Generalised Anxiety Disorder:

What you should know

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Anxiety is a normal (and common) feeling that most of us experience at

some time in our daily lives. The reasons for anxiety can vary from job-

related anxiety to that related to health, family or financial matters. However,

the majority of the time, these feelings are manageable and eventually they

subside as the body’s natural tendency to reduce its stress levels takes over and

the situations seem less catastrophic than once thought.

However, for some people, anxiety becomes a major negative contributor

to life – anxiety that may exist for no apparent reason, is unmanageable,

and may cause extreme distress. This is known as Generalised Anxiety

Disorder. It is a recognised medical condition – with a number of characteristic

symptoms – and importantly, it can be treated. If you suffer from Generalised

Anxiety Disorder, you understand first-hand its debilitating effects on your life.

This booklet contains information about Generalised Anxiety Disorder

and its treatment, and the positive steps you can take to seek help. It is a

resource designed to help you, your family and friends to understand your illness.

Knowing more about the disorder will enable you to get the most

out of your treatment.

Introduction

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The Cambridge Dictionary Online defines anxiety as “an uncomfortable feeling

of nervousness or worry about something that is happening or might happen

in the future”.

Most of us have at one time or another, experienced this feeling of worry and

unease, which may occur for any number of reasons – such as a major project

deadline, anticipation of speaking in public, or before a job interview, important

meeting or examination. Anxiety is what you feel when walking along a poorly

lit street at night, or if a child suddenly steps onto the road without looking.

We can become anxious about the health of a family member, about financial

obligations, or numerous other situations in our day-to-day lives.

Typically, the experience of anxiety is the body’s normal reaction to a challenging

situation. It keeps us alert in times of crisis or demand. The body may respond

with accelerated heartbeats, sweating or a flushed face, which may take some

time to subside even after the event that caused the anxiety has passed. These

reactions are normal and most of us have experienced this in some manner

during our lives.

Is there such a thing as “normal anxiety”?

In short – yes. When harnessed properly, anxiety can lead to a positive

experience or outcome.

For example:

• prior to a major event, an athlete may use his or her nervousness to

advantage, by training harder and using the “nerves” to kick-start a

better performance

• the anxious feeling before a job interview or examination may lead to better

preparation, and therefore, a better result

• anxiety about health may lead to positive steps towards a more healthy life

– say by improving diet or doing more exercise

• in a more immediate situation such as walking along a dimly lit street at

night, the feeling of anxiety helps keep you alert to the surroundings and

more vigilant of your safety.

These are just some examples of how and why the normal experience of anxiety

when managed well, can be a positive experience.

Is anxiety useful?

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If anxiety is normal and even useful, it begs the question: when does anxiety

become a problem? In some people, the feeling of anxiety is heightened and

pervades all aspects of their lives. This extreme anxiety may occur for a very

minor or no apparent reason or, if there is a reason, the intensity of the feeling

is far greater than is normal for the type of situation.

When the extreme anxiety becomes a significant part of daily life, seems

uncontrollable or even catastrophic, and begins to hinder the ability to

work or lead a healthy life – this is a problem. In medical terms this is known

as an anxiety disorder, which can take many different forms (see below).

Anxiety as a problem

Generalised Anxiety Disorder is a medical condition that typically involves

excessive and chronic anxiety and worry about a number of events or activities.

The anxiety occurs over a long period of time (more than 6 months) and is

difficult to control. In people who suffer Generalised Anxiety Disorder, the

anxiety and worry is linked to three or more of the following symptoms:

• restlessness or feeling wound up or on edge

• becoming fatigued easily and lacking energy

• difficulty concentrating or the mind going blank

• irritability

• muscle tension

• sleep disturbance – difficulty falling asleep or experiencing interrupted,

fitful sleep

Some people may experience additional symptoms such as:

• nausea, vomiting or abdominal discomfort (feelings of emptiness, butterflies

in the stomach, gas pains, diarrhoea)

• perspiring excessively

• dry mouth

• increase in heart rate

• shallow breathing (or rapid breathing)

• trembling

Generalised Anxiety Disorder often coexists with some form of depression.

The symptoms and the feelings of overwhelming anxiety and worry almost

always cause significant distress and have a strong negative impact on a

person’s emotional health, relationships, work, or leisure activities.

What is Generalised Anxiety Disorder?

Generalised Anxiety Disorder

An excessive and persistent worry or anxiety that does not fit the person’s life circumstance.

Social Anxiety Disorder

An extreme fear of humiliation or embarrassment in social or performance situations and the avoidance of these situations.

Agoraphobia

Anxiety about being in places or situations such as in a crowd or in open spaces, outside the home, from which escape or egress is feared to be impossible. The situation is avoided or endured with marked distress, sometimes including the fear of having a panic attack.

