What Is Generalized Anxiety Disorder (GAD)?

Approximately one in five Americans and close to one billion people worldwide suffer from some form of mental illness as of 2019. General anxiety disorder (GAD) is the most common of these illnesses, with nearly half of all Americans being diagnosed with some sort of anxiety disorder over the course of their lifetime.

Worrying is a normal response to life situations, but most people can control worry by dealing with the problems or distracting themselves with other activities. Individuals with GAD tend to worry about everyday activities without cause, waiting for something to go wrong and generally living their daily lives in constant fear or worry.

The symptoms of GAD can last a long time and even be lifelong when left unaddressed. Typically, an individual with GAD is worried about a specific event — for example, an upcoming surgery or current finances. Once the situation rectifies itself, these feelings of excessive worry pass. GAD is often an ongoing condition that returns and can affect a person’s ability to function. It’s just one of the five major anxiety disorders.

Five Major Anxiety Disorders

According to the U.S. Department of Health and Human Services, there are five major types of anxiety disorders. These include:

• Generalized anxiety disorder (GAD). One of the most common disorders, GAD is characterized by excessive worry and tension.
• Obsessive-compulsive disorder (OCD). Includes obsessions or repetitive behaviors.
• Panic disorder. Symptoms include repeated episodes of fear with physical symptoms that may include chest pain, palpitations, shortness of breath and dizziness.
• Post-traumatic stress disorder (PTSD). Develops after exposure to a terrifying event.
• Social anxiety disorder. Characterized by anxiety and excessive self-consciousness when dealing with others on a daily basis.

How Is Generalized Anxiety Disorder Diagnosed?

The GAD-7 scale was developed as an accurate measure to screen for GAD. Using the GAD-7 brief, adults aged 18 and older who’ve had anxiety symptoms in the past two weeks are asked a series of seven questions that measure anxiety symptoms. These questions cover symptoms, from how frequently the individual worries to how easy it is to relax. Someone with a score of 0 to 4 has minimal anxiety, scores from 5 to 9 mean mild anxiety and scores from 15 to 21 indicate severe anxiety.

According to the Centers for Disease Control, in 2019, close to 3% of all adults experienced severe symptoms of anxiety, 3% experienced moderate anxiety, 10% experienced mild anxiety and approximately 84% experienced no or minimal symptoms.

Is There Treatment for GAD?

Treatment for GAD is provided by trained health professionals, including psychologists, psychiatrists and in milder cases, by general practitioners.

Treatment for GAD can take several forms and may include a combination of treatment techniques.

A child or teenager with GAD may also worry constantly about their performance in school or in extracurricular activities. They may worry about major catastrophes, like war or extreme weather, and they may feel anxious about the health or safety of family members.

Causes of GAD (Generalized Anxiety Disorder)

The exact cause of anxiety disorders is unknown, but research suggests it’s a combination of factors, one of which is genetics. One study published by PLOS One reports the RBFOX1 gene may be involved in the development and ongoing condition of anxiety-related disorders. 

The development of parts of the brain, including the amygdala and hippocampus, is being studied as another cause of anxiety disorders. The amygdala is a small structure inside the brain that processes threats and alerts the brain to any signs of danger, such as fearing bees, drowning and dogs. 

Another part of the brain that may be responsible for anxiety is the hippocampus. This region is involved in storing memories from past events. Traumatic events may act as a trigger that causes a person to worry excessively when in certain circumstances — for example, when someone with prior combat experience is triggered by loud noises.

When Does GAD appear?

 GAD can appear at any time in an individual’s life, but it typically happens in the middle of a traumatic experience. It’s possible to develop GAD as either a child or an adult. 

The Cure for GAD

While there isn’t any one cure for GAD, this mental health condition is highly treatable. Anxiety disorders tend to affect people with specific personality types more than others, such as individuals who are more prone to worry. Most individuals who’ve been diagnosed with GAD describe themselves as lifelong worriers, and their tendency to over-stress is visible to others, so the goal is treatment over a cure. 

