Generalized anxiety disorder

Generalized anxiety disorder (GAD) is a type of anxiety disorder where you have uncontrollable worry that impacts your day-to-day life. Generalized anxiety disorder involves constant and chronic worrying, nervousness, and tension. Unlike a phobia, where your fear is connected to a specific thing or situation, the anxiety of generalized anxiety disorder is diffused—a general feeling of dread or unease that colors your whole life. This anxiety is less intense than a panic attack, but much longer lasting, making normal life difficult and relaxation impossible. Generalized anxiety disorder is mentally and physically exhausting. It drains your energy, interferes with sleep, and wears your body out.

If you have generalized anxiety disorder you may worry about the same things that other people do, but you take these worries to a new level. A co-worker’s careless comment about the economy becomes a vision of an imminent pink slip; a phone call to a friend that isn’t immediately returned becomes anxiety that the relationship is in trouble. Sometimes just the thought of getting through the day produces anxiety. You go about your activities filled with exaggerated worry and tension, even when there is little or nothing to provoke them.

Whether you realize that your anxiety is more intense than the situation calls for, or believe that your worrying protects you in some way, the end result is the same. You can’t turn off your anxious thoughts. They keep running through your head, on endless repeat. But no matter how overwhelming things seem now, you can break free from chronic worrying, learn to calm your anxious mind, and regain your sense of hope.

You could be dealing with generalized anxiety disorder if:

• you uncontrollably worry about many different things, a lot of the time
• you find it hard to stop worrying
• your worry makes it hard to do everyday things like working and seeing friends
• you’re often tired but can’t sleep properly
• you constantly feel tense or restless
• your heart races or your mouth gets dry
• you have difficulty concentrating
• you are irritable
• you have trouble sleeping
• your jaw or back is sore from muscle tension

If you have these symptoms on more days than not for 6 months or more, it could be generalized anxiety disorder.

If you’re feeling constantly anxious and worried, the safest way to start dealing with generalized anxiety disorder is to talk to a doctor or a mental health professional. It is treatable. A health professional might advise on supportive psychological therapy or, if it’s more severe, medicines that can help manage anxiety.

The 12-month prevalence of generalized anxiety disorder is 0.9% among adolescents and up to 20% adults in the general community of the United States ¹ and the condition is more common in people from the ages of 35 to 59. The 12-month prevalence for generalized anxiety disorder in other countries ranges from 0.4% to 3.6%. Childhood anxiety occurs in about 1 in 4 children at some time between the ages of 13 and 18 years. The median age at onset is 11 years. However, the lifetime prevalence of a severe anxiety disorder in children ages 13 to 18 is approximately 6%. General prevalence in children younger than 18 years is between 5.7% and 12.8% ¹. Women are twice as likely as men to experience generalized anxiety disorder ². The prevalence of the diagnosis peaks in middle age and declines across the later years of life.

Individuals of European descent tend to experience generalized anxiety disorder more frequently than do individuals of non-European descent (i.e., Asian, African, Native American and Pacific Islander). Furthermore, individuals from developed countries are more likely than individuals from nondeveloped countries to report that they have experienced symptoms that meet criteria for generalized anxiety disorder in their lifetime.

What is the difference between normal worry and generalized anxiety disorder?

Worries, doubts, and fears are a normal part of life. It’s natural to be anxious about an upcoming test or to worry about your finances after being hit by unexpected bills. The difference between “normal” worrying and generalized anxiety disorder is that the worrying involved in generalized anxiety disorder is:

• excessive
• intrusive
• persistent
• disruptive

Table 1. Normal worry versus generalized anxiety disorder

Normal worry	Generalized anxiety disorder
Your worrying doesn’t get in the way of your daily activities and responsibilities.	Your worrying significantly disrupts your job, activities, or social life.
You’re able to control your worrying.	Your worrying is uncontrollable.
Your worries, while unpleasant, don’t cause significant distress.	Your worries are extremely upsetting and stressful.
Your worries are limited to a specific, small number of realistic concerns.	You worry about all sorts of things, and tend to expect the worst.
Your bouts of worrying last for only a short time period.	You’ve been worrying almost every day for at least six months.

