Anxiety and generalised anxiety disorder (GAD)

Anxiety is a word we use to describe the unpleasant feeling we get when we are in a stressful, threatening or difficult situation, or are facing a problem. It is not in itself a mental health condition.

Most of us will experience anxiety at some point in our lives for many different reasons. It can be a normal response, and usually goes away over time, when the situation changes, or when you leave the situation that is causing you anxiety.

Anxiety can become a problem when:

• your anxiety is very strong
• you feel anxious all or most of the time
• there is no obvious reason for why you feel anxious
• it negatively affects your daily life

When this happens anxiety can make you feel constantly uncomfortable, stop you from doing the things you want to, and make it difficult for you to enjoy life.

Anxiety can cause you to feel lots of different things in your mind and body, including:

In the mind

• feeling worried all the time
• feeling tired or sleeping badly
• being unable to concentrate
• feeling irritable or depressed
• feeling uneasy or tense
• feeling overwhelmed
• feeling afraid that something awful might happen.

In the body

• fast or irregular heartbeat (palpitations)
• sweating
• a dry mouth
• muscle tension and pain
• headaches
• trembling/shakiness
• numbness or tingling in the fingers, toes or lips
• breathing fast
• feeling dizzy or faint
• stomach problems like indigestion, cramps or feeling sick
• going to the toilet a lot
• feeling a lot of anxiety related to these physical sensations.

Sometimes, people with anxiety worry that their symptoms are a sign of physical illness. This can make their anxiety even worse.

When anxiety goes on for a long time, it's easy to start to feel depressed. Some people with anxiety will also experience depression at the same time.

Anxiety can be caused by a huge number of things, including:

• everyday events like receiving a stressful email at work or interacting with a difficult customer
• major life events like going through a divorce, having a physical illness, or knowing someone who has died.

Sometimes we even experience anxiety when something good is happening. For example, if we are about to go on a date or have a job interview. These aren’t bad things, but they can create the physical and psychological effects of anxiety in our bodies.

Although anxiety can feel unpleasant, it can be helpful in certain circumstances and for limited periods of time:

• psychologically – In difficult situations, anxiety tells us that something is wrong and keeps us alert so that we can react appropriately.
• physically – The physical feelings of anxiety can prepare our body to run away from danger or to protect ourselves. This is called the 'fight or flight' response.

Generalised anxiety disorder (GAD) is a type of anxiety disorder. There are lots of other anxiety disorders that aren’t covered here, such as obsessive-compulsive disorder (OCD) or panic disorder.

If you have GAD, you will:

• have lots of different worries at the same time
• have worries that are out of proportion to the situation
• find it difficult to control your worries.

GAD is quite common and affects 1 in every 25 people in the UK. 

GAD does not have a single cause. Your genes, social environment and life experiences all play a role, and interact with each other.

If you have a close family member with GAD, you are four to six times more likely to develop an anxiety disorder. However, no single gene causes anxiety disorders. Instead, multiple genes, each having a small effect, interact to increase your risk.

If your anxiety is having a negative impact on your life, or you think you might be experiencing GAD, the sooner you ask for help the sooner you can start to get better.

There are lots of reasons that people put off getting help, and it’s normal to have some of the following thoughts even if they aren’t true:

• “This is just what I’m like, I should try to manage on my own” – No one should have to struggle alone, and everyone deserves support. Try to talk to yourself with kindness and compassion, like you would talk to someone you care about.
• “I have other more important things to focus on” – Many people struggle to make their mental health a priority. This can be particularly hard if they have important responsibilities within their family or wider community, or are facing other external challenges. However, you won’t be able to keep doing the things that are important to you if you are unwell. By helping yourself you will be best placed to help other people.
• “I’m worried about what people will think if I ask for help” – You might be surprised by how many people will understand what you’re going through, and possibly have experienced similar challenges themselves. Try to listen to the people in your life who are understanding and supportive of you getting help.

If you are struggling with your anxiety or have GAD there is lots of help available. Often, anxiety can improve by taking steps to help yourself:

• Talk about it – If your anxiety has started because of something happening in your life, like a relationship breakdown, a child becoming ill or losing a job, it can be helpful to talk to someone about it. Speak to someone you trust and respect, and who is a good listener. This could be a close friend, GP, religious leader, or anyone who you feel comfortable asking for support.
• Self-help tools – There are a number of self-help tools that you can use to improve your mental health. These include things like meditation or mindfulness apps, as well as books or apps that allow you to practice cognitive behavioural therapy (CBT) on your own. You can find out more about CBT in the section below on psychological therapies.
• Self-help groups – Contact your GP to ask for suggestions of self-help groups, where you will be able to meet with people who have similar problems. As well as having the chance to talk, you may be able to find out how other people manage their anxiety. Some of these groups are about specific anxieties and phobias. Ask your GP what kind of group might be helpful for you.
• Peer support – Peer support is where you meet other people with similar experiences to you in a safe and supportive environment. Find out more about finding peer support.

You might also be able to find a self-help group, or peer support through a charity. For example, the mental health charity Mind have local services that run different groups depending on who you are and what help you need.

If you have tried helping yourself and are still struggling, you might need further support. What treatment you are offered will depend on your circumstances, but these are some of the treatments you might be offered if you have GAD.

Psychological therapies

Psychological therapies, or ‘talking treatments’, are where you talk with a therapist about the problems you are facing.

Different approaches are used to help different mental health conditions. The following two approaches are recommended for GAD:

Cognitive behavioural therapy (CBT)

CBT is a talking therapy that can help you learn more helpful ways of thinking and reacting to everyday situations. It aims to improve your state of mind by teaching you to spot the links between your thoughts, actions and feelings.