Panic Disorder

Unexpected, spontaneous and recurrent panic attacks, accompanied by the fear of future attacks and avoidance of situations that are thought to have triggered a previous attack.

Obsessive-Compulsive Disorder

Repetitive, intrusive or distressing thoughts, images or impulses (obsessions), and repetitive behaviours that a person feels driven to perform (compulsions).

Post-traumatic Stress Disorder

Specific symptoms of stress and/or anxiety that are precipitated by exposure to a traumatic event that causes intense fear, helplessness or horror.

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The exact cause of Generalised Anxiety Disorder is unknown. Some studies

indicate that a person’s vulnerability to developing Generalised Anxiety Disorder

may be (at least in part) genetic. However, not every person who possesses

genetic risk factors will develop the condition. Studies also suggest that

Generalised Anxiety Disorder develops when genetic risk factors are accompanied

by unique and family-related environmental factors.

While stress has not been implicated as the cause of Generalised Anxiety

Disorder, the apprehension and worry may worsen during times of stress.

If you suffer from Generalised Anxiety Disorder, you are certainly not alone.

It is one of the most common anxiety disorders, which reportedly affects up to

5% of the population at any given time.

Excessive and chronic anxiety can be extremely distressing and debilitating

often also for family members and friends. Over time the anxiety and worry

worsens, and hinders the ability to lead an active and fulfilling life. Work and

family relationships begin to suffer and you may find that it is increasingly

difficult to enjoy your leisure time.

While the situation at times may seem hopeless – it is not. Generalised

Anxiety Disorder is a medical condition that is better understood now than

ever before. It can be treated, and there are a number of resources available

to help you.

Some people feel ashamed of their over-anxious disposition. However, it is

important to regain perspective and recognise that what you have is a medically

defined illness – just as you wouldn’t look down upon a person with, say, asthma,

or diabetes, why should you be so hard on yourself? Everyone deserves the

best help available for any medical condition and to be provided with the tools

to try and live a healthy and active life.

Good mental health is the key to good physical health and also determines

your ability to work and interact with others. Seeking help is the first step in the

treatment strategy for Generalised Anxiety Disorder.

What causes Generalised Anxiety Disorder?

Seeking help for Generalised Anxiety Disorder

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Two important questions regarding Generalised Anxiety Disorder are:

• what types of treatments are available and

• who should I ask for help?

There are a number of approaches to treatment (often used in combination) and

also a variety of professionals and other people that may be able to help you.

Treatment options for Generalised Anxiety Disorder include:

• medications

• psychotherapy

• self-help techniques

Generally, pharmacological agents (ie, medications) are used along with

psychotherapy in the treatment of Generalised Anxiety Disorder.

Who can help

• GP

• Psychologist

• Counsellor

• Family and friends

Your GP should be the first point of contact. He or she will determine the

type of treatment appropriate for you and may recommend other healthcare

professionals as needed.

Several types of drugs are available for the treatment of Generalised Anxiety

Disorder. These include antidepressants and others. After careful consideration

of your symptoms, medical history, family history, current state of health,

other medications you’re taking, any allergies you may have, your doctor

will choose the treatment that best suits you, and the duration of therapy

that is appropriate.

Remember to follow your doctor’s instructions carefully. Most drugs will not

show an immediate effect and may need to be taken for weeks or months to

get the best results. To get the most out of your treatment, it is important to

discuss your expectations with your doctor. He or she will be able to inform you

realistically about the treatment and clarify any myths and misconceptions.

All medications have the potential to cause side effects. The experience of

side effects may vary based on the individual and the medication. If you have

any concerns, discuss these with your doctor and report any side effects that

you may encounter.

Finally, the treatment strategy for Generalised Anxiety Disorder is multi-

dimensional. Medications are rarely used in isolation. Drug treatments need

to be combined with psychotherapy to achieve best outcomes.

Treating Generalised Anxiety Disorder

Medications for Generalised Anxiety Disorder

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Psychotherapy is an important part of the treatment strategy for Generalised

Anxiety Disorder. It falls under two broad categories, (a) professional counselling

and (b) cognitive behavioural therapy.

Professional counselling

Counselling (conducted by a trained psychologist or counsellor) may be useful

to help explore the environmental (eg, family, etc) issues that may have

contributed to your condition or impact on your anxiety. Counselling provides

the opportunity to talk to a trained professional about your problems, and

receive objective guidance and support.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a type of psychotherapy. Research

has shown that this is an effective and useful strategy for the treatment

of Generalised Anxiety Disorder. CBT should be conducted by a qualified

psychologist.