The essential feature of generalized anxiety disorder is excessive anxiety and worry (apprehensive expectation) about a number of events or activities. The intensity, duration, or frequency of the anxiety and worry is out of proportion to the actual likelihood or impact of the anticipated event. The individual finds it difficult to control the worry and to keep worrisome thoughts from interfering with attention to tasks at hand. Adults with generalized anxiety disorder often worry about everyday, routine life circumstances, such as possible job responsibilities, health and finances, the health of family members, misfortune to their children, or minor matters (e.g., doing household chores or being late for appointments).

Children with generalized anxiety disorder tend to worry excessively about their competence or the quality of their performance. During the course of the disorder, the focus of worry may shift from one concern to another.

Several features distinguish generalized anxiety disorder from nonpathological anxiety:

• First, the worries associated with generalized anxiety disorder are excessive and typically interfere significantly with psychosocial functioning, whereas the worries of everyday life are not excessive and are perceived as more manageable and may be put off when more pressing matters arise.
• Second, the worries associated with generalized anxiety disorder are more pervasive, pronounced, and distressing; have longer duration; and frequently occur without precipitants. The greater the range of life circumstances about which a person worries (e.g., finances, children’s safety, job performance), the more likely his or her symptoms are to meet criteria for generalized anxiety disorder.
• Third, everyday worries are much less likely to be accompanied by physical symptoms (e.g., restlessness or feeling keyed up or on edge). Individuals with generalized anxiety disorder report subjective distress due to constant worry and related impairment in social, occupational, or other important areas of functioning.

The anxiety and worry are accompanied by at least three of the following additional symptoms:

1. Restlessness or feeling keyed up or on edge,
2. Being easily fatigued,
3. Difficulty concentrating or mind going blank,
4. Irritability,
5. Muscle tension, and disturbed sleep,
6. Although only one additional symptom is required in children.

Associated features supporting generalized anxiety disorder diagnosis

Associated with muscle tension, there may be trembling, twitching, feeling shaky, and muscle aches or soreness. Many individuals with generalized anxiety disorder also experience somatic symptoms (e.g., sweating, nausea, diarrhea) and an exaggerated startle response. Symptoms of autonomic hyperarousal (e.g., accelerated heart rate, shortness of breath, dizziness) are less prominent in generalized anxiety disorder than in other anxiety disorders, such as panic disorder. Other conditions that may be associated with stress (e.g., irritable bowel syndrome, headaches) frequently accompany generalized anxiety disorder.

Generalized anxiety disorder causes

The exact cause of generalized anxiety disorder is not fully understood, although it’s likely that a combination of several factors plays a role.

As with many mental health conditions, the cause of generalized anxiety disorder likely arises from a complex interaction of biological and environmental factors, which may include:

• Differences in brain chemistry and function. Some changes in brain functioning have been associated with generalized anxiety disorder such as overactivity in areas of the brain involved in emotions and behavior. An imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood
• Genetics: People with generalized anxiety disorder often have a history of mental health problems in their family. First-degree relatives with generalized anxiety disorder (25%). You’re estimated to be 5 times more likely to develop generalized anxiety disorder if you have a close relative with the condition. However, this doesn’t mean that a person will automatically develop anxiety if a parent or close relative has had a mental health condition.
• Differences in the way threats are perceived
• Development and personality
• Substance abuse. Having a history of drug or alcohol misuse
• Stressful life events: People may be more at risk if they experience a major life change that causes stress, such as the birth of a child, the breakdown/loss of a close relationship, or moving house/job. Physical, sexual or emotional abuse, child abuse, domestic violence also increase the risk of developing generalized anxiety disorder, as do other traumatic experiences in childhood, such as the death, being bullied of or separation from a parent.
• Psychological factors: Some personality traits may put a person at greater risk of generalized anxiety disorder, including: − being sensitive − being emotional or experiencing general nervousness − inability to tolerate frustration − feeling inhibited − having perfectionistic tendencies.
• Physical condition such as diabetes or other comorbidities such as depression.
• Having a painful long-term health condition, such as arthritis.

