Generalized anxiety disorder is a very debilitating illness characterized by intense irrational fear and worry that is not appropriate for the given situation. Oftentimes, people suffering from generalized anxiety disorder will catastrophize small things. It is not uncommon for them to be “on edge” most of the time and to even experience panic attacks where they are in a “fight, flight, or freeze” state of mind.

Someone with this disorder may find it painstakingly difficult to do something as simple as making small talk with a cashier or even being in the presence of other people. They will usually isolate themselves from others in order to help them feel “safe” and to help minimize the intense anxiety that they deal with on a daily basis.

Though it may give them temporary relief to avoid situations that may give them anxiety, the negative ramifications of this action will only make their anxiety worse in the long term.

Generalized anxiety disorder affects roughly 6.8 million adults, or 3.1% of the U.S. population, in any given year. Women are twice as likely to get diagnosed with this illness. The insidiousness of this disorder can begin at any time in one’s life, though the risk is at its highest between childhood and middle age [1]. It is not uncommon for someone who is diagnosed with generalized anxiety disorder to also be diagnosed with other mental illnesses like depression or obsessive compulsive disorder (OCD) for example.



Causes of Generalized Anxiety Disorder

The exact cause of generalized anxiety disorder is not fully known. However, a number of different factors including genetics, brain chemistry, and environmental stresses appear to contribute to the development of this mental illness [2]. If you have a family history of generalized anxiety disorder or mental illness in general, then this will increase your chances of developing it. This is not to say that if no one in your immediate family has ever suffered from mental illness that you are then exempt from developing it. You would merely have a decreased risk.

Using brain imaging technologies and neurochemical techniques, scientists are finding that a network of interacting structures is responsible for the many different emotions that are present in an anxiety disorder. There is a lot of research on the amygdala, which is an almond-shaped structure deep in the brain. The amygdala can signal that a threat is present, which then triggers a feelings of anxiety. It seems evident that emotional memories stored in the central part of the amygdala may play a role in disorders that deal with very distinct fears like specific phobias, while different parts may be involved in other forms of anxiety [3].




Symptoms of Generalized Anxiety Disorder

The symptoms that people deal with as a result of having generalized anxiety disorder are very debilitating and cause a great deal of mental anguish. Here are some common symptoms of generalized anxiety disorder:

  • Excessive worrying
  • Irritability
  • Sweating
  • Difficulty concentrating
  • Lethargy
  • Muscle tension
  • Being easily startled (nervousness)
  • Trouble sleeping
  • Restlessness
  • Indecisiveness
  • Overthinking

Generalized Anxiety Disorder Diagnostic Criteria

To get diagnosed with generalized anxiety disorder you will need to get a psychiatric evaluation by a psychiatrist or by a therapist who can diagnose patients. The healthcare professional will ask you about your family history to see if that may be a contributing factor, as well as some personal questions about how your anxiety affects your daily life and for how long this has been occurring, among many other questions.

Commonly used and effective diagnostic interviews for adults include the Structured Clinical Interview for DSM Disorders (SCID) and the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5). There is also a child version of the ADIS, where both parent and child are asked about the child’s symptoms. These different interviews also evaluate the presence of other mental disorders such as depression [4].



Generalized Anxiety Disorder Treatments (abridged)

Unlike some other mental illnesses, generalized anxiety disorder is a very treatable disease. Cognitive behavioral therapy (CBT) and/or medication are very effective at helping to reduce symptoms. Oftentimes, CBT is used in conjunction with a low dose of an anti-depressant drug or an anti-anxiety drug.

Usually a short-term treatment, CBT focuses on teaching you specific skills to where you can directly manage your many worries and help you gradually return to the activities you’ve avoided because of your intense anxiety. Throughout this process, your symptoms improve as you build on your initial success [5]. Mindfulness meditation is also a very effective form to help reduce anxiety. There is a type of treatment called Mindfulness Based Stress Reduction (MBSR) where you use mindfulness techniques to help reduce your symptoms of anxiety and to enhance your overall equanimity.

Some common drugs that may help with your anxiety are SSRI’s like Lexapro, Zoloft, and Prozac, among several others. Benzodiazepines like Valium, Xanax, and Ativan may also be prescribed to help with short term anxiety relief. Talk to your doctor or therapist to see what the best course of action is for you to get healthier as such drugs may or may not be necessary for you.

Treatments (expanded)

Cognitive Behavioral Therapy (CBT)

CBT is a psycho-social intervention that aims to improve one’s mental health. It is a modality that is often used to treat people suffering from anxiety disorders such as generalized anxiety disorder and OCD. Someone with generalized anxiety disorder may also be able to benefit from CBT as well seeing as how it would allow them to have a much better understanding as to why they think and behave the way they do in relation to their irrational fears.

