Anxiety

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Introduction

Introduction

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe.

Everyone has feelings of anxiety at some point in their life - for example, you may feel worried and anxious about sitting an exam, or having a medical test or job interview. During times like these, feeling anxious can be perfectly normal.

However, some people find it hard to control their worries. Their feelings of anxiety are more constant and can often affect their daily lives.

Anxiety is the main symptom of several conditions, including:

However, the information in this section is about a specific condition called generalised anxiety disorder (GAD).

GAD is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event. 

People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue.

GAD can cause both psychological (mental) and physical symptoms. These vary from person to person, but can include:

Read about the symptoms of GAD.

When to see your GP

Although feelings of anxiety at certain times are completely normal, see your GP if anxiety is affecting your daily life or causing you distress.

Your GP will ask about your symptoms and your worries, fears and emotions to find out if you could have GAD.

Read more about diagnosing GAD.

What causes GAD?

The exact cause of GAD isn't fully understood, although it's likely that a combination of several factors plays a role. Research has suggested that these may include:

  • overactivity in areas of the brain involved in emotions and behaviour
  • an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood
  • the genes you inherit from your parents - you're estimated to be five times more likely to develop GAD if you have a close relative with the condition
  • having a history of stressful or traumatic experiences, such as domestic violence, child abuse or bullying
  • having a painful long-term health condition, such as arthritis
  • having a history of drug or alcohol misuse

However, many people develop GAD for no apparent reason.

Who is affected?

GAD is a common condition, estimated to affect up to 5% of the UK population.

Slightly more women are affected than men, and the condition is more common in people from the ages of 35 to 59.

How GAD is treated

GAD can have a significant effect on your daily life, but several different treatments are available that can ease your symptoms. These include:

There are also many things you can do yourself to help reduce your anxiety, such as: 

  • going on a self-help course
  • exercising regularly
  • stopping smoking
  • cutting down on the amount of alcohol and caffeine you drink

Read how stopping smoking can improve your anxiety.

With treatment, many people are able to control their anxiety levels. However, some treatments may need to be continued for a long time and there may be periods when your symptoms worsen.

Read more about:

Symptoms of generalised anxiety disorder

Symptoms of generalised anxiety disorder

Generalised anxiety disorder (GAD) can affect you both physically and mentally.

How severe the symptoms are varies from person to person. Some people have only one or two symptoms, while others have many more.

You should see your GP if anxiety is affecting your daily life or is causing you distress.

Psychological symptoms of GAD

GAD can cause a change in your behaviour and the way you think and feel about things, resulting in symptoms such as:

  • restlessness
  • a sense of dread
  • feeling constantly "on edge"
  • difficulty concentrating
  • irritability

Your symptoms may cause you to withdraw from social contact (seeing your family and friends) to avoid feelings of worry and dread.

You may also find going to work difficult and stressful, and may take time off sick. These actions can make you worry even more about yourself and increase your lack of self-esteem.

Physical symptoms of GAD

GAD can also have a number of physical symptoms, including:

Anxiety triggers

If you're anxious because of a specific phobia or because of panic disorder, you'll usually know what the cause is.

For example, if you have claustrophobia (fear of confined spaces), you know that being confined in a small space will trigger your anxiety.

However, if you have GAD, it may not always be clear what you're feeling anxious about. Not knowing what triggers your anxiety can intensify it and you may start to worry that there's no solution.

Diagnosing generalised anxiety disorder

Diagnosing generalised anxiety disorder

See your GP if anxiety is affecting your daily life or is causing you distress.

Generalised anxiety disorder (GAD) can be difficult to diagnose. In some cases, it can also be difficult to distinguish from other mental health conditions, such as depression.

You may have GAD if:

  • your worrying significantly affects your daily life, including your job and social life
  • your worries are extremely stressful and upsetting
  • you worry about all sorts of things and have a tendency to think the worst
  • your worrying is uncontrollable
  • you've felt worried nearly every day for at least six months

Talking to your GP about anxiety

Your GP may ask you questions about:

  • any physical or psychological symptoms and how long you've had them
  • your worries, fears and emotions
  • your personal life

You may find it difficult to talk about your feelings, emotions and personal life. However, it's important that your GP understands your symptoms and circumstances, so the correct diagnosis can be made.

You're most likely to be diagnosed with GAD if you've had symptoms for six months or more. Finding it difficult to manage your feelings of anxiety is also an indication that you may have the condition.

To help with the diagnosis, your GP may carry out a physical examination or blood tests to rule out other conditions that may be causing your symptoms, such as:

Treating generalised anxiety disorder

Treating generalised anxiety disorder

Generalised anxiety disorder (GAD) is a long-term condition, but a number of different treatments can help.

Before you begin any form of treatment, your GP should discuss all your treatment options with you. They should outline the pros and cons of each and make sure you're aware of any possible risks or side effects.

With your GP, you can make a decision on the most suitable treatment, taking into account your personal preferences and circumstances.

If you have other problems alongside GAD, such as depression and drug or alcohol misuse, these may need to be treated before having treatment specifically for GAD.