But many people develop generalized anxiety disorder for no apparent reason.

Risk factors for developing generalized anxiety disorder

Women are diagnosed with generalized anxiety disorder somewhat more often than men are. The following factors may increase the risk of developing generalized anxiety disorder:

• Personality. A person whose temperament is timid or negative or who avoids anything dangerous may be more prone to generalized anxiety disorder than others are.
• Genetics. Generalized anxiety disorder may run in families.
• Experiences. People with generalized anxiety disorder may have a history of significant life changes, traumatic or negative experiences during childhood, or a recent traumatic or negative event. Chronic medical illnesses or other mental health disorders may increase risk.

Anxiety triggers

If you’re anxious because of a specific phobia or because of panic disorder, you’ll usually know what the cause is.

For example, if you have claustrophobia (fear of confined spaces), you know that being confined in a small space will trigger your anxiety.

But it may not always be clear what you’re feeling anxious about. Not knowing what triggers your anxiety can intensify it and you may start to worry that there’s no solution

Generalized anxiety disorder prevention

There’s no way to predict for certain what will cause someone to develop generalized anxiety disorder, but you can take steps to reduce the impact of symptoms if you experience anxiety:

• Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
• Keep a journal. Keeping track of your personal life can help you and your mental health professional identify what’s causing you stress and what seems to help you feel better.
• Prioritize issues in your life. You can reduce anxiety by carefully managing your time and energy.
• Avoid unhealthy substance use. Alcohol and drug use and even nicotine or caffeine use can cause or worsen anxiety. If you’re addicted to any of these substances, quitting can make you anxious. If you can’t quit on your own, see your doctor or find a treatment program or support group to help you.

Generalized anxiety disorder symptoms

Not everyone with generalized anxiety disorder has the same symptoms, but most people experience a combination of emotional, behavioral, and physical symptoms that often fluctuate, becoming worse at times of stress.

Emotional symptoms of generalized anxiety disorder include:

• Constant worries running through your head
• Feeling like your anxiety is uncontrollable; there is nothing you can do to stop the worrying
• Intrusive thoughts about things that make you anxious; you try to avoid thinking about them, but you can’t
• An inability to tolerate uncertainty; you need to know what’s going to happen in the future
• A pervasive feeling of apprehension or dread

Behavioral symptoms of generalized anxiety disorder include:

• Inability to relax, enjoy quiet time, or be by yourself
• Difficulty concentrating or focusing on things
• Putting things off because you feel overwhelmed
• Avoiding situations that make you anxious

Physical symptoms of generalized anxiety disorder include:

• Feeling tense; having muscle tightness or body aches
• Having trouble falling asleep or staying asleep because your mind won’t quit
• Feeling edgy, restless, or jumpy
• Stomach problems, nausea, diarrhea
• Fatigue
• Muscle tension or muscle aches
• Trembling, feeling twitchy
• Nervousness or being easily startled
• Sweating
• Irritability

There may be times when your worries don’t completely consume you, but you still feel anxious even when there’s no apparent reason. For example, you may feel intense worry about your safety or that of your loved ones, or you may have a general sense that something bad is about to happen.

Your anxiety, worry or physical symptoms cause you significant distress in social, work or other areas of your life. Worries can shift from one concern to another and may change with time and age.

Generalized anxiety disorder symptoms in children

In children, excessive worrying centers on future events, past behaviors, social acceptance, family matters, personal abilities, and school performance. Unlike adults with generalized anxiety disorder, children and teens often don’t realize that their anxiety is disproportionate to the situation, so adults need to recognize their symptoms. Along with many of the symptoms that appear in adults, some red flags for generalized anxiety disorder in children are:

• “What if” fears about situations far in the future
• Perfectionism, excessive self-criticism, and fear of making mistakes
• Feeling that they’re to blame for any disaster, and their worry will keep tragedy from occurring
• The conviction that misfortune is contagious and will happen to them
• Need for frequent reassurance and approval

