Generalized Anxiety and Worry

What is generalized anxiety disorder?

The main symptom of generalized anxiety disorder (GAD) is excessive worry. If you have GAD, you may feel:

What is worry?

When you worry, you think about problems that might happen in a way that leaves you feeling anxious or nervous. Worry is a chain of thoughts and images that can progress in ever more catastrophic and unlikely directions. It often feels hard to control and seems to take on a life of its own.

Is it bad to worry?

Worry isn’t always a bad thing – we all foresee problems in our lives and spend at least some time thinking about what we could do to manage them. The difference between normal and problematic worry depends on the amount of worrying that you do (people with excessive worry just do more of it) and whether you worry about ‘real’ or ‘hypothetical’ scenarios.

What do people with GAD worry about?

If you have GAD, you tend to worry about the same things as other people, the main difference is that you worry more and worry more often.

If you have problematic worry, you tend to worry more about unlikely or remote future events. If you have worry scenarios play in your mind you might feel more and more anxious, and yet nothing has even happened so far.

What is it like to have GAD and worry?

People who suffer from GAD find that their worries affect how they think, feel and act. Roshi struggled with GAD and her story illustrates what it can feel like.

Roshi’s anxiety

I’ve always been a worrier; my father left when I was young and my mother has severe health problems, so I always felt very responsible for the people around me. I’m often tense, and sometimes lie awake for hours because I find it hard to relax and ‘switch off’. What really bothers me is ‘not knowing’. My way of coping was that I ‘needed to know’: any time I wasn’t sure of something I would make sure I found out. This could be simple things like planning journeys or what we were going to eat that night, but it would get worse if I had to do anything out of the ordinary. To cope with my worry, I was phoning my mother three times a day to make sure she was safe, and constantly needing my boyfriend to reassure me that he was happy. I spent most of my time making plans and checking for obstacles. I also worried about not being good enough at work, so I took on lots of extra responsibility and didn’t delegate. I thought that worrying was the best way to stay prepared, and I wasn’t sure who I would be, or how I would cope, if my worry wasn’t there.

Do I have generalized anxiety disorder?

GAD should only be diagnosed by a mental health professional or a doctor. However, answering the screening questions below can give you an idea of whether you might find it helpful have a professional assessment.

Did you worry a lot when you were younger?
Never	Occasionally	Sometimes	Often
Do you find yourself worrying even when there is nothing to worry about?
Never	Occasionally	Sometimes	Often
Do worries about minor everyday things spiral into major concerns?
Never	Occasionally	Sometimes	Often
Do you find it hard to stop worrying once you have started?
Never	Occasionally	Sometimes	Often
Does worry get in the way of you enjoying your life?
Never	Occasionally	Sometimes	Often
If you were not worrying about whatever you are concerned with today, would you be worrying about something else?
Never	Occasionally	Sometimes	Often

 

If you answered ‘often’ or ‘yes’ to most of these questions then you could be experiencing excessive levels of worry about everyday situations. This is one of the factors that a psychologist will use to make a diagnosis of GAD.

What causes generalized anxiety disorder and worry?

There is no single cause for generalized anxiety disorder. You are more likely to experience GAD if you have:

• High intolerance of uncertainty.
• Positive beliefs about worrying.

There may be genes which make you more likely to develop emotional problems, but no specific genes which put you at greater risk of developing generalized anxiety disorder.

What keeps GAD and worry going?

Cognitive Behavioral Therapy (CBT) is a popular evidence-based psychological therapy. It is always very interested in what keeps a problem going. This is because by working out what keeps a problem going we can treat the problem by breaking the cycle. Some factors that psychologists think are important in keeping GAD going are:

Treatments for generalized anxiety disorder (GAD)

Psychological treatments for generalized anxiety disorder (GAD)

Two psychological treatments, Cognitive Behavioral Therapy (CBT) and applied relaxation are well supported by evidence and are both recommended for generalized anxiety disorder (GAD). Guidelines recommend 12-15 weekly sessions, each lasting one hour ^[3]. Treatment for GAD and worry might include some of the following ‘ingredients’ which research trials have shown to be helpful:

• Understanding more about how worry is an attempt to cope with uncertainty.
• Practicing becoming more aware of your worries.
• Exercises to increase your tolerance of uncertainty.
• Exploring what happens when you try postponing your worries.
• Examining your rules and assumptions about uncertainty.
• Practicing solving problems effectively.
• Deliberately exposing yourself to ‘hypothetical event worry’.

Medical treatments for generalized anxiety disorder (GAD)

The National Institute for Health and Care Excellence (NICE) recommends that if you have GAD and choose drug treatment, you should be offered a selective serotonin reuptake inhibitor (SSRI) at first, or a serotonin-noradrenaline reuptake inhibitor (SNRI) if SSRIs are ineffective^[3]. The NICE guidelines recommend against offering benzodiazepines for the treatment of GAD except as a short-term measure during crises.

References

1. Stansfeld, S., Clark, C., Bebbington, P., King, M., Jenkins, R., & Hinchliffe, S. (2016). Chapter 2: Common mental disorders. In S. McManus, P. Bebbington, R. Jenkins, & T. Brugha (Eds.), Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital.
2. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627.
3. National Institute for Health and Care Excellence (NICE: 2011). Generalised anxiety disorder and panic disorder in adults: management. Retrieved from https://www.nice.org.uk/guidance/cg113/resources/generalised-anxiety-disorder-and-panic-disorder-in-adults-management-pdf-35109387756997

About this article

This article was written by Dr Matthew Whalley and Dr Hardeep Kaur, both clinical psychologists. It was last reviewed on 2021/12/08.