waves, and this brain state has been found to promote relaxation of the entire nervous system.

Scientific studies show that the regular practice of meditation can be a powerful tool in anxiety management.

Exercise and managing generalised anxiety disorder

Exercise is proving to be an effective strategy to help people manage symptoms of depression and anxiety. There are various theories to explain how exercise can lift a person's mood. These include:

• altered brain chemicals – Queensland researchers have found that regular exercise, and the subsequent increase in physical fitness, alters levels of a brain chemical called serotonin, which leads to improved mood and feelings of wellbeing
• reduced adrenaline – physical activity burns up stress chemicals like adrenaline, which promotes a more relaxed body and mind
• distraction – an enjoyable bout of exercise may be distracting enough to break the vicious cycle of worrying.

Seeking professional help for generalised anxiety disorder

Health professionals who can help treat GAD include psychologists, psychiatrists and general practitioners (doctors).

Treatments that are helpful for alleviating GAD include a variety of psychological therapies and medications. A combination of cognitive behaviour therapy, anxiety management techniques and improving physical wellness has been found to be successful in bringing generalised anxiety disorder under the person's control.

Medication is sometimes used to relieve anxiety symptoms; however, if it is used, it is generally only recommended as a short-term measure.

Don't hesitate to seek professional advice if your self-help strategies don't seem to be working for you.

Where to get help

• Your GP (doctor)
• Health professionals, including psychologists and psychiatrists
• Anxiety Recovery Centre Victoria (ARCVic) - Helpline. Tel. (03) 9830 0533 or Tel. 1300 ANXIETY (269 438)
• Anxiety Disorders Association of Victoria. Tel. (03) 9853 8089
• Mental Health Branch, Department of Health and Aged Care. Tel. 1800 066 247