Dr. Angela Hanford
Celeste is a 29-year-old elementary school teacher who has been married for six years. She has friends and is active in her school and church communities. Not many people know how much worry and dread plagues Celeste’s life.
Although she has always had praise for her work as a teacher, she often fears that she will be in trouble at work. For example, her mornings are filled with constant dread that she will be late for work and that this will result in her dismissal. Celeste also experiences difficulty making simple decisions, such as which dress to buy or planning meals, as she worries that she will make the wrong decision.
There are many evenings that she sits at home worrying that something catastrophic will happen to her husband, only to relax when he is finally home for the evening. Celeste has tried to stop the anxious thoughts and even realizes that they are extreme, but she finds herself overwhelmed and feels hopeless about the anxiety ever ceasing.
Johnny is a 12-year-old boy who loves to play baseball and soccer. His grades tend to be average to above average and he has plenty of friends. However, Johnny constantly worries that he will fail out of school. He is unable to finish math tests because, despite knowing the concepts, he checks and rechecks his answers and ends up not finishing.
As for baseball, Johnny is a great pitcher, yet he worries that he will hurt someone if he pitches too hard and that he will send them to the hospital. Prior to games his stomach hurts and he is overwhelmed with dread.
Johnny also worries about his family, specifically that something bad will happen to one of his family members. For example, he worries that they will get hurt in a car accident or develop cancer. Johnny’s fears tend to change over time, and as soon as one fear is overcome, another develops. It feels like an endless cycle.
Celeste and Johnny each experience a generalized type of anxiety, in that their anxiety does not revolve around one specific topic (e.g., fear of separation or fear of judgment). Anxiety in and of itself is not necessarily harmful.
As you know, experiencing worry or stress is a normal part of life. In fact, some level of stress can be motivating, as it helps us to move forward in life and to accomplish goals. On the other hand, Generalized Anxiety Disorder (GAD) is excessive anxiety that can have a devastating effect on one’s life and functioning.
Generalized Anxiety Disorder can affect anyone. Researchers for the National Comorbidity Survey Replication (NCS-R) discovered that about 5.7% of adults in the United States will develop GAD at some point (Harvard Medical School, 2007).
Furthermore, impairment from GAD can be significant, with estimates of serious impairment at 32.3% and moderate impairment at 44.6% (Kessler et al, 2005). For adolescents in the National Comorbidity Survey Adolescent Supplement (NCS-A), the estimated prevalence rate was 2.2% with 0.9% having severe impairment (Merikangas et al, 2010).
What is Generalized Anxiety Disorder?
According to the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) (APA, 2013), anxiety can take several forms, of which one is GAD. The types of anxiety specified in the DSM-5 include: separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, substance/medication induced anxiety disorder, anxiety disorder due to anther medical condition, and other specified (or unspecified) anxiety disorder.Generalized Anxiety Disorder is distinct from other anxiety disorders in that the worries are usually more diverse. For example, social anxiety is confined to worry about social situations, whereas anxiety in GAD could be about any number of areas. For instance, someone with GAD may be worrying about school performance, fear of hurting another person, and fear of making a mistake.
According to the DSM-5, someone who has GAD displays significant worry and anxiety that does not just occur occasionally, but for most days and for at least six months (APA, 2013). Furthermore, symptoms are not present at just one event, but in multiple events or arenas of life. It is also very difficult for someone who has GAD to control his or her worry.
An individual who experiences GAD also displays at least three symptoms, such as:
- A feeling of restlessness or being “on edge”
- Has the experience of one’s mind going blank or finding it difficult to concentrate
- Being irritable
- Tension in one’s muscles
- Difficulty with sleep (e.g. experiencing problems falling asleep or staying asleep)
Furthermore, GAD causes someone significant distress and/or leads to difficulty functioning or other impairment (e.g. in school or work). As you can see, GAD is more than the occasional concern about doing well on a test or uncertainty about one’s future. It is very pervasive and can be quite distressing.
What Causes Generalized Anxiety Disorder?
There are several factors that may contribute to someone developing GAD, such as genetic factors (e.g. genes that relate to neurotransmitters), personality traits, and life experiences (e.g., prolonged stressor such as an illness, abuse) (APA, 2013; HMHL, 2011).
It should also be noted that medical conditions such as hyperthyroidism can cause someone to develop excessive anxiety. Therefore, a medical examination is always warranted to rule-out physical causes to symptoms. Furthermore, certain substances, including caffeine, may also contribute to anxiety.
Regardless of the specific factors that lead to anxiety, it is apparent that GAD involves parts of the brain misinterpreting threats. You have probably heard of the fight or flight response. This response (a.k.a. the flight, flight, freeze, or faint response) is helpful for when there is a dangerous situation and you need to react quickly without taking the time to think through options.
For example, if there is a dog charging your child you have no time to slowly think of all possible responses. Instead, you react before the dog attacks. During these fight or flight moments, certain parts of your brain take over (e.g., brainstem and limbic areas) and our body mobilizes to quickly deal with the fear-inducing situation in a way that will allow survival.