Initial treatment

At first, your GP may suggest trying an individual self-help course for a month or two, to see if it can help you learn to cope with your anxiety.

This usually involves working from a book or computer programme on your own (you'll be given advice before you start), with only occasional contact with your doctor.

Alternatively, you may prefer to go on a group course where you and a few other people with similar problems meet with a therapist every week to learn ways to tackle your anxiety.

See self-help tips for anxiety for more information on these treatments.

If these initial treatments don't help, you'll usually be offered either a more intensive psychological treatment or medication. These are described below.

Psychological treatment

If you've been diagnosed with GAD, you'll usually be advised to try psychological treatment before you're prescribed medication.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is one of the most effective treatments for GAD. Studies of different treatments for GAD have found that the benefits of CBT may last longer than those of medication, but no single treatment is best for everyone.

CBT helps you to understand how your problems, thoughts, feelings and behaviour affect each other. It can also help you to question your negative and anxious thoughts, and do things you would usually avoid because they make you anxious.

CBT usually involves meeting with a specially trained and accredited therapist for a one-hour session every week for three to four months.

Your therapist should carry out CBT in a standardised way according to a treatment manual, and they should receive regular supervision to support them in providing the most effective treatments.

Mindfulness and applied relaxation

Mindfulness and applied relaxation are alternative types of psychological treatment that can be as effective as CBT in treating GAD.

Mindfulness works by focusing your awareness on the present moment and by acknowledging and accepting certain feelings. Being mindful can reduce anxiety caused by the fear of actual situations or sensations, or anticipated ones. It helps to counter the sense of "tunnel vision" that may develop during anxiety. Although mindfulness originates from Buddhism, it doesn't require you to change or take on any religious beliefs.

Applied relaxation focuses on relaxing your muscles in a particular way during situations that usually cause anxiety. The technique needs to be taught by a trained therapist, but generally involves:

  • learning how to relax your muscles
  • learning how to relax your muscles quickly and in response to a trigger, such as the word "relax"
  • practising relaxing your muscles in situations that make you anxious

As with CBT, applied relaxation therapy will usually mean meeting with a therapist for a one-hour session every week for three to four months.

Medication

If the psychological treatments above haven't helped or you would prefer not to try them, you'll usually be offered medication.

Your GP can prescribe a variety of different types of medication to treat GAD. Some medication is designed to be taken on a short-term basis, while other medicines are prescribed for longer periods.

Depending on your symptoms, you may need medicine to treat your physical symptoms, as well as your psychological ones.

If you're considering taking medication for GAD, your GP should discuss the different options with you in detail before you start a course of treatment, including:

  • the different types of medication
  • length of treatment
  • side effects and possible interactions with other medicines

You should also have regular appointments with your doctor to assess your progress when you're taking medication for GAD. These will usually take place every two to four weeks for the first three months, then every three months after that.

Tell your GP if you think you may be experiencing side effects from your medication. They may be able to adjust your dose or prescribe an alternative medication.

The main medications you may be offered to treat GAD are described below.

Selective serotonin reuptake inhibitors (SSRIs)

In most cases, the first medication you'll be offered will be a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). This type of medication works by increasing the level of a chemical called serotonin in your brain.

Examples of SSRIs you may be prescribed include:

SSRIs can be taken on a long-term basis but, as with all antidepressants, they can take several weeks to start working. You'll usually be started on a low dose, which is gradually increased as your body adjusts to the medicine.

Common side effects of SSRIs include:

These side effects should improve over time, although some - such as sexual problems - can persist.

If your medication isn't helping after about two months of treatment, or if it's causing unpleasant side effects, your GP may prescribe an alternative SSRI.

When you and your GP decide it's appropriate for you to stop taking your medication, you'll normally have your dose slowly reduced over the course of a few weeks to reduce the risk of withdrawal effects. Never stop taking your medication unless your GP specifically advises you to.

Serotonin and noradrenaline reuptake inhibitors (SNRIs)

If SSRIs don't help ease your anxiety, you may be prescribed a different type of antidepressant known as a serotonin and noradrenaline reuptake inhibitor (SNRI). This type of medicine increases the amount of serotonin and noradrenaline in your brain.

Examples of SNRIs you may be prescribed include:

Common side effects of SNRIs include: 

  • feeling sick 
  • headaches
  • drowsiness 
  • dizziness 
  • dry mouth 
  • constipation 
  • insomnia 
  • sweating

SNRIs can also increase your blood pressure, so your blood pressure will be monitored regularly during treatment.

As with SSRIs, some of the side effects - such as feeling sick, an upset stomach, problems sleeping and feeling agitated or more anxious - are more common in the first one or two weeks of treatment, but these usually settle as your body adjusts to the medication.

Pregabalin

If SSRIs and SNRIs aren't suitable for you, you may be offered pregabalin. This is a medication known as an anticonvulsant, which is used to treat conditions such as epilepsy. However, it's also been found to be beneficial in treating anxiety.

