GENERALIZED ANXIETY DISORDER

Generalized Anxiety Disorder (GAD) is much more than the typical anxiety that most people face in their daily life. GAD can be defined as an anxiety disorder that is characterized by excessive, uncontrollable and often irrational worry that is out of proportion than what might be expected in a given situation; that is, GAD is a worry that people have about events or activities.[1]

Psychologists use the DSM 5 criteria to diagnose GAD. An individual must have GAD symptoms for at least six months before a diagnosis of GAD can be made. People suffering from GAD often excessively fear and worry about internal and external factors in their lives; whether it is a worry about their health, career, finances, family, or relationships. People who have experienced GAD have a constant fear and worry about being overwhelmed or stressed, which makes it difficult to get through a day. The person is caught in a vicious cycle – the more that the person worries and stresses about feeling overwhelmed, the more the person feels overwhelmed and the more the person feels overwhelmed, the more he/she will fear and stress about feeling overwhelmed.

Canadian Statistics

  • In 2013, 11.8% of all Canadians, who are aged 18 years and older, reported that they had a mood and/anxiety disorder.[2]
  • In 2013, it is estimated that 2.6% of Canadians, who are between 15 and 18 years old, reported symptoms of anxiety disorders.2
  • GAD is one of the most common anxiety disorders. According to Canadian Psychological Association, at least one in every 20 people will suffer from GAD at some point in their lifetime. It can be mild or moderate or severe and can contribute to unemployment and serious family and social problems.[3]
  • Women have higher prevalence rates for anxiety disorders and are two times more likely to experience anxiety disorders than men.[4]
  • Twenty three percent of people who had an anxiety disorder reported that they did not consult any health professionals in the past 12 months.[5]
  • Twenty-seven percent of people reported that their disorder affected their life negatively in the previous 12 months. People reported that basic life activities and the ability to work were the biggest challenges.4
  • Most of the people who consulted a health professionals sought help from:4
o   Family doctor or General Practitioner ·       64.9%
o   Psychiatrist ·       19.7%
o   Other Health Professional (Psychologist, Social Worker, Counsellor, Psychotherapist, Other ·       35.2%
o   Other Medical Doctor or Specialist                     5.2%
  • *Percentages do not add to 100% because an individual can visit more than one type of Health Professional in a 12-month period.
  • Sixty-two percent of the people suffering from anxiety disorders reported that a doctor or other health professionals had suggested that they get psychological counselling to help them cope with the anxiety disorder.4
  • Twenty percent of people reported that they received psychological counselling to help manage their disorders in the past 12 months.4

Behaviours associated with GAD:

  • Using alcohol or illegal drugs to manage symptoms
  • Not showing up to work because you have not finished a project on time
  • Relying on a friend or spouse to calm you down on a daily basis
  • Inability to relax, enjoy quiet time, or be by yourself
  • Not paying bills because finances give you anxiety
  • Repeatedly calling your spouse because you are worried about them

Feelings associated with GAD:

  • Panicked
  • Fearful
  • Uneasy
  • Restless
  • Tense
  • Worried

Thoughts associated with GAD:

  • “I don’t know where to take her on the first date. I think the beach could be nice but maybe that’s too romantic. I think a coffee shop might be good, but she said she likes being outdoors. I really don’t know which to choose.”
  • “I can’t remember if my boss asked me to file or copy this first. If I do the wrong thing, I might get fired. I think he already doesn’t like me. Then I won’t be able to pay my rent.”
  • “My boyfriend was supposed to call me once he arrived in Florida. I know his plane landed and he hasn’t contacted me. I wonder if he met someone on the plane and he’s cheating on me.”
  • “If I fail this test, I’m never going to be a doctor.”

GAD and the Body:

People suffering from GAD often experience different physical symptoms. These may include:

  • Shortness of Breath
  • Muscle Tension
  • Dizziness
  • Nausea
  • Heart Palpitations
  • Nail biting, skin picking, hair pulling etc.

