Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD)occurs when a person feels anxious all of the time and when there is no obvious reason for worry. This person may overly worry about money, family, or health when there is no evident reason to feel this way. This disorder most often hits people when they are children or adolescents and is more common in women than in men. The symptoms of anxiety fall into two categories: apprehensive expectation and physical symptoms. People with Generalized Anxiety Disorder aften feel a sense of general dread that something bad is going to happen. This is differentiated from depression in which a person feels that something bad “has” happened. Muscle tension, fatigue, inability to relax, difficulty concentrating, irritability, and fatigue are typical symptoms. Peronsality traits of individuals with GAD are essentially unknown.

Theoretical approaches associated with this disorder are cognitive-behavioral, and behavioral. Methods of treatment include pinning down the cognitive responses that add to the anxiety and then questioning whether those cognitions are rooted in reality. Self-monitoring, relaxation, and exposure methods are often used in behavioral therapy. A combination of the above seems to be the most effective short term treatment for the disorder.

A multimodal approaches often yield the best results since the anxiety the patient is experiencing is a result of several interacting systems. Pharmacotherapy may be an option if symptoms are severe or when psychological interventions are not possible. Tricyclic antidepressants have been found to be as effective and anxiolitics in the treatment of GAD. Tricyclics seem more efficatious in treatement of the negative affects and cognitions, while anxiolitics seem to act on somatic symptoms.

You will need to conduct an assessment, establish a working relationship, and arrange some measure of instant symptom relief. When doing the assessment be sure to get a thorough clinical history as well as an emotional psychosocial. You will need to refer to a psychiatrist for possible medication (if needed). You should also refer to a physician to see if there is any medical cause for the symptoms.

Finally, you should discuss the diagnosis with the patient and make agreements for treatment. Empathy and support are very important when dealing with this disorder. Instant relief is often achieved by an empathic stance, since people with GAD may be misunderstood by the people around them. Since others are less affected by the concerns of the patient, their feelings of worry may be discounted. It an be freeing for an individual to listen and “get inside” the patients worry and not rationalize away the fears and concerns (this is what family and friends do).

Once treatment has begun, several approaches have been found useful. Behavioral approaches can be used if treatment is short term and is controlled by third party payors. In this case, systematic desensitization or progressive relaxation has been show quite effective. Imagined and real life situations are utilized in the relaxation procedure. Cognitive restructuring may be useful to alleviate the negative cognitions of worry and negative anticipation.