Generalized anxiety disorder complications

Having generalized anxiety disorder can be disabling. It can:

• Impair your ability to perform tasks quickly and efficiently because you have trouble concentrating
• Take your time and focus from other activities
• Sap your energy
• Increase your risk of depression

Generalized anxiety disorder can also lead to or worsen other physical health conditions, such as:

• Digestive or bowel problems, such as irritable bowel syndrome or ulcers
• Headaches and migraines
• Chronic pain and illness
• Sleep problems and insomnia
• Heart-health issues

Generalized anxiety disorder often occurs along with other mental health problems, which can make diagnosis and treatment more challenging. Some mental health disorders that commonly occur with generalized anxiety disorder include:

• Phobias
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Depression
• Suicidal thoughts or suicide
• Substance abuse

Generalized anxiety disorder diagnosis

To help diagnose generalized anxiety disorder, your doctor or mental health professional may begin by addressing your behavior or somatic symptoms. Evaluation for psychosocial stress, psychosocial difficulties, and developmental issues. Review past medical history, including trauma, psychiatric conditions, and substance abuse ³.

• Do a physical exam to look for signs that your anxiety might be linked to medications or an underlying medical condition
• Order blood or urine tests or other tests, if a medical condition is suspected
• Ask detailed questions about your symptoms and medical history
• Use psychological questionnaires to help determine a diagnosis
• Use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association (see below)

The following evaluation may be obtained to exclude organic causes:

• Thyroid function tests
• Blood glucose level
• Echocardiography
• Toxicology screen

The Generalized Anxiety Disorder 7-Item (GAD-7) Questionnaire is a screening tool that can also be used to monitor patients with generalized anxiety disorder.

Figure 1. Generalized Anxiety Disorder 7 Questionnaire

[Source ⁴ ]

Generalized anxiety disorder DSM 5

Generalized anxiety disorder DSM 5 diagnostic criteria ⁵:

• A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
• B. The individual finds it difficult to control the worry.
• C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months);
  • Note: Only one item is required in children.
  • 1. Restlessness or feeling keyed up or on edge.
  • 2. Being easily fatigued.
  • 3. Difficulty concentrating or mind going blank.
  • 4. Irritability.
  • 5. Muscle tension.
  • 6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
• D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
• F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

Generalized anxiety disorder treatment

Generalized anxiety disorder can have a significant effect on your daily life, but several different treatments are available that can ease your symptoms.

Treatment decisions are based on how significantly generalized anxiety disorder is affecting your ability to function in your daily life. The two main treatments for generalized anxiety disorder are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you ⁶.

1. Psychological therapies – you can get psychological therapies like cognitive behavioral therapy (CBT)
2. Medicine – such as a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs)

Psychotherapy is used in addition to medications; this combination has proven to be effective. With treatment, many people are able to control their anxiety levels. But some treatments may need to be continued for a long time and there may be periods when your symptoms worsen.

The education of the patient is vital as it can help ease anxiety. The triggers for anxiety should be managed like avoiding caffeine, alcohol, nicotine, stress) and improving sleep.

Many complementary and alternative remedies are available but the evidence to support their efficacy is lacking. Further, some agents like Kava may injure the liver. Others like St John’s wort and hydroxytryptophan may interact with selective serotonin reuptake inhibitors (SSRIs) and induce serotonin syndrome.

Psychotherapy

Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. Cognitive behavioral therapy is the most effective form of psychotherapy for generalized anxiety disorder.

Generally a short-term treatment, cognitive behavioral therapy (CBT) focuses on teaching you specific skills to directly manage your worries and help you gradually return to the activities you’ve avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.

Cognitive-behavioral therapy (CBT)

Cognitive-behavioral therapy (CBT) is one type of therapy that is particularly helpful in the treatment of generalized anxiety disorder. CBT examines distortions in our ways of looking at the world and ourselves. Your therapist will help you identify automatic negative thoughts that contribute to your anxiety. For example, if you catastrophize—always imagining the worst possible outcome in any given situation—you might challenge this tendency through questions such as, “What is the likelihood that this worst-case scenario will actually come true?” and “What are some positive outcomes that are more likely to happen?”.

