A person who suffers from Generalized Anxiety Disorder (GAD) experiences a constant, uncontrollable worry and anxiety related to different aspects of life. Although everybody worries to some extent, the difference between regular worry and GAD, is that GAD is stronger, more persistent, occurs more frequently and is harder to control. Furthermore, the anxiety, the worry and the physical symptoms have significant negative consequences for important areas of life - for example, social och occupational areas.

The anxiety is difficult to control and is therefore a problem for all areas of everyday life. Adults suffering from GAD worry about things like their work, their economy, the health of family members, but also about small things; that the car needs to be repaired or that the basement has to be tidied up. Children's anxiety and worry tend to concern their competence or performance in different situations, and catastrophic scenarios like earthquakes or nuclear war. It is typical for this disorder that focus is constantly shifting between different concerns.

The expression of GAD

Along with the anxiety and the worry comes symptoms like restlessness or a feeling of being on edge. One can also have difficulty concentrating, and easily become fatigued or irritated. Furthermore, there may be muscle tensions and different types of sleep disturbances. Only one of these items is required in order to suspect GAD in children.

The symptoms listed above can also be associated with, or lead to other symptoms. Muscle tensions, for example, may lead to muscle aches, trembles and twitches. There may also be somatic symptoms (resembling the symptoms in panic attacks) such as dry mouth, nausea, sweating, or trouble swallowing. Depressive symptoms, like depressed mood, diminished interest or pleasure in most activities, or loss of appetite, are also common.

It is also common that GAD co-occurs with other disorders, such as mood disorders (depression, bipolar disorder), other anxiety disorders (panic attacks, social phobia) or substance-related disorders (medication, alcohol or drug abuse). GAD may be an isolated disorder, but most people with GAD also suffer from some of the problems mentioned above. However, a person will not be diagnosed with GAD, if the symptoms can be fully explained by other diagnoses.

Studies show that approximately five percent of all people get GAD at some period of their life, and that the disorder has shown to be slightly more common among women than men. For the majority of those affected, the problems begin during childhood or adolesence, but it is not unusual that the anxiety also appears in later stages of life. There is a cultural variation in the expression of anxiety; therefore it is important to also have a cultural perspective when evaluating anxiety problems.

GAD is thought to have biological as well as environmental causes. That means that parts of the explanation to GAD may be found in the person's background and in his or her present life situation, as well as in the chemical composition in the person's brain.

What is there to do?

Anxiety is a very powerful human emotion, with an original purpose of acting as a warning signal that we need to take quick action and get to safety. For a person suffering from GAD, the anxiety no longer serves that purpose. The anxiety instead has become a persistent unpleasant feeling, mentally as well as physically. The result is that the anxiety more and more controls the affected person's life, which leads to avoiding lots of situations, thoughts and areas of life. This is a clear sign that it is time to begin to question the anxiety. This can be difficult to do without help, so it is a good idea to consult an expert (a psychologist, therapist or doctor). Another possibility is to contact a local and/or internet support group.

For people who suffer from GAD, a lot of their time is spent on endless pondering, which often is very negative and includes lots of catastrophic thinking. A way to begin to challenge your anxiety is to start to see a situation from different perspectives. A good starting point is a neutral everyday event. Later on, you can try the same analysis for more difficult situations, such as what your boss thinks of you, or how well you will do on your next exam. Persons suffering from GAD often tend to have rigid thinking, making it hard for them to see things from another point of view. Therefore it might be necessary to get help and guidance in learning to handle the anxiety.

Learning to deal with your destructive thinking is one part of the work, but it is not enough just to do this on a cognitive level. You also need to investigate in which situations the anxiety occurs, focus on which emotions triggers it, and see how the anxiety affects your behaviour.

The treatment for GAD consists of therapy, but also of medication or a combination of both. The most common medication is SSRI, which has an anxiety-reducing effect, by affecting the balance of serotonin in the brain. These medications have been found to have relatively small side effects. The other alternative is benzodiazepines, for example Valium and Xanax. These have a tranquillizing effect with good results on anxiety, but should be used with caution since they have side effects and can be addictive.

