Understanding general anxiety disorder: An expert's guide

General anxiety disorder is a common mental health condition, that can prove debilitating if not treated. In her latest online article, renowned chartered counselling psychologist Melanie Phelps offers her expert insight into the condition.

What is general anxiety disorder?

General anxiety disorder (GAD) is a mental health condition characterised by excessive worries over a time frame of six months or more. The worries are about a wide range of things which begin to interfere with everyday life.

GAD can present with severe physical symptoms (such as sweating, shaking, breathlessness, changes in body temperature, inability to sleep, heart palpitations, feeling faint, nauseous, and restless), in addition to psychological symptoms (nervousness, feeling out of control, a sense of dread, emotional irritability, difficulty concentrating etc.).

Sometimes symptoms can escalate to what is known as an “anxiety (or panic) attack” and are so concerning that sufferers often call an ambulance for urgent medical support because the symptoms feel like a serious physical emergency.

Panic attacks occur when the body releases a surge of the hormone adrenaline which is a natural mechanism in response to a threat. Adrenaline speeds up the body by increasing heart rate and breathing. It is to help us deal with a threat.

In this context, however, the “threat” could be a memory, a thought, or a worry. A typical worry which acts as a threat is “What if there is something wrong with my heart… it is beating so fast?” In response to this, the body releases more adrenaline which perpetuates further symptoms of anxiety and leads to further worries. This vicious cycle escalates to an uncontrollable state of panic which is extremely distressing. After this experience, the anxiety sufferer understandably does all they can to avoid any other anxiety-provoking situations and their world shrinks.

It is recommended to get any physical symptoms checked by a medical professional such as a GP. GAD can present similarly to other physical and mental health conditions.

What are the reasons a person could develop anxiety?

As with many mental health concerns, there is no one reason people develop anxiety disorders. Some of the common reasons are what might be termed “traumas” (for example: experiencing the unexpected or sudden death of a loved one, bullying, abuse, losing a job, a difficult divorce etc.).

Often, a sequence of life events occurs within a relatively short time frame (e.g., over a few months or a few years) which could include positive events such as being promoted, meeting a new partner, getting married, moving home, or becoming a parent.

Processing or coming to terms with traumas or life-changing events requires time to adjust, reflect, get used to the consequences, and express any feelings.  

When this does not happen or happen in the way someone really needs at the time, the thoughts and feelings which were present at the time (back then) can be easily “fired” or triggered, seemingly randomly or in response to a similar thought or feeling (in the present).    

Additionally, the mind becomes inadvertently hypervigilant, continually anticipating any further life changes or traumas, and a kind of “red alert” state occurs, where the mind is continually trying to predict any possible threats, impacts of life changes and outcomes. This takes up a huge amount of mental energy leaving sufferers feeling exhausted.

Other factors in the development of anxiety are:

• chronic stress
• busy schedules with no downtime
• lack of adequate rest and sleep
• inability to express feelings
• erratic eating (due to a link between low blood sugar and anxiety, and nutritional and energy demands required for healthy brain functioning)
• dehydration (stress and anxiety hormones are felt less powerfully when diluted in a well-hydrated body).

As you can see, anxiety is a mix of psychological, emotional and biological factors.

What kind of symptoms and behaviour do people with general anxiety disorder show and have?

• Avoidance: Due to an overwhelming sense of dread, nervousness, and fear, those with anxiety disorder tend to avoid bright, loud, noisy, open places. Large supermarkets, festivals, airports, warehouse-type DIY stores, gyms with strip lighting and loud music are often typical culprits. Anxiety can build up and the fear of becoming anxious means that the place where anxiety occurred (e.g., a supermarket is avoided, as well as all other supermarkets). This means the world of an anxiety sufferer shrinks and home becomes the safest place to be.
• Reassurance seeking: It is common for those with GAD to Google search their symptoms, seeking information and reassurance, this includes reassurance from loved ones and/or medical professionals. Whilst this is a natural response it can become habitual, compulsive, and frequent as reassurance given feels very temporary.   
• Relationships: can suffer, as the anxiety sufferer does not always want to socialise, feeling too unwell and may be irritable. For those who do not suffer from anxiety, the fears and worries may seem irrational, and the anxiety sufferer may feel guilty or embarrassed or wrong to feel the way they do, the continual reassurance seeking can take its toll, and those with GAD may feel as if they can express their feelings.  
• Depression: often goes hand in hand with anxiety as it feels as if the anxiety will never go away, impacting mood and leading to feelings of helplessness and hopelessness which are synonymous with depression.

How is general anxiety disorder treated? How can they ensure they don’t relapse?

As with many mental health concerns, there is no one “cause” for general anxiety disorder, and there is no one “cure” either. Instead, what works best is a combination of therapeutic techniques and interventions specifically tailored to suit each unique person. Sometimes medication prescribed by the GP and/or nutritional supplementation, especially if someone has been eating erratically for a while or feeling too nauseous to eat (under the direction of a nutritionist) can additionally help.

Cognitive behavioural therapy (CBT) which was originally developed in the 1960s and 70s has further evolved and been developed over the years to incorporate aspects of modern neuroscience and remains the recommended* treatment of choice for anxiety disorders (by the National Institute of Care Excellence, a government body*).

CBT techniques and strategies not only enable sufferers to individually understand the unique way their anxiety developed, but also learn techniques to manage it, so that they feel they are starting to regain some control, as well as working on the original source of the anxiety (such as life-changing events or traumas etc.).

Other techniques, if required, might include EMDR (eye movement reprocessing and desensitisation) and hypnotherapy-style interventions. This means that if the anxiety can be traced back to traumatic events, those events (if too uncomfortable) do not need to be discussed in any detail to be cleared.

Mild to moderate anxiety can usually be treated in 6-8 sessions, but if anxiety has become severe, it may take longer. To keep the treatment on track it is always helpful to assess and benchmark the degree of severity/level of anxiety at the start (including the frequency and duration of any panic attacks) and review after the initial few sessions. When anxiety starts to reduce, we may then start to spread out the sessions, so that support remains whilst we can assess any further concerns or wobbles as they happen over time. The aim is to eliminate the general anxiety disorder and panic attacks, providing insight and a plan to ensure (as much as possible) that they do not return in the same way.

It is important to remember that some anxiety is part of everyday life and something that we can all experience from time to time, in response to specific stressors or situations. General anxiety disorder, however, differs in duration, intensity and presence of physical symptoms, it impairs everyday functioning and does not occur in response to a known reason or current situation.

If you would like to book a consultation with Melanie Phelps, you can do so today via her Top Doctors profile.