If you have GAD, CBT can help you test out your fears and tolerate your anxiety. CBT can take place individually, or as part of a group. You can have CBT in person or online, and it is usually given once a week for several weeks or months.

You can find out more about CBT by reading our CBT information resource.

Applied relaxation

Applied relaxation is a therapy that helps you to relax your body during situations where you would usually be anxious. A trained therapist will work with you in one-hour sessions every week for several months and teach you how to relax your body.

Once you have had this therapy, you should be able to use applied relaxation in everyday situations when you are experiencing anxiety.

Medication

If psychological treatments haven’t helped, or you would prefer not to have them, you might be offered medication.

Your doctor might offer you a combination of medication and talking therapy. This is because having both at the same time can be more effective for some people than just medication or talking therapy.

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant. Even though SSRIs are called antidepressants, they can be used to treat generalised anxiety disorder.

It is thought that SSRIs increase levels of serotonin in the brain. Serotonin is thought to have a good influence on mood, emotion and sleep. SSRIs cause fewer side effects than other antidepressants.

SNRIs

If SSRIs don’t work for you, you might be offered a serotonin-noradrenaline reuptake inhibitor (SNRI). This is another type of antidepressant and is similar to SSRIs but works slightly differently.

Antidepressants usually take 2 to 8 weeks to work and have to be taken regularly to work properly. Like all medications, antidepressants can cause side-effects, which your doctor should discuss with you. You can find out more about these in our antidepressants resource.

Pregabalin

If SSRIs and SNRIs don’t work for you, you might be offered pregabalin, which is also used to treat seizures and pain. It has been shown to help people with anxiety.

Pregabalin can be addictive. If you feel that you are becoming dependent on pregabalin or are taking more than you have been prescribed, speak to your doctor straight away.

Other treatments

Benzodiazepines

Benzodiazepines are a type of sedative. You may be offered these for a short time if you are struggling to cope and your anxiety feels out of control. Benzodiazepines can become addictive if they are used for too long. If you feel you are becoming dependent on benzodiazepines, speak to your doctor straight away.

Beta-blockers

Rarely, you might be given beta blockers, which are a medication that works by slowing down your heart. This can help to stop the physical feelings of anxiety.

Herbal remedies

Some people find herbal remedies helpful for their anxiety. However, there is no strong evidence that any of these work. You should speak to your doctor before using any alternative medicines as they can cause serious problems when taken with other medications.

You can find out more about these by reading our information resources on complementary and alternative medicines and physical treatments.

Most people experience anxiety from time to time without it becoming a problem. Here are some things to look out for if you think someone you know might be experiencing higher levels of anxiety than usual:

• They seem to be worrying about something, or lots of things, to a level that doesn’t seem rational.
• They avoid situations or environments that they didn’t avoid in the past. For example, going to parties, out for dinner or to crowded places.
• They complain of physical symptoms like headaches, stomach aches or tiredness.
• They seem upset, angry or frustrated for no obvious reason.
• They cancel plans, or don’t do things they say they will.
• They seem distracted or unable to listen when you are talking to them.

Different people experience and communicate anxiety in different ways, depending on their life experiences, cultural or religious background, and their primary language. This might mean that someone’s anxiety isn’t immediately obvious to you.

Supporting someone with anxiety can be challenging, especially if you are not an anxious person yourself. Here are some things you can do to help:

• Listen - Being there to listen to someone struggling with their anxiety can be a huge support. Sometimes just sharing anxious feelings with another person can help to ease their anxiety.
• Be patient - Try to be patient if the person you know finds it difficult to stick to plans you’ve made, or seems irritable or distracted. It's important not to take it personally.
• Take them seriously - Even if someone is anxious about things that don’t seem rational to you, the way they are feeling will be very real to them. You don’t have to encourage their anxious thoughts, but you can reassure them that their feelings are valid and that they deserve support.

If you know someone who is struggling with their anxiety, encourage them to seek help, whether that means supporting themselves, or getting help from a professional.

The charity Anxiety UK has helpful tips for supporting someone with anxiety.

Here are some useful sources of information and support if you or someone you know is struggling with anxiety or GAD.

Information and support on anxiety

• Anxiety and panic attacks, NHS – This section of the NHS website offers a broad range of information on anxiety.
• Every Mind Matters, information on anxiety – This information from the NHS offers tips to cope with anxiety as well as a free plan to help you deal with stress and anxiety.
• Anxiety UK, information on anxiety – This page from the charity Anxiety UK explains what anxiety is and has a video on practical tips for dealing with it.
• Mind, anxiety and panic attacks – This information from the mental health charity Mind looks at anxiety disorders in general, and includes information on GAD.
• Mental Health Foundation, Anxiety – This information from the Mental Health Foundation looks at anxiety and anxiety disorders.

Information and support on GAD

• Generalised anxiety disorder in adults information, NHS – This overview explains what GAD is and how to get help.
• Anxiety UK, information on Generalised Anxiety Disorder – The charity Anxiety UK offers information on GAD, as well as a free factsheet which you can download.
• Generalised anxiety disorder and panic disorder in adults: management – This information for the public from the National Institute for Health and Care Excellence (NICE) explains what care you can expect to receive if you have GAD.

This information was produced by the Royal College of Psychiatrists’ Public Engagement Editorial Board (PEEB). It reflects the best available evidence at the time of writing.

Expert authors: Professor David Veale and Professor David Nutt

Full references for this resource are available on request.