The five components of CBT for anxiety are:

1. Education. CBT involves learning about generalized anxiety disorder. It also teaches you how to distinguish between helpful and unhelpful worry. An increased understanding of your anxiety encourages a more accepting and proactive response to it.
2. Monitoring. You learn to monitor your anxiety, including what triggers it, the specific things you worry about, and the severity and length of a particular episode. This helps you get perspective, as well as track your progress.
3. Physical control strategies. CBT for generalized anxiety disorder trains you in relaxation techniques to help decrease the physical over-arousal of the “fight or flight” response.
4. Cognitive control strategies teach you to realistically evaluate and alter the thinking patterns that contribute to generalized anxiety disorder. As you challenge these negative thoughts, your fears will begin to subside.
5. Behavioral strategies. Instead of avoiding situations you fear, CBT teaches you to tackle them head on. You may start by imagining the thing you’re most afraid of. By focusing on your fears without trying to avoid or escape them, you will feel more in control and less anxious.

Medications

Several types of medications are used to treat generalized anxiety disorder, including those below. Talk with your doctor about benefits, risks and possible side effects.

• Antidepressants. Antidepressants, including medications in the selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) classes, are the first line medication treatments. Examples of antidepressants used to treat generalized anxiety disorder include escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva). Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) classes are the first-line agents with a response rate of 30% to 50%. This class of drugs includes escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva). In a study, 81% of children with anxiety disorders who received combined sertraline hydrochloride and cognitive behavioral therapy (CBT) were responded to the treatment. Your doctor also may recommend other antidepressants.
• Buspirone. An anti-anxiety medication called buspirone may be used on an ongoing basis. Buspirone is a non-benzodiazepine which does not cause dependency. It is also less sedating than benzodiazepines, and tolerance does not occur at therapeutic doses. This agent has a therapeutic lag in the efficacy of two to three weeks which limits its use.
• Benzodiazepines. Examples are diazepam and clonazepam are long-acting agents. In limited circumstances, your doctor may prescribe a benzodiazepine for relief of anxiety symptoms. These sedatives are generally used only for relieving acute anxiety on a short-term basis. Generally, cooperative and compliant patients who are aware that their symptoms have a psychological basis are more likely to respond to benzodiazepines. Because they can be habit-forming, these medications aren’t a good choice if you have or had problems with alcohol or drug abuse.
• Antipsychotics may also help some patients, especially those with associated behavior problems.

All medications should be titrated slowly and continued for at least 4 weeks to determine if they work. Once symptoms are under control, the medications need to be used for at least 12 months before gradually tapering them. Every single medication has adverse effects like weight gain, hyperlipidemia, and diabetes; thus the patients need to be monitored.

Self-help for generalized anxiety disorder

Connect with others

Support from other people is vital to overcoming generalized anxiety disorder. Social interaction with someone who cares about you is the most effective way to calm your nervous system and diffuse anxiety, so it’s important to find someone you can connect with face to face on a regular basis—your significant other, a family member, or a friend, perhaps. This person should be someone you can talk to for an uninterrupted period of time, someone who will listen to you without judging, criticizing, or continually being distracted by the phone or other people.

Build a strong support system

Human beings are social creatures. We’re not meant to live in isolation. But a strong support system doesn’t necessarily mean a vast network of friends. Don’t underestimate the benefit of a few people you can trust and count on to be there for you.

Talk it out when your worries start spiraling

If you start to feel overwhelmed with anxiety, meet with a trusted family member or friend. Just talking face to face about your worries can make them seem less threatening.

Know who to avoid when you’re feeling anxious

Your anxious take on life may be something you learned when you were growing up. If your mother is a chronic worrier, she is not the best person to call when you’re feeling anxious—no matter how close you are. When considering who to turn to, ask yourself whether you tend to feel better or worse after talking to that person about a problem.

