GENERALIZED ANXIETY DISORDER (GAD)

Generalized anxiety disorder (GAD) is a common anxiety disorder that involves constant and chronic
worrying, nervousness, and tension.

It is different from a phobia wherein, a person’s fear is connected to a specific

trigger/thing/situation. GAD is a general feeling of dread or unease that impacts ones whole life.
GAD is less intense than a panic attack, but much longer lasting, making normal life difficult and
relaxation impossible. People with GAD worry about the same things other people do, but at a much
more magnified level. For example, a phone call to a friend that is not returned results in anxiety
that the relationship is in trouble. A boss asking to meet with an employee regarding a work related
matter may cause anxiety whether he/she is going to be fired. While worries, doubts and fear are
normal things every individual feels, the anxiety in people with GAD is:

 Excessive- more than what is warranted.

 Intrusive- affects the individual’s life and functioning.
 Persistent- is constant.
 Disruptive- is counterproductive.

CAUSES OF GAD

Neurological Causes

It is thought differences in the neurotransmitters (brain chemicals) such as Serotonin, Dopamine,

Norepinephrine, Gamma-aminobutyric acid (GABA) play a role in causing GAD. It is these chemicals
that are altered by antidepressants, some of which are effective treatments for generalized anxiety
disorder. Abnormal levels of other chemicals, like peptides and hormones, may also partially cause
generalized anxiety disorder. MRI scans have revealed that some structures of the brain are changed
in some anxiety disorders. Impaired cognitive functioning also appears to be tied to GAD in both
children and adults.

Genetics

One can be genetically predisposed for developing generalized anxiety disorder.Research into
genetics and GAD indicates that we can have a genetic vulnerability to developing GAD if certain
genetic markers have been passed on to us. Vulnerability, in combination with certain
environmental factors, can trigger the development of symptoms.

Studies have also shown that first degree relatives of someone with GAD (parent, sibling, or your
child) are more likely to develop mood and anxiety disorders, in general, with a specific increased
risk for developing GAD.

Finally, women are actually twice as likely to be impacted by generalized anxiety disorder. Although
the condition typically begins around 30 years old, many of those who are diagnosed are found to
have been struggling with symptoms for years before seeing a professional and being properly
diagnosed. GAD comes on gradually, with the greatest risk between childhood and middle age.

Life Experiences

GAD can be shaped by environmental and life factors also.

Experiencing Trauma: Childhood trauma can increase the risk of developing GAD. Difficult
experiences such as physical and mental abuse, neglect, the death of a loved one,

abandonment, divorce, or isolation can all be contributing factors. Research has shown that life
events that result in specific feelings of loss, humiliation, entrapment, and danger are reliable
predictors of the development and onset of generalized anxiety disorder.

Learned Behaviour: Some behavioural scientists believe that anxiety is a learned behaviour,
suggesting that if we have a parent or caregiver who demonstrates anxious behaviour, we may tend
to mirror that same anxious behaviour.

Lifestyle Factors

Caffeine: Caffeine can heighten feelings of worry or nervousness, contributing to the development of
anxiety. Relying on caffeine sources such as coffee, tea, soda and energy drinks can cause some
people to feel restless and anxious, especially in large quantities.

Relationships: Relationships can be a source of great comfort, as well as great pain. Women are
twice as likely as men to develop GAD and it is important to note that relationships can be a
significant source of anxiety for women, in particular. According to research, anxiety develops in
women when they were being afraid of and/or humiliated by a current partner or ex-partner.
Dangerous and fearful experiences within intimate relationships can influence the development of
anxiety.

Job Stress: Work can be a great source of stress and become a trigger in the development of anxiety.
Some employers expect extraordinarily high levels of performance and productivity that can
threaten our sense of employment security.

Stress related to the ability to provide for ourselves and our families; career and work-related stress,
particularly the loss of a job, can be a significant source of heightened anxiety.

Societal Factors

Researchers are finding that excessive use of social media, can greatly impact our mental health,
sometimes resulting in anxiety and depression. Interacting with others through social media can
present us with the same challenges as when we are interacting in person, such as feelings of
loneliness, rejection, abandonment, or humiliation.

People with GAD are less effective in accurately interpreting social cues and interactions, leaving
them to potentially feel a heightened sense of danger or rejection, even when there is

no observable threat present. Interactions through social media can be interpreted in these same
inaccurate ways, possibly even more so when we are, at times, missing essential nonverbal cues in
communication such as facial expressions, body language, and tone and exacerbating GAD.

Brain Structure

The limbic system is a collection of brain structures that are responsible for our feelings and
reactions. Although it is generally under the control of the "thinking" part of our brain, it can
respond to stimuli on its own as well.

