What is Generalized Anxiety Disorder (GAD)

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Generalized Anxiety Disorder is a typical anxiety disorder that is characterized by a steady and constant stressing, tension, and strain. Excessive worry is one of the main symptoms of this disorder. In addition, a large number of physical symptoms are also present. As a result, they frequently go to physical evaluations and lab investigations. These usually reveal nothing significant. The people with this disorder are not able to focus and there is a marked decline in functioning. These people can’t stop thinking negatively regarding health, job, family, career, etc. After the major depression, this disorder is highly prevalent in our society. The lifetime risk of developing this disorder is 5 to 10 percent.

Symptoms of Generalized Anxiety Disorder
Following are the main symptoms of this disorder
Excessive Worry; the core symptoms
Out of all the symptoms, excessive worry is the core symptom. Following are the main features of this symptom

Following example illustrates how the worries of an individual with GAD make a chain that is responsible for the keyed-up feeling in him or her.
All these what if’s fuel more into the anxiety of an individual that incapacitates the individual to stop worrying. An individual is compelled to keep on worrying regardless of realizing it that it is insane to stay anxious. An individual has an endless repetitive session of overly thought scenarios that seems too real to be stopped. So, simply suggesting patient that not to worry is not helpful

Psychological Arousal
These symptoms include decreased concentration or inability to focus, irritability, and sensitivity to noise, disturbance of sleep
Autonomic Arousal
This is due to the increased norepinephrine release in the body. Symptoms include increased heart rate, sweating of hands and feet, cold extremities, dry mouth, abdominal discomfort, increased micturition reflex.

Muscular Symptoms
Patients feel the inability to relax, shivering or tremors usually in hands, headache, shoulder or neck muscle pain
Hyperventilation
In order to overcome the anxiety symptoms, patients try to breathe excessively. This excessive breathing causes more oxygen intake and more carbon dioxide release. This changes the acid-base balance and the patient further experience symptoms such as dizziness and numbness.
Five Bad Behaviors in People with GAD
Reassurance. Individuals with GAD are in a habit of taking suggestions from multiple persons before taking a small decision. Since not everyone has the same intention and perspective so they get numerous options and then get anxious.
List-making. Before the execution of small task individuals make a proper list so they know everything is under control
Procrastination. They avoid initiating a new task or making new friends because they would worry about something not going right.
Use of Distraction. They try to stay distracted so they don’t have to worry about only one thing again and again which is an unhealthy mechanism the benefits of this strategy are short-lived.
Checking. They try to keep a regular check on things or people they love because they are excessively worried about something happening to them.

Factors responsible for Generalized Anxiety Disorder

Genetic factor: GAD does have a genetic disposition. The individual whose first relative has developed generalized anxiety disorder has chances of developing an anxiety disorder. Also, the prevalence rate in women for anxiety disorders is twice as compared to men in the general population.
Neurobiological factors: Abnormalities in the amygdala is responsible for consistent worrying as this region is responsible for emotional regulation. Among the neurotransmitters, those that play a significant role in the development of anxiety symptoms are serotonin, norepinephrine, dopamine, and GABA.
Environmental factors: Any type of traumatic event experienced such as humiliation, loss of a loved one, abuse, and bullying have a role in the development of generalized anxiety disorder. See the study of life events by Brown and Harris in our blog of Depression.
Cognitive factors: Certain coping and thinking styles are also responsible for predisposing an individual toward anxiety disorders.
Paying more attention to stressful or threatening situations e.g. results of exams.
Overestimating chances of the negative outcome when thinking about a situation.
Their brain memorize those things related to a situation that has an unfavorable outcome
Modules for Treatment

Guided self-help
This includes the improvement in the following areas
Lifestyle modifications
Change your lifestyle by eating healthy, avoiding caffeine, getting a good night’s sleep. A healthy body produces a healthy mind; you need to make your body healthy as well. The benefits of a healthy lifestyle are underestimated. An unhealthy lifestyle is the root of so many problems.
Reduce self-monitoring
As discussed above there is a wide range of symptoms of generalized anxiety disorder ranging from psychological to physical. These different symptoms are not different illnesses rather they are produced by a single disorder. Giving more attention to these symptoms prolongs the illness. So, try not to focus on symptoms as much as possible. For example, stop checking pulse, blood pressure, etc. frequently.