Scientific studies show that cognitive behaviour therapy (CBT) is effective on GAD. According to some results, almost two thirds of those who recieved CBT-treatment experienced a significant improvement in life. In general, research show that CBT, on its own, is the most effective method. After that comes a combination of CBT and medication (can be as effective as CBT alone, but with a higher relapse percentage), and last comes medication without therapy.

Treatment with Gestalt therapy

In addition to this, Gestalt therapeutic methods can lead to good results. This kind of treatment is performed by a specially trained therapist. An example of Gestalt therapy can be summarized as follows:

The patient lies on a sofa or on a mattress on the floor. They are then asked to close their eyes, contact their inner feelings and sense how they feel deep inside. The therapist asks the patient to try to capture the feeling in the body, to extend and delve into it.

People suffering from GAD often make huge efforts to avoid causing the unpleasant feelings. The Gestalt therapeutic method attempts to get patients to confront their unpleasant emotions; learn what these emotions feel like, how their body expresses them and how they can put words on them.

Gestalt therapy can lead to quick, dramatic results for people with anxiety. The main idea is to break the pattern of avoidance and to confront the anxiety with full power. By releasing their anxiety, patients learn to understand it. The result is that the anxiety, due to self-confrontation, is neutralized and then diminishes or disappears.

Step by step-summary of CBT-treatment

The following are some steps that are used in cognitive behaviour therapy, and lead to improved control over the anxiety and the worry:

• Think about, and write down, which areas and situations the worry and the anxiety are mostly concerned with. Then write down what your goals are; what you want to achieve and where you want to get. Try to be specific and concrete, rather than general and abstract.
• Do different kinds of relaxation exercises and practice relaxation techniques. Learn to find appropriate meditative activities, for example, silent meditation or long walks.
• Investigate what triggers your anxiety. Be aware of, and take notes on your so called triggers (thoughts, events and situationes), and make an estimation how severe the anxiety is in different situations (on a scale from 0 to 100).
• Learn to notice and challenge classical cognitive traps. One example of a cognitive trap is overgeneralization. A woman who overgeneralizes comes to the conclusion, after being turned down on the dance floor once, that she will never find a man. Another example is catastrophic thinking, which is characterized by always expecting the worst to happen. Yet another example is selective perception, which means that you only notice things around you that confirm your pet worry.
• Stop the behaviour that the anxiety causes. Often anxiety is reduced by different types of avoidant behaviour. That is why you can challenge the anxiety by attacking the connection between avoidance and anxiety. Examples of this can be to leave the house, to ask someone out, or to apply for an interesting job, even though the anxiety tells you not to.
• Make plans for specific moments during the day, when you occupy yourself with the anxiety and the worry completely. About half an hour a day, not just before going to sleep, may be enough. During that time you should not be disturbed and you should try to fully release your anxiety and worry. By doing so, you are learning what your specific worries look like, but the purpose is also to make them less dramatic by meeting them face to face. Furthermore, you should also establish some free-zones; times and situations that you keep entirely free from anxiety and worry.
• Practice realistic time planning, and practice handling and solving problems, as well as ranking problems by their priority.
• Learn to release and discover your emotions. People who suffer from GAD are often more occupied with their thoughts and ponderings than their emotions. They often have an unrealistic fear of feelings and do everything to keep them at a distance. One way to work with emotions is to sense how different emotions feel in the body, when and why they appear, and to also practice how to attach words to them.

What can you do as a relative?

To live near a person suffering from GAD can be very trying and challenging. It is important to try to be open and honest in a respectful way. Tell the person with GAD how their pondering and anxiety affects you, and focus on your own emotions. Try to be flexible and creative, and try to come with new perspecives and new ways of thinking that challenge the negative thoughts. Do so without being judgmental, accusatory or supercilious. People suffering from GAD need a lot of help and support from their surroundings. However, often the good will of relatives gets them to take part in the pondering, by answering endless questions or by getting convinced by the negative view of life; all in attempts to lessen the person's anxiety and worry. Instead, this most likely just strengthens the problems. What is much more needed is to give motivation and hope. Notice and support even the slightest improvements, and encourage and support attempts to seek professional help, if the problems seem to be to difficult to handle without help.