The Amygdala: Imaging studies of patients diagnosed with GAD show elevated amygdala activity
during the processing of negative emotions. It is this heightened activity within the amygdala that
researchers believe might influence the inaccurate interpretations of social behaviour for patients
with GAD. In other words, people with GAD may inaccurately perceive a social cue or interaction as
threatening when it is not actually threatening, for example.

Grey Matter: An increased volume of grey matter has been repeatedly found in GAD patients. The
putamen in an area that lies over and to the sides of our limbic system. Interestingly, researchers
found that a larger volume of grey matter in the right putamen was positively correlated with
childhood maltreatment. In other words, the greater the report of childhood maltreatment, the
greater likelihood of increased volume of grey matter in that area of their brain.

IMPLICATIONS OF GAD ON WORK LIFE/CAREER

In the workplace, GAD symptoms could translate into

 difficulty working with colleagues and clients,

 preoccupation over the fear instead of focusing on work,
 turning down assignments because of fear of failure, flying, going in to the elevator, or
public speaking.
 inability to concentrate
 inability to focus/excessive self-focus failure to meet deadlines/taking too long to do things
 somatic (body) problems such as tension, headaches, feeling of pressure, dizziness, and
upset stomach , forgetfulness , sick days/lost productivity , spill over effect onto family life

In addition,

 People who experience attacks related to panic, trembling, or other different effects of GAD
will have trouble to do the tasks, which often require perfection.
 People who suffer from disorder related to anxiety also have muscle pains, which make it
very difficult for them to do physical work.
 There are many who suffer generalized anxiety attacks after they have had a complete meal.
The digestive system does not cope with the thinking that is going on in the mind. The blood
supplies in the body increases because the heartbeats are faster. The person starts worrying
about their heart and this causes breathlessness, due to over thinking
 People who have generalized anxiety disorder (GAD) sometimes also have obsessive
compulsive disorder (OCD), which can have greater difficulty in the work place.

REMEDIES

SELF- COPING AT THE WORKPLACE

Speak to the Manager: Speaking to your manager or supervisor about your anxiety disorder may
help. You may be offered accommodations to help you do your job more effectively.

Tell a trusted Co-worker: by telling a trusted co-worker how you are feeling, there will be someone
there at work who knows what you are going through and who may be able to help keep you on
track.

Work within Your Limits: Understand the limits placed on you by your anxiety disorder and learn to
work within them. Take time off when you need to. Take a brisk walk or escape for a vacation for a
few days. Focus on a single task at a time and try not to worry about
everything that needs to get done. Listen to music at work if you are allowed and if it helps you
cope. Set mini deadlines to keep yourself focused.

Be Mindful: If you find yourself losing concentration or focus and becoming wrapped up in worry,
practice mindfulness. Become observant of your surroundings and refocus on the present moment.
Try mindfulness meditation or any other practice that teaches you how to bring yourself back to the
present.

Have Good Health Habits: While GAD can cause insomnia, try your best to stick to a regular
sleep/wake cycle. Eat healthy foods and avoid caffeine.

PSYCHOTHERAPIES

The following Cognitive Behavioural Therapies are effective in the treatment of GAD:

Relaxation training: Teaching people who worry a great deal to relax can be an important part of
treatment. Because people who worry a lot usually have a great deal of muscle tension, it can be
hard to go through any of the other CBT interventions without first learning to relax. Physical
relaxation makes it easier for the mind to relax and let go of worries. Yoga and Meditation and be
extremely helpful too.

Cognitive restructuring: With generalized anxiety disorder, cognitive restructuring focuses

specifically on negative predictions about the future, and unhelpful attitudes about one’s ability to
cope with difficult situations.

Mindfulness training: Mindfulness is simply the art of learning to bring one’s attention to the present
moment. This can be a very important skill for someone whose mind tends to time-travel to worry
about the future.

Systematic exposure: Systematic exposure is an intervention that helps people to face their fears
and test their extreme predictions. Usually this involves imagining the worstcase scenario that is the
object of so much worry, and over-time making peace with it such that it no longer triggers anxiety.
Exposure can also involve behavioural

experiments, testing what happens when people act out of line with their worrisome thinking.

Problem-solving training: Because people often feel anxious when crises arise, or are overwhelmed
by their obligations, problem-solving training can be a helpful way to reduce objective stressors.
Through learning skills to effectively manage stress, people can feel at ease even in difficult
situations.

MEDICATIONS

Several types of medications are used to treat generalized anxiety disorder, including those below.

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 Buspirone. An anti-anxiety medication called buspirone may be used on an
ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully
effective. Benzodiazepines. In limited circumstances, these sedatives are generally used only for
relieving acute anxiety on a short-term basis. They can be habit-forming and aren't a good choice if
one had problems with alcohol or drug abuse.