There are also physiological changes that occur during the fight or flight response, such as (Wilson & Lyons, 2013):
- Dilation of pupils
- Increased perspiration
- Increased heart rate
- Muscle tension
- Increased blood sugar
- Blood flow increases to certain parts of the body (e.g. head, trunk) and decreases to others (e.g. hands, feet)
You likely recognize some of these physical symptoms from when you have experienced fear. It has been postulated that when someone experiences an anxiety disorder, the signals in his or her brain become confused and the brain becomes mobilized for a crisis without a crisis being present (Wilson & Lyons, 2013).
Strategies for Coping with GAD
There are a variety of strategies that can be helpful for coping with symptoms of anxiety or for helping someone else to cope with anxiety.
Several strategies include:
1. Examine your diet: For example, stop consuming caffeine to see if that results in a decrease in anxiety. Note: be careful if you regularly consume caffeine, as you can develop significant withdrawal symptoms from suddenly stopping caffeine intake. You may ask your medical doctor the easiest and safest way to taper off of caffeine.
2. Engage in daily self-care, such as getting enough sleep and healthy eating.
3. Exercise, as long as you are cleared by your medical doctor, can be helpful for clearing your mind and activating brain chemicals.
4. Relaxation exercises can be helpful for decreasing anxiety and releasing muscle tension.
5. Mindfulness: This is a practice that helps people learn to be fully present in the moment, and has been linked to a decrease in anxiety over time.
6. Meditating on Bible verses. For example:
“No, in all these things we are more than conquerors through him who loved us. For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.” – Romans 8:37-39
“God is our refuge and strength, an ever-present help in trouble.” – Psalm 46:1
7. Boundaries: Developing the ability to set healthy boundaries is important so as to not become overwhelmed. This could include saying “no” to too many responsibilities or setting limits with friends and families.
8. Avoidance: When someone avoids a stressor, this does not allow one to overcome anxiety, since avoidance creates temporary relief. That being said, when the feared object or situation is actually dangerous (e.g. a bully or abuser), other strategies should be utilized.
9. Uncertainty: According to Wilson and Lyons (2013), anxiety is a way to seek “certainty and comfort” in the present. However, uncertainty is a part of life. Someone with anxiety may constantly ask questions such as, ”Am I okay?”, “Am I sick?”, “Do I have _____?”, “Is ____ safe?”, “What if _____?”. Always answering these questions does not allow one to learn how to combat the anxious thoughts or learn how to self-soothe.
10. Avoid rescuing: Someone with anxiety needs to learn how to assert themselves or take responsibility for a situation. Rather than rescuing someone from an anxiety-provoking situation, help them to problem-solve ways of coping or approaching the situation.
Treatment for Generalized Anxiety Disorder
When anxiety interferes with functioning or becomes overwhelming, it is time to seek professional help. One place to start would be to look for a counselor who has experience treating anxiety. You may also be referred to your family physician in order to rule out any physical contributors to anxiety. A medication evaluation may also be recommended.
Once you have chosen a counselor, he or she will conduct a thorough assessment of your symptoms and then make treatment recommendations. There are several types of therapy that are used to treat anxiety, depending on the assessment.
For example, Cognitive Behavioral Therapy (CBT) can help an individual learn to recognize maladaptive thoughts (e.g. catastrophic thinking), so that they are able to learn to evaluate their thoughts and determine which ones are anxiety-based versus reality-based. With CBT you will also learn problem-solving skills and how to face anxiety-provoking situations.
Eye Movement Desensitization and Reprocessing (EMDR) may be recommended if some type of trauma is underlying the anxiety symptoms. Other approaches include Dialectical Behavioral Therapy (DBT), relaxation training, mindfulness, psychodynamic therapy, exposure therapies, and play therapy (for children).
Ultimately, it is important to remember that GAD is treatable! You do not need to live life feeling overwhelmed and filled with dread. We have caring counselors available to help you move through this phase of life towards growth and wholeness.
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Harvard Medical School (2007). National Comorbidity Survey (NCS). (2017, August 21). https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 1: Lifetime prevalence DSM-IV/WMH-CIDI disorders by sex and cohort. Retrieved on 11/23/18.
Harvard Mental Health Letter (HMHL) (2011). Generalized anxiety disorder. https://www.health.harvard.edu/newsletter_article/generalized-anxiety-disorder. Retrieved on 11/24/18.
Kessler R.C., Chiu W.T., Demler O., Merikangas K.R., Walters E.E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 62(6):617-27.
Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, & Swendsen J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child Adolescent Psychiatry. 49(10):980-9.
Wilson, R. & Lyons, L. (2013). Anxious Kids, Anxious Parents: 7 ways to stop the worry cycle and raise courageous and independent children. Deerfield Beach, FL: Health Communications, Inc.
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