CBT equips you with three types of skills:

• coping skills for your anxiety

• cognitive restructuring skills (to enable you to identify and ‘restructure’ the

catastrophic thoughts associated with Generalised Anxiety Disorder)

• behavioural skills (use of imagery to examine the worst-case scenario for

your anxiety and the opportunity to also imagine the alternatives).

Relaxation training helps relieve some of the physical symptoms such as muscle

tension, restlessness, etc. Cognitive restructuring is a tool that assists with

“clear thinking” – it allows you to restructure your thought processes when they

become catastrophic. Finally, behavioural skills learned in CBT are designed to

help you desensitise to the worst-case scenario and to visualise more moderate

alternatives – thereby reducing the level of distress associated with your anxiety.

Alongside your healthcare team, there are positive steps that you can take to

manage your persistent anxiety. Most anxiety-reducing self-help techniques

involve calming the body and the mind. Some of these (eg, yoga, meditation

and Tai Chi) originated in ancient times in Eastern cultures and are now

increasingly being recognised in the Western world as beneficial to overall

health and wellbeing.

Relaxation

Self-relaxation techniques can be learned through classes, or performed via the

help of guided relaxation tapes. Consciously relaxing the body and mind helps to

relax muscles and release tension from the body. This in turn calms the mind and

reduces mental worry and tension.

Meditation

This is a process of mental quietness and contemplation that may help to

achieve a sense of calmness and mental poise. Find a reputable practitioner

with whom you can practice guided meditation or use a guided meditation

tape at home.

Yoga

Originating many thousands of years ago in India, yoga has now found a

firm place in the Western world. Yoga teaches you to focus on strengthening

and stretching your body, strengthening the breath through deep breathing

techniques, calming the mind through meditation. You may find that this helps

alleviate symptoms such as fatigue, muscle tension, shortness of breath, etc.

Tai Chi

The benefits of this ancient Chinese practice are increasingly being recognised in

the West. Tai Chi involves slow, deliberate, dance-like movements that develop

strength and mental focus. Benefits include strengthening and mobilising joints

and muscles, and calming the breath.

Psychotherapy for Generalised Anxiety Disorder

Self-help techniques for Generalised Anxiety Disorder

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Your GP, after excluding other physical causes for your symptoms (eg, thyroid

problems), may make an initial diagnosis and may start treatment with

a medication for your anxiety. Alternatively, your GP may refer you to a

psychiatrist for the initial diagnosis and treatment. If medication is to be used,

the choice of drug will be influenced by a number of factors, including your

symptoms, medical and family history, allergies, concurrent medical conditions

or medications, and your wishes.

It is important to take your medication as instructed by your doctor and to

discuss with him or her any concerns about your illness or its treatment.

Your doctor needs to be fully informed of your needs and concerns for you

both to be able to make a genuinely collaborative decision about the best

treatment option for you.

Most likely, your GP will refer you to other healthcare professionals such as a

psychiatrist or psychologist, or a trained counsellor. These professionals can help

in different ways to address the core issues surrounding your anxiety and equip

you with the skills and techniques to combat your anxiety symptoms.

Your GP will want to see you regularly throughout your treatment. These

consultations provide an opportunity to:

• discuss how you are feeling and your response to treatment

• air any concerns regarding your condition or medication, including

any side-effects

• consider whether you require any changes to treatment

• discuss any other issues or concerns including aspects of your life that may

be influencing your response to treatment.

A psychologist is a trained healthcare professional specialising in psychotherapy

for mental health conditions. Psychotherapy used alongside pharmacological

treatments is an important part of the treatment for Generalised Anxiety Disorder.

A psychologist may provide counselling – where you explore and deal with the

issues (such as past trauma or family history) that may have contributed to your

condition. Additionally, a psychologist may initiate CBT (cognitive behavioural

therapy – see page 10) to teach you the coping, cognitive and behavioural skills

required to fight morbid anxiety.

It is important to attend your sessions regularly and to discuss openly all aspects

of your history and illness with your psychologist. You may find that you receive

‘homework’ – ie, exercises that you can practice at home to readjust your

thinking and behaviour. Make every effort to practice these exercises diligently

and to use the techniques you have learned whenever anxiety grips you.

Your commitment to the therapy may be a key determinant in your long-term

health and wellbeing.

What your GP can do What a psychologist can do

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You may choose to see a professional counsellor (ie, someone with a qualification

in counselling), or sometimes, people may turn to their minister, pastor, religious or

spiritual advisor for some preliminary counselling. Alternatively, your psychologist

may be able to provide counselling along with CBT.

Counselling can help identify some of the reasons for your anxiety and will likely

help your recovery and reduce the chance of your condition deteriorating. It

helps to talk to a professional about your thoughts, feelings and concerns and to

deal with any grief or trauma that you may have suffered previously.

Contrary to what some people believe, counselling is not a “soft option”.

It takes courage to seek help and to admit your feelings or relive past trauma.