Avoid frequent Lab investigations.
After making a confident diagnosis of generalized anxiety disorder, frequent lab investigations are usually discouraged. It is also observed that people go for investigations by themselves without physician’s advice just for reassurance. For example, they may go ECGs multiple times. This type of behavior also maintains the illness.
Avoid frequent reassurance seeking
Another important behavior of these patients is getting frequent reassurance from others such as relatives, friends, and doctors. They discuss their symptoms with them and other persons try to motivate. They feel relieved a little bit. Remember this relief is temporary. Again they will experience symptoms and again seek reassurance. This type of reassurance is discouraged. It delays the recovery. So whenever you feel anxiety symptoms especially the physical ones, try not to discuss with everyone.
Avoid the Avoidance
Some people try to avoid situations that are anxiety-provoking. The best strategy is to face the situation rather than avoiding. This avoidance also prolongs the illness. For example, a student tries to avoid appearing in the examination.
Few coping statements
They coping statements may be helpful in case of generalized anxiety disorder e.g.
“Let it be”
“What the worst can happen”
“If the worst happens then what”
Relaxation Exercises
The two most commonly used techniques are breathing retraining and progressive muscle relaxations.
In breathing-retraining individual is enabled to continue calm and abdominal breathing even during the phase of anxiety.
Progressive muscle relaxation is based on the principle that when muscles are stretched deliberately for some time you will feel relaxation afterward. So, almost all muscle groups of the body are first stretched and then relaxed. For details see Breathing Retraining and Progressive muscle relaxation.
Cognitive Behavior Therapy
Cognitive behavior therapy has the greatest efficacy in the treatment of anxiety disorders. Following are the main aims of CBT:
Identifying and modifying the negative beliefs about the uncontrollable nature of worries by the use of strategies including questioning the evidence and alternating explanation for the evidence, pie charting, questioning the mechanism. For details see Cognitive behavior therapy.
Modifying the positive beliefs that the patient is having concerning his or her worrisome behavior.
Disconfirming the negative beliefs that the patient is having regarding his or her worry by the use of behavioral experiments such as suppression experiment, abandoning thought control, controlled worry period, etc. One example of a behavioral experiment i.e. Controlled Worry Period is given below:

Following are the steps of problem-solving strategy:

Drug Treatment
The mainstay of drug treatment for anxiety disorders is Selective Serotonin Reuptake Inhibitors (SSRIs). Usually, a single medicine is started in low dose and dose is gradually increased till the desired response is achieved. Medicine takes almost two to three weeks to start its effect. Once the response is achieved the medicine is continued for almost one year. The decision to start medicine is based on the severity of illness and psychological treatment is not available or not working.
Benzodiazepines such as diazepam, clonazepam, etc. are also used in anxiety disorder but remember these are not the mainstay of treatment. These should be avoided as much as possible because of their addictive potential. However, a short course of benzodiazepines may be used along with SSRIs and then their dose is tapered down.

Case Study
Client S. U is a 25 years old female, educated till Masters, married and second-born among four siblings. She came to the psychiatric ward of the hospital with the complaints of excessive anxiety and worry about day to day activities, inability to control worry and fear of going crazy due to excessive worry. She also reported to have sleep disturbances, mood irritability and found great difficulty in focusing on her tasks. The client also complained that due to constantly being in a keyed-up state she failed to execute most of her tasks efficiently and for which she often been bashed by her boss. She reported that she was having these symptoms for the past eight months and tried to get a hold of them by some meditational exercises but all her efforts were in vain.

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