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What is Generalised Anxiety Disorder (GAD)

According to the Mental Health Manuals (ICD-10; DSM-V), Generalised Anxiety Disorder (GAD) is defined as chronic and pervasive worry -" a constant chain of thoughts and images which are negative and out of control." The worry process represents an attempt to engage in mental problem solving" but actually does not solve problems and thus is never-ending (Borkovec,1983).  

Often, people diagnosed with generalised anxiety report that they feel obligated to worry and, at the same time, try to STOP worrying. The topic of worry often is just EVERYTHING. 

Historically, in the psychological literature, GAD is viewed as an "unsuccessful search for safety through worry" (Rachman, 2004), or "positive/negative" beliefs about the process of worry" (Wells, 2006), and as "Intolerance of uncertainty" (Dugas, 1998). 

GAD results from a complex interaction of situational, social, neuro-biological, historical and psychosocial factors.

People who are more predisposed to develop symptoms associated with GAD are those who have difficulties tolerating uncertainty, rigid positive/negative beliefs about the process of worrying, the tendency to avoid or suppress worrying thoughts, or a negative mindset for approaching problems.

     Prevalence 

GAD has up to a 5% lifetime prevalence rate, 50% onset before 31 years, and 75% onset before 47 years (Kessler et al., 2005).

Women show double the rate of severity of the experienced symptoms and comorbidity than men. Chronic lifetime conditions significantly interfere with individuals' well-being, functioning and quality of life. 

     The most common symptoms associated with GAD are: 

  • Constant worries 

  • A feeling of uncontrollable anxiety 

  • Inability to relax

  • Difficulty to concentrate

  • Procrastination

  • Intrusive thoughts about things and attempt to avoid thinking, but without success

  • Inability to tolerate uncertainty

  • Pervasive feeling of apprehension or dread

  • Feeling tension, muscle tightness and stiffness

  • Difficulties falling asleep or staying asleep (because the mind will not quit )

  • Feeling edgy, restless, or jumpy

  • Stomach problems, nausea, diarrhoea 

  • Avoiding situations or topics that can provoke anxiety

In GAD, the focus of the anxiety and worry is not confined to a phobia, OCD, anorexia or PTSD. The worry causes clinically significant distress or impairment in social/occupational functioning. The disturbance is not due to the effects of substance use or general medical conditions.

      The most common beliefs associated with GAD are:

  • Beliefs regarding general threats - "Bad things happen to me /out there".

  • Personal vulnerability – "I am a fragile, vulnerable, sensitive person who cannot deal with adverse events/ I cannot control negative events".

  • Uncertainty – "Not knowing is intolerable/I must be prepared for the unexpected."

  • Metaworry (what the worrier thinks about his process of worrying): "Worrying about bad things stops them from happening," Worrying prepares me," "Worry means I take things seriously," "If I were less sensitive, I would be able to control my worries," "Worry is necessary to solve problems," etc.

     The most common Worry Control Strategies used by worriers are:

  • Directed suppression: "Stop worrying!" 

  • Self-Reassurance: "It will be OK." 

  • Seeking reassurance from others: "Do you think it will be OK?" 

  • Checking repeatedly 

  • Directed expression: Let the worry run its course 

  • Distraction – "Keep busy with housework to stop worrying or deliberately think positively.

  • Engaging in problem-solving "Right. The doctor said she was fine unless her temperature lasted more than 8 hours. If she does, what I need to do is…."

  • Relaxation: Allocate 30 minutes to engage in a form of relaxation

 Unfortunately, all the above strategies work for a very short time. Then, the worry and anxiety either come back or shift to another topic, so the process of worrying never really ends.

Those strategies often give a false sense of effectiveness because they reinforce avoidance response to perceived future threats mainly by non-occurrence of the predicted catastrophe, removal of personal unpreparedness for the catastrophe and removal of negative somatic symptoms (Borkovec et al. (2004)).  

      Treatment for GAD

Generalised Anxiety Disorder (GAD) should only be diagnosed by a mental health professional or a doctor.

Medications, psychological treatments, or both can treat GAD.

Psychological treatment (talking therapies) is the first line of treatment for GAD. It can be combined with medications in moderate and severe presentations. 

The psychological treatment for GAD transforms the worry process from an uncontrollable avoidant strategy to a controlled, limited problem-solving approach.

According to the National Institute for Health and Care Excellence (NICE) Guidelines, Cognitive Behavioural Therapy (CBT) and applied relaxation are recommended in the UK. The guidelines recommend 12–15 weekly sessions, each lasting 50 minutes.

      References:

American Psychiatric Association. (2022). Bipolar and related disorders. In Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.) https://doi.org/10.1176/appi.books.9780890425787.x05_Anxiety_Disorders

International Classification of Diseases, Eleventh Revision (ICD-11), World Health Organization (WHO) 2019/2021 https://icd.who.int/browse11. It is licensed under Creative Commons Attribution-NoDerivatives 3.0 IGO licence (CC BY-ND 3.0 IGO).

National Institute for Health and Care Excellence (NICE), Generalised anxiety disorder and panic disorder in adults: management (CG113), Retrieved from https://www.nice.org.uk/search?q=GAD