Side effects of pregabalin can include:

  • drowsiness
  • dizziness
  • increased appetite and weight gain
  • blurred vision
  • headaches
  • dry mouth
  • vertigo

Pregabalin is less likely to cause nausea or a low sex drive than SSRIs or SNRIs.

Benzodiazepines

Benzodiazepines are a type of sedative that may sometimes be used as a short-term treatment during a particularly severe period of anxiety, because they help ease the symptoms within 30 to 90 minutes of taking the medication.

If you're prescribed a benzodiazepine, it will usually be diazepam.

Although benzodiazepines are very effective in treating the symptoms of anxiety, they can't be used for long periods of time because they can become addictive if used for longer than four weeks. Benzodiazepines also start to lose their effectiveness after this time.

For these reasons, you won't usually be prescribed benzodiazepines for any longer than two to four weeks at a time.

Side effects of benzodiazepines can include: 

  • drowsiness
  • difficulty concentrating
  • headaches
  • vertigo
  • tremor (an uncontrollable shake or tremble in part of the body)
  • low sex drive

As drowsiness is a particularly common side effect of benzodiazepines, your ability to drive or operate machinery may be affected by taking this medication. You should avoid these activities during treatment.

Referral to a specialist

If you've tried the treatments mentioned above and have significant symptoms of GAD, you may want to discuss with your GP whether you should be referred to a mental health specialist.

A referral will work differently in different areas of the UK, but you'll usually be referred to your community mental health team. These teams include a range of specialists, including: 

  • psychiatrists
  • psychiatric nurses
  • clinical psychologists
  • occupational therapists
  • social workers

An appropriate mental health specialist from your local team will carry out an overall reassessment of your condition. They'll ask you about your previous treatment and how effective you found it.

They may also ask about things in your life that may be affecting your condition, or how much support you get from family and friends.

Your specialist will then be able to devise a treatment plan for you, which will aim to treat your symptoms.

As part of this plan, you may be offered a treatment you haven't tried before, which might be one of the psychological treatments or medications mentioned above.

Alternatively, you may be offered a combination of a psychological treatment with a medication, or a combination of two different medications.

Self-help treatments for generalised anxiety disorder

Self-help treatments for generalised anxiety disorder

If you have generalised anxiety disorder (GAD), there are many ways to help ease the symptoms of anxiety yourself.

Try a book or online course

When you're diagnosed with GAD, your GP may recommend trying self-help treatments before having more intensive psychological therapy or medication.

This usually involves working from a book or computer programme for around six weeks or longer. In some cases, you may be closely supported by a trained therapist who you'll speak to every week or two. Some treatments only involve minimal or occasional contact with a therapist, who monitors your progress.

There are numerous books and courses that can help you learn to cope with your anxiety, but the National Institute for Health and Care Excellence (NICE) only recommends trying treatments based on the principles of cognitive behavioural therapy (CBT).

CBT is a type of psychological treatment that can help you understand your condition better and how your problems, thoughts, feelings and behaviour affect each other. The aim of CBT-based treatments is to help you learn ways to manage your anxiety by modifying negative or unhelpful thoughts and behaviour.

Read more about self-help therapies for anxiety.

Exercise regularly

Regular exercise, particularly aerobic exercise, may help you combat stress and release tension. It also encourages your brain to release serotonin, which can improve your mood.

Examples of good aerobic exercises include:

  • walking fast or jogging
  • swimming
  • cycling
  • tennis
  • hiking
  • football or rugby
  • aerobics

You should aim to do at least 150 minutes of moderate-intensity exercise a week. Moderate-intensity exercise should raise your heart rate and make you breathe faster.

Read more information and advice about:

Learn to relax

As well as regular exercise, learning how to relax is important.

You may find relaxation and breathing exercises helpful, or you may prefer activities such as yoga or pilates to help you unwind.

You can also try this five-minute audio guide to dealing with anxiety.

Avoid caffeine

Drinking too much caffeine can make you more anxious than normal. This is because caffeine can disrupt your sleep and also speed up your heartbeat. If you're tired, you're less likely to be able to control your anxious feelings.

Avoiding drinks containing caffeine - such as coffee, tea, fizzy drinks and energy drinks - may help to reduce your anxiety levels.

Read more about water, drinks and your health.

Avoid smoking and drinking

Smoking and alcohol have been shown to make anxiety worse. Only drinking alcohol in moderation or stopping smoking may help to reduce your anxiety.

To reduce the risk of harming your health: 

 

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over three days or more if you drink as much as 14 units a week

 

Fourteen units is equivalent to six pints of average-strength beer or 10 small glasses of low-strength wine. 

Read how stopping smoking can reduce your anxiety.

Read more about alcohol units and stopping smoking.

Contact support groups

Support groups can give you advice on how to manage your anxiety. They're also a good way to meet other people with similar experiences.

Examples of support groups you may find useful include:

Support groups can often arrange face-to-face meetings, where you can talk about your difficulties and problems with other people. Many support groups also provide support and guidance over the phone or in writing.

Ask your GP about local support groups for anxiety in your area, or search online for mental health information and support services near you.