Many people find that they feel better after having discussed these things.

If you are seeing a counsellor, attend your sessions regularly so you can work

through your experiences with him or her and begin the road to recovery.

Your GP may refer you to a psychiatrist for a thorough evaluation of your

symptoms and to confirm the diagnosis of Generalised Anxiety Disorder. Don’t

be alarmed if you receive a referral to a psychiatrist. He or she is a doctor who

specialises in treating mental health conditions – just as a cardiologist specialises

in problems associated with the heart.

The psychiatrist will need to know about all your symptoms and feelings

and the length of time over which they’ve occurred. Also, he or she will take

a thorough medical and family history, and will use all the information

you provide to arrive at a diagnosis of Generalised Anxiety Disorder (with or

without depression). In consultation with you, the psychiatrist may prescribe

the medication that he or she determines is appropriate for you. Sometimes,

your psychiatrist may provide CBT or counselling as part of your therapy.

Don’t be afraid to discuss with the psychiatrist your needs or concerns

regarding your illness or treatment. You may need to return to the psychiatrist

for regular visits, or alternatively your GP and psychiatrist may share

responsibility for your management.

What your counsellor can do What your psychiatrist can do

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As debilitating as your anxiety is for you, it also can be extremely distressing for

your family and friends. They may not understand your feelings and may think

that you are simply being unreasonable or “overly dramatic”. It is confusing and

distressing for them to see someone they care about become irritable or restless,

or show little interest in activities that you used to enjoy. If they do not realise

you are ill, they may feel hurt or rejected when you refuse their invitations to

participate in social activities.

Your family and friends need to understand that Generalised Anxiety Disorder is

an illness. It is a complex condition that may need different modes of treatment

to help with recovery. They also need to be aware that it may take some time

before you feel well, and contrary to popular belief, you cannot simply “snap out

of” the feelings of overwhelming anxiety. Their support and understanding will be

an immense help while you are receiving treatment.

If they are having difficulty understanding your condition or want to learn more,

you may want to take a family member or close friend to the GP with you. They

can then help by reminding you to take your medication and encouraging you

to attend counselling sessions. Also, friends or family members may be able

recommend reputable teachers for meditation/yoga/Tai Chi, etc.

As you begin to feel better, you may feel like socialising again – but your friends

should realise that you will need to do things gradually, and should not feel hurt

if you decline some of their invitations. They will understand this better if you

talk to them openly about your progress and the way you feel.

You may find it helpful to join an anxiety support group to talk to others who

are in a similar situation – either those who currently suffer from Generalised

Anxiety Disorder, or those that have recovered from the condition. It can be

reassuring to know that you are not alone and it is an opportunity to exchange

ideas about techniques that can help you to feel better.

Your GP, psychologist or counsellor may be able to provide information about

support groups in your local area.

If you have access to the Internet, you will find there are a number of websites

dedicated to Generalised Anxiety Disorder. Some of these have been developed

by people with anxiety disorders. These may be useful for information about your

illness and hints on how to manage it.

However, not all data from the Internet is reliable – discuss what you may find

with your GP or your counsellor.

What your family and friends can do Patient support groups

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Use this page to list useful addresses and telephone numbers – eg, your

GP, counsellor or support group. You may also want to include reputable

Internet addresses.

Name ..................................................................................................................................................................................................................

Contact details ........................................................................................................................................................................................

Name ..................................................................................................................................................................................................................

Contact details ........................................................................................................................................................................................

Name ..................................................................................................................................................................................................................

Contact details ........................................................................................................................................................................................

Name ..................................................................................................................................................................................................................

Contact details ........................................................................................................................................................................................

Name ..................................................................................................................................................................................................................

Contact details ........................................................................................................................................................................................

Anxiety Australia www.anxietyaustralia.com.au

HealthInsite www.healthinsite.gov.au

Serenity NSW www.serenitynsw.com.au

Anxiety Self Help Association

of Western Australia www.cnswa.com/asha

Useful contacts Additional resources

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Please use the space below to note any questions or comments you may have

for your GP, psychologist or counsellor about your illness or the treatment that

has been prescribed.

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Personal notes

This patient information leaflet is published with the support of The Lundbeck Institute, Taastrup, Denmark.

Lundbeck would like to thank Doctor Sean Hood for his valuable comments on this booklet.

©2006 Lundbeck. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form by any means, electronic, mechanical, photocopying, recording or otherwise without written permission from Lundbeck.

June 2006

This medical information booklet has been prepared by

Lundbeck Australia Pty Ltd

ABN 86 070 094 290

Ground Floor, 1 Innovation Road

North Ryde NSW 2113

Ph: 1800 025 554 Fax: 02 9836 1755

Med Info: 1300 721 277

LUN

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