GAD and the Brain:

According to scientific research, the areas of the brain most involved in GAD are the amygdala, the insula, and the interior cingulate. These three areas are the “fear network,” and work together to control emotional and physical responses to fear.[6] In the brain of people with anxiety disorder, the amygdala has difficulty connecting with the other parts of the brain that can help minimize the fear response. This leads to difficulties in regulating emotional conflicts, which is a major part of Generalized Anxiety Disorder.[7]

Does Psychology work?

  • Mindfulness-Based Cognitive Behavioral Therapy (MCBT): MCBT is a type of psychological treatment model that aims to help you change your thoughts, which in turn helps you change your behaviors. According to the research, CBT is an effective treatment for GAD.[8] MCBT has been shown to be moderately effective for treating anxiety and mood symptoms.[9] MCBT involves teaching you to be aware of the present moment without judging it. It encourages you to become more open, curious, and accepting of your experience and you learn to tolerate the sensations; in turn, you are less likely to fear experiencing the symptoms if they come up again.
  • Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a fairly new type of treatment which has shown promising results. This type of therapy involves the recall of unpleasant memories while your therapist guides you and paces you. This process aims to help you heal painful memories so that you experience a reduction or resolution of psychological symptoms. Whether the source of your anxiety lies in the present or in a past negative experience, EMDR can help. Research on EMDR has shown that it is equally effective at treating anxiety as other well-researched therapies.[10]

Tips to Manage GAD!

While psychological treatment for GAD is an option that often leads to the resolution of symptoms, you can also take steps to manage your symptoms at home. Some of the ways you can do this are:[11]

  • Getting plenty of sleep can help you get a new perspective on things that are causing your anxiety.
  • Try to confront some of the things that give you anxiety by imagining yourself successfully managing or overcoming the anxiety.
  • Caffeine can increase anxiety, so avoid drinking coffees, teas, and energy drinks with caffeine in it. Being tired is sometimes better than feeling anxious!

There are different combinations of the above symptoms that you can have and still meet the criteria for GAD. This means that your experience of GAD will likely be unique. Moreover, you may also experience other mental health issues concurrently. For example, we often counsel people who are experiencing depression and GAD simultaneously or who have experienced a traumatic incident and have trauma responses and GAD at the same time. In turn, treatment must be personalized to your unique needs and the use of multiple types of interventions and multiple treatment modalities may be best. At Hopewell Psychological, we provide a range of services so that we can offer you options to suit your wishes. We provide current and evidence-based treatments, and we also work with couples, families, and groups, which could also improve your interpersonal relationships.

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*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.

References

[1] Association, American Psychiatric (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th Ed.). Washington, D.C.: American Psychiatric Association. p. 222. ISBN 978-0-89042-554-1.

[2] Statistics Canada, 2013 Canadian Community Health Survey: Annual Component

[3] Canadian Psychological Association, “Psychology Works”: Fact Sheet: GAD.

[4] (Canadian Mental Health Association, [CMHA] 2013.

[5] 2014 Survey on Living with Chronic Diseases in Canada (SLCDC) which was funded and developed by the Public Health Agency of Canada and conducted by Statistics Canada.

[6] Holzschneider, Kathrin & Mulert, Christoph. “Neuroimaging in anxiety disorders.” Dialogues in Clinical Neuroscience 13.4 (2011): 453-461.

[7] Amit, Etkin et al. “Failure of the Anterior Cingulate Activation and Connectivity with the Amygdala during Implicit Regulation and Emotional Processing in Generalized Anxiety Disorder.” American Journal of Psychiatry 167.5 (2010): 545-554.

[8] Evans, Susan, et al. “Mindfulness-based cognitive therapy for generalized anxiety disorder.” Journal of Anxiety Disorders. 22.4 (2008): 715-721.

[9] Hofmann, Stefan G., et al. “The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review.” Journal of consulting and clinical psychology 78.2 (2010): 169.

[10] Davidson, Paul R., and Kevin CH Parker. “Eye movement desensitization and reprocessing (EMDR): a meta-analysis.” (2001): 305.

[11] “Mental Health: Anxiety Disorders.” Health Canada. Health Canada, July 2009. Web. 28 Mar. 2017.

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