Be aware that having generalized anxiety disorder can get in the way of your ability to connect with others

Anxiety and constant worrying can leave you feeling needy and insecure, causing problems in your relationships. Think about the ways you tend to act when you’re feeling anxious, especially anxious about a relationship. Do you test your partner? Withdraw? Make accusations? Become clingy? Once you’re aware of any anxiety-driven relationship patterns, you can look for better ways to deal with any fears or insecurities you’re feeling.

Learn to calm down quickly

While socially interacting with another person face-to-face is the quickest way to calm your nervous system, it’s not always realistic to have a friend close by to lean on. In these situations, you can quickly self-soothe and relieve anxiety symptoms by making use of one or more of your physical senses:

• Sight – Look at anything that relaxes you or makes you smile: a beautiful view, family photos, cat pictures on the Internet.
• Sound – Listen to soothing music, sing a favorite tune, or play a musical instrument. Or enjoy the relaxing sounds of nature (either live or recorded): ocean waves, wind through the trees, birds singing.
• Smell – Light scented candles. Smell the flowers in a garden. Breathe in the clean, fresh air. Spritz on your favorite perfume.
• Taste – Slowly eat a favorite treat, savoring each bite. Sip a hot cup of coffee or herbal tea. Chew on a stick of gum. Enjoy a mint or your favorite hard candy.
• Touch – Give yourself a hand or neck massage. Cuddle with a pet. Wrap yourself in a soft blanket. Sit outside in the cool breeze.
• Movement – Go for a walk, jump up and down, or gently stretch. Dancing, drumming, and running can be especially effective.

Exercise

Exercise is a natural and effective anti-anxiety treatment. It relieves tension, reduces stress hormones, boosts feel-good chemicals such as serotonin and endorphins, and physically changes the brain in ways that make it less anxiety-prone and more resilient.

For maximum relief of generalized anxiety disorder, try to get at least 30 minutes of physical activity on most days. Exercise that engages both your arms and legs—such as walking, running, swimming, or dancing—are particularly good choices.

For even greater benefits, try adding mindfulness element to your workouts. Mindfulness is a powerful anxiety fighter—and an easy technique to incorporate into your exercise program. Rather than spacing out or focusing on your thoughts during a workout, focus on how your body feels as you move. Try to notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of the wind on your skin. Not only will you get more out of your workout—you’ll also interrupt the flow of constant worries running through your head.

Look at your worries in new ways

The core symptom of generalized anxiety disorder is chronic worrying. It’s important to understand what worrying is, since the beliefs you hold about worrying play a huge role in triggering and maintaining generalized anxiety disorder. You may feel like your worries come from the outside—from other people, events that stress you out, or difficult situations you’re facing. But, in fact, worrying is self-generated. The trigger comes from the outside, but your internal running dialogue keeps it going.

When you’re worrying, you’re talking to yourself about things you’re afraid of or negative events that might happen. You run over the feared situation in your mind and think about all the ways you might deal with it. In essence, you’re trying to solve problems that haven’t happened yet, or worse, simply obsessing on worst-case scenarios.

All this worrying may give you the impression that you’re protecting yourself by preparing for the worst or avoiding bad situations. But more often than not, worrying is unproductive—sapping your mental and emotional energy without resulting in any concrete problem-solving strategies or actions.

How to distinguish between productive and unproductive worrying

If you’re focusing on “what if” scenarios, your worrying is unproductive.

Once you’ve given up the idea that your worrying somehow helps you, you can start to deal with your worry and anxiety in more productive ways. This may involve challenging irrational worrisome thoughts, learning how to stop worrying, and learning to accept uncertainty in your life.

Practice relaxation techniques for generalized anxiety disorder

Anxiety is more than just a feeling. It’s the body’s physical “fight or flight” reaction to a perceived threat. Your heart pounds, you breathe faster, your muscles tense up, and you feel light-headed. When you’re relaxed, the complete opposite happens. Your heart rate slows down, you breathe slower and more deeply, your muscles relax, and your blood pressure stabilizes. Since it’s impossible to be anxious and relaxed at the same time, strengthening your body’s relaxation response is a powerful anxiety-relieving tactic.