CBT can be immensely helpful for someone with this condition given the sheer automaticity of their symptoms. For example, when someone with this condition is exposed to their fear, they will almost always have an instantaneous subconscious reaction to their fear. Such a lack of introspection is likely a large part of why someone with this condition will suffer to the extent that they will. CBT can help you to take a step back and analyze your fears more deeply than you typically would.

Besides learning to be more fastidious with regards to understanding one’s specific fears, someone with generalized anxiety disorder engaging in CBT can also expect to learn various other skills aimed at helping to relieve the anxiety caused by their condition.

Mindfulness-Based Stress Reduction (MBSR)

MBSR is an 8-week evidence-based program that offers secular, intensive mindfulness training to help people who are suffering from anxiety, stress, depression, and other sorts of mental anguish. MBSR may be able to significantly help someone who is suffering from generalized anxiety disorder as mindfulness meditation has been shown to be very beneficial for anxious people. In such a structured program, someone with generalized anxiety disorder can expect to learn a plethora of different skills that can help them to relieve the intense anxiety that’s associated with their specific phobia.

Talk to your doctor or therapist to see if MBSR can help you to reduce the intensity of your symptoms of this condition, as well as where to find MBSR programs in your area.

Meditation

There are many different forms of meditation that exists which can be very advantageous for someone suffering from generalized anxiety disorder. Specifically, mindfulness meditation has been shown to be quite beneficial for helping people to enter into a more equanimeous state. There are many different ways with which you can implement mindfulness meditation and there are also many different meditation apps which are designed to make things as easy as possible for you.

Mindfulness has the potential to significantly help those suffering from generalized anxiety disorder due to how it will help one to distract themselves from their fear by refocusing their attention onto something else that does not have any sort of emotional baggage attached to it, such as by focusing on the breath for example. This is one of the most basic ways that one can meditate and be present.

For someone with generalized anxiety disorder in the midst of a panic attack, redirecting one’s attention to the various sensations felt when breathing can actually help to reduce the amount of mental anguish experienced during such an influx of anxiety.

To implement mindfulness meditation to help relieve one’s symptoms of this disorder, you can do so by paying close attention to the way the muscles in your abdomen and chest contract and relax with every inhale and exhale. You can spend time dwelling on how it feels as your chest expands during each inhale and how it sinks in with every exhale.

Besides focusing on your breathing, you can also focus on the sounds around you, the way your skin feels as you touch certain objects, the way foods taste, as well as the way certain aromas smell. Essentially, honing into your 5 senses can significantly help you to reduce some of the anxiety that is associated with generalized anxiety disorder. Also, remember that it will take a lot of practice to become an adept meditator. So, practice is key.

Exposure Therapy

As previously mentioned, exposure therapy is one of the most common ways to treat anxiety disorders such as generalized anxiety disorder. It can be an efficient way to help desensitize the patient to their specific fears. Be that as it may, it is imperative that the therapist implementing it on their patient is very adept at doing so. For example, if the therapist were to slightly expose someone with generalized anxiety disorder to their fear, then it may not be very effective as they may need a higher amount of exposure to truly trigger any sort of worthwhile change in the patient.

The same can be said for the antithesis of this scenario. If the therapist were to excessively expose someone with this disorder to their fear, then doing so could be highly counterproductive to the point to where their generalized anxiety disorder may become immensely worse due to the therapy alone. So, it is paramount that the therapist implementing exposure therapy for someone with this condition has a very strong sense of just how severe their symptoms are so that they can know the level of exposure that the patient will likely be able to handle.

Exercise

Exercise has been shown to be extremely beneficial for people suffering from anxiety disorders, including generalized anxiety disorder. Specifically, cardiovascular exercise can significantly help to relieve one’s stress. This is not to say that weight-resistance training would not benefit someone with anxiety, but rather that aerobic exercise is has been shown to be more effective at releasing those feel good chemicals in the brain, such as endorphins.

According to the American Psychology Association, exercise can help to condition the mind to better cope with stressful situations. This makes sense when we take into consideration the high amount of stress that the body is put under during strenuous exercise. So, if you yourself are sedentary, then engaging in some form of aerobic exercise may be able to significantly help reduce your symptoms of generalized anxiety disorder by making it much easier for you to cope with the anxiety and stress that’s associated with this condition.

There are many different aerobic modalities that you can partake in to help reduce your symptoms of this disorder, such as swimming, biking, skiing, walking, and jogging. You can also acquire the many benefits of exercise by playing sports such as tennis, soccer, basketball, and racquetball, among many other sports. Engaging in some form of exercise consistently may be able to help relieve some of the pain associated with generalized anxiety disorder over time.