Treatment Options for Anxiety

Anxiety disorder therapies and treatment options for anxiety include psychotherapy, cognitive-behavioral therapy for anxiety, and medications for the relief of anxiety symptoms. Anxiety disorders can also co-occur with other disorders: anxiety, personality, and substance abuse. It is important to note that most individuals benefit from a combination of psychotherapy and medications. Furthermore, since it takes time for treatment to work, some trial and error may be involved to arrive at the best anxiety disorder therapies.

Anxiety Disorder Therapies: Psychotherapy

Psychotherapy is the most commonly used therapy in the various treatment options for anxiety. Also called talk therapy, psychotherapy is both proven and effective in treating anxiety. Since trust and confidence are essential to successful counseling, finding a psychotherapist who makes you feel at ease and with whom you can explore your issues is vital.

Be prepared to feel resistance to some of the guidance the therapist provides. This is normal and nothing to worry about. It may mean you’re beginning to explore areas of concern you’ve kept hidden or were unaware of but require more profound work to resolve. Among them may be deep-seated fears that fuel your anxiety disorder.

What Happens During Psychotherapy?

During psychotherapy, you and your psychotherapist talk one-on-one about your experiences and feelings. The therapist asks questions to understand your thoughts and behavior better. The psychotherapy sessions allow you to learn about how anxiety disorder affects your life: your feelings, behaviors, thoughts, and moods.

Benefits of psychotherapy include:

• Discovering easier and more effective ways to cope with anxious feelings, worries, and fear.
• Gradually change your thoughts and behavior to improve and support your overall emotional and mental well-being.
• The ability to express and process feelings in a safe, supportive environment.
• Delving deeper into problems and issues to gain insight.
• Knowing you can discuss things you’d never feel comfortable revealing to others, and it will remain confidential.

Cognitive-Behavioral Therapy for Anxiety

Cognitive-behavioral therapy for anxiety is one of the anxiety disorder therapies that is proven to be effective. This therapy, called CBT for short, is considered one of the best current front-line treatment options for anxiety. It also shows significant symptom relief for anxiety sensitivity and sleep problems.

CBT is a short-term treatment for anxiety disorders. The focus is on learning specific skills and techniques to help improve anxiety symptoms and facilitate returning to activities that were avoided due to anxiety.

What Happens During CBT?

Anxiety disorder therapies like CBT involve changing the individual’s negative behaviors and thoughts that contribute to their anxiety. During CBT, the therapist helps guide the individual with:

• Behavioral activation
• Challenging
• Problem-solving
• Stopping thoughts
• Exposure
• Reframing thoughts
• Tracking patterns
• Psychoeducation
• Exposure Therapy

A subset of CBT is exposure therapy, another highly effective treatment to help individuals manage their anxiety symptoms and situations triggering anxiety.

What Happens During Exposure Therapy?

Exposure therapy is one of the anxiety disorder therapies used to treat different anxiety conditions. The technique varies depending on the type and severity of the anxiety disorder. In a safe environment, the therapist and the individual confront anxiety triggers and fears.

The treatment may involve the progression of the fear hierarchy at three paces: graded (gradual fear source exposure), systematic desensitization (using relaxation techniques), and flooding (highest level of fear exposure at once).

Types of exposure therapy techniques include:

• Imaginal
• In vivo
• Interoceptive
• Virtual reality

Medications for Anxiety Relief

While no medications can cure anxiety disorders, they are effective in some people to improve symptoms and daily life functioning. Depending on which anxiety disorder you have, your doctor may prescribe medications for anxiety relief. This may not apply to every person who is diagnosed with some anxiety disorder. Furthermore, the type of medication the doctor may consider using among the treatment options for anxiety depends on what type of anxiety disorder is present.

Antidepressants

Among the medications used as treatment options for anxiety relief that are commonly prescribed are certain antidepressants. These drugs facilitate improvements in mood and the ability to manage stress by adjusting chemistry in the brain. Antidepressants are slow-acting and generally take time to show positive results.

Serotinin reuptake inhibitors (SSRIs) are one type of antidepressant medication that may be prescribed to treat anxiety disorders and obsessive-compulsive disorder (OCD). They are considered a first-line medication treatment for GAD.