Effective relaxation techniques for relieving anxiety include:

• Deep breathing. When you’re anxious, you breathe faster. This hyperventilation causes symptoms such as dizziness, breathlessness, lightheadedness, and tingly hands and feet. These physical symptoms are frightening, leading to further anxiety and panic. But by breathing deeply from the diaphragm, you can reverse these symptoms and calm yourself down.
• Progressive muscle relaxation can help you release muscle tension and take a “time out” from your worries. The technique involves systematically tensing and then releasing different muscle groups in your body. As your body relaxes, your mind will follow.
• Meditation. Research shows that mindfulness meditation can actually change your brain. With regular practice, meditation boosts activity on the left side of the prefrontal cortex, the area of the brain responsible for feelings of serenity and joy.

Adopt anxiety-busting habits

A healthy, balanced lifestyle plays a big role in keeping the symptoms of generalized anxiety disorder at bay. In addition to regular exercise and relaxation, try adopting these other lifestyle habits to tackle chronic anxiety and worry:

• Get enough sleep. Anxiety and worry can cause insomnia, as anyone whose racing thoughts have kept them up at night can attest. But lack of sleep can also contribute to anxiety. When you’re sleep deprived, your ability to handle stress is compromised. When you’re well rested, it’s much easier to keep your emotional balance, a key factor in coping with anxiety and stopping worry. Improve your sleep at night by changing any daytime habits or bedtime routines that can contribute to sleeplessness.
• Limit caffeine. Stop drinking or at least cut back on caffeinated beverages, including soda, coffee, and tea. Caffeine is a stimulant that can trigger all kinds of jittery physiological effects that look and feel a lot like anxiety—from pounding heart and trembling hands to agitation and restlessness. Caffeine can also make generalized anxiety disorder symptoms worse, cause insomnia, and even trigger panic attacks.
• Avoid alcohol and nicotine. Having a few drinks may temporarily help you feel less anxious, but alcohol actually makes anxiety symptoms worse as it wears off. While it may seem like cigarettes are calming, nicotine is actually a powerful stimulant that leads to higher, not lower, levels of anxiety.
• Eat right. Food doesn’t cause anxiety, but a healthy diet can help keep you on an even keel. Going too long without eating leads to low blood sugar—which can make you feel anxious and irritable—so start the day right with breakfast and continue with regular meals. Eat plenty of fruits, and vegetables, which stabilize blood sugar and boost serotonin, a neurotransmitter with calming effects. Reduce the amount of refined carbs and sugar you eat, too. Sugary snacks and desserts cause blood sugar to spike and then crash, leaving you feeling emotionally and physically drained.

Generalized anxiety disorder prognosis

The prognosis for patients with generalized anxiety disorder is guarded. Many patients are not compliant with medications because of cost and adverse effects. Relapses are common and patients often search physicians who comply with their needs. Because of the lack of conventional medicine to cure the disorder, many opt for alternative therapies without much success. Overall, the quality of life of these patients is poor.

1. Munir S, Takov V. Generalized Anxiety Disorder (GAD) [Updated 2019 Nov 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441870[↩][↩]
2. Silva MT, Caicedo Roa M, Martins SS, da Silva ATC, Galvao TF. Generalized anxiety disorder and associated factors in adults in the Amazon, Brazil: A population-based study. J Affect Disord. 2018 Aug 15;236:180-186.[↩]
3. Rosellini AJ, Bourgeois ML, Correa J, Tung ES, Goncharenko S, Brown TA. Anxious distress in depressed outpatients: Prevalence, comorbidity, and incremental validity. J Psychiatr Res. 2018 Aug;103:54-60.[↩]
4. Spitzer, Robert & Kroenke, Kurt & Williams, Janet & Löwe, Bernd. (2006). A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7. Archives of internal medicine. 166. 1092-7. 10.1001/archinte.166.10.1092[↩]
5. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing.[↩]
6. Latas M, Trajković G, Bonevski D, Naumovska A, Vučinić Latas D, Bukumirić Z, Starčević V. Psychiatrists’ treatment preferences for generalized anxiety disorder. Hum Psychopharmacol. 2018 Jan;33(1).[↩]