My mum used to say this, it was a family joke, a self-deprecating saying given in humour rather than in angst. And as I began to write this post these words came unbidden to my mind, an echoing memory that resonated as an apt refrain for the type of anxiety that I will be explaining here – General anxiety disorder (GAD). I find it apt because it highlights in a light-hearted way one of the key symptoms of GAD, itself far from being light-hearted, which is that the anxiety, tension or dread experienced is constant, unrelenting and is not tied to a specific situation or event: the suffers worries about many things, all of the time.
In a nutshell, the symptoms of GAD can be summarised as being:
GAD is excessive because..
.. the worry is out of proportion to the perceived or real risk – what is often referred to as catastrophising.
GAD is intrusive because..
.. it is/seems impossible to relax and escape from the anxious thoughts, they are uncontrollable and are not specific to one situation, event or thing. If one source of worry is resolved the sense of fear and dread becomes attached to something else and so it continues. Over time sufferers lives becomes increasingly disrupted as they seek, often in vain, to avoid any source of anxiety.
GAD is persistent as ..
.. it is characterised by prolonged, unremitting worry occurring daily for at least 6 months or more (duration used in formal diagnosis)
GAD is debilitating as..
.. well, because of all of the above! To live with these symptoms is exhausting, both mentally and physically. Concentration is difficult and insomnia is common. Those suffering from GAD report experiencing difficulties in coping with commitments at work and within the family as well as there being detrimental repercussions on close relationships.
Approaches that can help manage GAD
If you feel that you are suffering from GAD or another form of anxiety it is important that you first consult your GP in order to establish if there is a physical cause for the symptoms being experienced and if not, to obtain a formal diagnosis of an anxiety disorder. If you are diagnosed as suffering from GAD there are a number of things you can try to help manage and even alleviate your symptoms, as summarised below.
Understand the nature of GAD
It is generally accepted that recognising that this type of anxiety is self-generated is an important first step in beginning to reduce GAD. Whilst external factors can act as triggers which spark off the anxiety, it is the persistent internal dialogue that sustains it and causes it to develop into GAD. Constant worry about things that you dread or fear, which may not happen, is fruitless and exhausting. Running over what might happen is unproductive, although it may seem that you are protecting yourself - hence I worry if I have nothing to worry about! Instead you can use this evergy to challenge these thoughts an to fucus on something else and begin to learn to accept and be comfortable with uncertainty in you life.
Exercise is an effective way to relieve anxiety; it releases endorphins which counter low mood and it increase levels of physical and mental energy. In addition, when exercising, by focusing on your body and what you are doing physically - what muscles you are using, how you are breathing, patterns and rhythms in the exercise itself - you will interupt the worry laden thought process and redirect your mind to other matters.
It is impossible to be both anxious and relaxed. Therefore, finding a means to relax which fits your lifestyle and preferences can be beneficial. Giving yourself space to relax muscle tension, utlise breathing techniques and to meditate will all help to calm the physical syptoms of GAD and, again, work towards interupting the pattern of anxious thoughts.
Diffuse panic attacks
If the anxiety escaltes into a panic attack there are key techniques which are recommended for effectively de-escalting an attack, including grounding techniques, breathing exercises, reflexive thinking and gaining an understanding of the natural flight or fight response behind the psychical response to a sense of threat.
Fight the urge to isolate as this only intensifies GAD. It can make a significant postive difference if you have someone with whom you can share the anxious thoughts and feelings you are experiencing. Simply talking about your worries can make them feel less threatening. Ideally contact with this person should be face to face, happen regularly and take place in a safe, confidential and quiet setting. It is important that this person, be they partner, family member or friend, is someone who can listen and who will not be judgemental.
A healthy lifestyle
Some simple changes to your lifestyle can make a difference such as limiting the amount of caffeine and sugar in your diet and avoiding alcohol and nicotine. All of these can actually increase levels of anxiety.
When to seek therapy
If your worries and fears persist, despite your best efforts, then therapy may be an appropriate next step. This is of course in addition to and not instead of the measures to help yourself outlined above.
Research has shown that therapy is as effective as medication for most people in treating anxiety disorders. Cognitive Behavioural Therapy is a successful form of short-term therapy used to treat anxiety disorders. Other therapuetic approaches include Acceptance and Commitment Therapy, Psychodynamic Therapy and Integrative Therapy.
My approach to helping people suffering from GAD or any other anxiety disorder is an Integrative one. The specific needs of an individual is the starting point from which appropriate approaches from several different therapeutic models, some of which are mentioned above, are taken. It is based on the view that often no single therapeutic orientation is sufficient for a comprehensive and lasting treatment of anxiety disorders for all patients. Counselling or longer-term psychotherapy is recommended where there are felt to be underlying emotional or psychological issues involved in generating the anxiety. The self-reflective process of therapy enables people to unravel, understand and transform the causes of their anxiety.