How SSRIs Work

SSRIs start working within 2-6 weeks. However, they aren’t effective for everyone. SSRIs are non-habit-forming and don’t lead to dependence. Examples of SSRI medications used to treat anxiety disorders include paroxetine (Paxil, Pexeva), sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), escitalopram (Lexapro), and citalopram (Celexa).

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another antidepressant class of drugs that may be used in anxiety and depression treatment. They’re also used to treat chronic pain. Medical experts consider SNRIs a first-line anxiety treatment, but not as effective for OCD.

How SNRIs Work

It may take several weeks for SNRIs to begin to show results. The process involves reducing the chemical reabsorption of serotonin and norepinephrine in the brain. Some SNRI examples include venlafaxine (Effexor XR) and duloxetine (Cymbalta).

Tricyclic antidepressants (TCAs), an older class of antidepressants, are less commonly prescribed to treat anxiety and depression. Doctors typically prefer to prescribe SSRIs due to fewer side effects. However, TCAs may still be used in some individuals if other anxiety medications fail to offer relief.

How TCAs Work

TCAs block the reabsorption of the neurotransmitters norepinephrine and serotonin, Increasing their levels in the brain. Examples of TCAs include imipramine (Tofranil), amitriptyline (Elavil), and nortriptyline (Pamelor).

Anti-Anxiety Medications for Anxiety Relief

Anti-anxiety medications are a popular class of medications used to relieve anxiety symptoms, including worry and panic. They’re only meant to be used briefly because the body develops resistance to them.

Benzodiazepines are one form of anti-anxiety medication. A type of sedative drug, benzodiazepines, can reduce anxiety’s physical symptoms, like muscle tension. They also increase relaxation. The effects occur quickly. Benzos are rarely prescribed to treat anxiety disorders long-term because their effectiveness decreases over time, and the drugs may become addictive. However, they may be prescribed for short-term (less than six months) anxiety management.

Examples of benzodiazepines include lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax), and chlordiazepoxide (Librium).

Buspirone is another example of an anti-anxiety medication that the doctor may consider in treating anxiety. While the medication works slower than benzodiazepines, it results in fewer side effects and has lowered dependency risk. But Buspirone may not work to treat all of the anxiety disorder types.

Short-Term Course of Medications for Anxiety Relief

Although not the first line of treatment options for anxiety, the treating doctor may determine that other medication types may be helpful. The crucial point here is that these medications are only for short-term anxiety symptom relief. They are never intended to be continually used or prescribed for extended periods.

What are these other types of medications? They include sedatives and beta blockers.

Sedatives for Anxiety Relief

It is essential to remember that sedatives (benzodiazepines) are potent drugs. They should never be used indiscriminately. If prescribed for anxiety, it should only be for short-term relief of symptoms.

Beta Blockers for Relief of Anxiety

Similarly, beta-blockers may offer some short-term symptom relief in those diagnosed with anxiety disorders. Doctors prescribe beta blockers for several medical conditions. Chief among them are high blood pressure and certain kinds of heart or cardiovascular problems. Yet, beta blockers can also be beneficial in helping alleviate uncomfortable physical anxiety symptoms. Trembling, flushing, and a rapid heart rate can be minimized with beta-blockers.

However, the FDA has not formally approved the use of beta blockers for the treatment of anxiety disorders. They are considered off-label.

Examples of beta blockers include propranolol (Inderal) and atenolol (Tenormin).

Other Anxiety Disorder Therapies and Treatment Options

In conjunction with psychotherapy and medications prescribed for anxiety, other anxiety disorder therapies may be helpful. These adjunct therapies include:

• Exercise, specifically aerobic training
• Biofeedback
• Autogenic training (a mind-based relaxation technique)
• Hypnosis
• Acupuncture
• Self-help group participation

When To See a Doctor

If you think you have excessive anxiety or feel like anxiety is taking over your life, it may be time to visit a health care professional. A small amount of anxiety is normal, but you should contact a health professional if:

• Your worry becomes overwhelming and is interfering with relationships, work and other parts of your life
• You feel irritable and depressed and have difficulty with alcohol or drugs due to your anxiety
• You have suicidal thoughts or behaviors due to excessive worry

For more information on GAD and help with anxiety, contact us at Restore to learn more about our programs and how we can help.