Yoga

There are numerous different yoga poses that can substantially benefit someone who is suffering from generalized anxiety disorder. In part, this is due to the meditative state of mind that yoga tends to emit in those who practice it on a consistent basis. Yoga can be thought of as meditation in motion. It can help to relieve some of the anxiety associated with generalized anxiety disorder due to the mere fact that by engaging in yoga, your attention will be redirected to something more productive.

There are many different types of yoga that someone with this condition can benefit from, such as hatha yoga or hot yoga, among many others. Nevertheless, regardless of the many different forms of yoga that exist, virtually all of them can help to relieve some of the stress and anxiety that is associated with generalized anxiety disorder.

If you have never practiced yoga before, then it may be in your best interest to take a class or watch some guided videos that can help you through each pose. Just like with meditation, the more you practice yoga, the more adept you will become at it. Besides helping you to reduce your symptoms of generalized anxiety disorder, you can also expect to acquire increased strength and flexibility, among other benefits.

Reducing Caffeine

It is no secret that consuming large amounts of caffeine throughout the day can aid in making you more anxious. This makes sense when we look closely at how caffeine affects our body’s physiology. When we consume a high dose of caffeine, our heart will start to beat faster and we become more tense. Essentially, our body will begin to go into a “fight or flight” state of mind. Such a frame of mind is often a precursor for someone with generalized anxiety disorder to experience panic attacks.

So, consuming little to no caffeine throughout the day may be able to significantly help reduce your day to day anxiety. Although doing so will likely not make all of your anxiety go away, it will indeed help you to reduce any unnecessary suffering that you would have otherwise experienced if you were to consume a large amount of caffeine.

Beverages like coffee and tea are often high in caffeine, as well as some energy drinks. In fact, even some foods have caffeine in them as well, such as dark chocolate. Being more conscious of your daily caffeine consumption may help you to reduce some of the symptoms associated with this condition.

Dialectical Behavior Therapy (DBT)

DBT is a very effective form of treatment for people struggling with emotion regulation. It is often used to treat people suffering from borderline personality disorder. Nevertheless, it can also be very advantageous for someone suffering from anxiety disorders like generalized anxiety disorder too. This is due to the numerous amount of coping skills you can expect to learn in a DBT group. These groups typically last about 6 months long and can have anywhere from two people to several people depending on how many join the group.

One very effective DBT skill for helping someone with generalized anxiety disorder is half-smiling. This technique works by having you think about that which you fear or upsets you all while slightly raising the corners of your mouth by lightly smiling, thus the term “half-smiling.” Although, it isn’t enough to just think about your fear while half-smiling, you also have to try and refrain from entertaining those painful emotions that your specific fear may evoke.

Mindfulness meditation is also heavily used in DBT and can greatly benefit someone with this disorder as it is done in a group setting, which helps to put the patient out of their comfort zone. These group mindfulness practices may include drinking warm tea to hone in on the sense of taste and tactile senses or simply focusing on the breath.

Coping ahead is another very useful DBT skill that can help someone with this condition. With coping ahead, you will want to find a place where you can sit down quietly without distraction. Close your eyes and then think about the many different possible scenarios where you would face your specific fear and overcome it or cope with it. Doing so will help you to be much better adept at coping with your generalized anxiety disorder when you are actually exposed to the specific fear associated with it in real life.

Psychiatric Medications

Anti-anxiety meds

These types of medications are very useful to help prevent panic attacks. Such drugs can be extremely useful for people suffering from severe generalized anxiety disorder due to the fact that people with phobias often experience panic attacks as well. Some common anti-anxiety medications include Xanax, Valium, and Klonopin, among many others.

These types of drugs are not typically taken on a daily basis, but they may be insofar as their generalized anxiety disorder is severe enough. However, this is something that you should first discuss with your doctor before you decide to do so to ensure that it is safe and effective.

Antidepressants

These types of medications aren’t only for people who suffer from depression as they can also help people suffering from anxiety disorders as well, such as generalized anxiety disorder. Some common antidepressants are Paxil, Zoloft, and Lexapro, among several others. These drugs may be able to help reduce some of the symptoms of this disorder.

These types of drugs are typically taken on a daily basis. They can indeed help prevent panic attacks from occurring, but they are more so used to help reduce people’s daily anxiety. Talk to your doctor to see if taking antidepressants can help to reduce your symptoms of generalized anxiety disorder, as well as whether or not it is safe to do so.


References

https://www.betterhelp.com/advice/anxiety/

https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

https://www.webmd.com/anxiety-panic/guide/generalized-anxiety-disorder#1

https://www.psychologytoday.com/conditions/generalized-anxiety-disorder

https://www.verywell.com/dsm-5-criteria-for-generalized-anxiety-disorder-1393147

https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/diagnosis-treatment/drc-20361045