The Issue of Generalized Anxiety Disorder

I made the decision to research and write about Generalized Anxiety Disorder (GAD) because I have people close to me that could be affected by this in a rather mild way. I wanted to gain a better understanding about the causes, treatments, and also just generally how to improve the quality of life for someone who suffers from GAD. As seen in its name, GAD in more generalized, and it is so in the sense that it is not linked to 1 specific thing such as a phobia might be. This generalization I believe has a higher detrimental effect on the patient then someone who may suffer from a phobia, such as a phobia of heights. If you have a specific phobia, you can either avoid the thing that causes you fear or you can have a treatment that can take a specific track in order to really examine that single fear and how to overcome it.

Generalized Anxiety Disorder is characterized as “Excessive, ongoing anxiety and worry that are difficult to control and interfere with day-to-day activities” (Mayo Clinic Staff). GAD makes the sufferer have an over the top stress response to minor problems that arise or an over the top stress response to nothing in particular. The sufferer may find it hard to relax and experience difficulty dealing with any situation that they feel uncertain about. It also leads to overthinking in situations that may be seemingly simple. There is also an aspect of GAD that can make the sufferer feel threatened in situations where they otherwise should not feel that way. An accumulation of these symptoms can cause irritability and an inability to sleep along with feeling tired all the time.

There is also a possibility of a psychical response to GAD. These psychical symptoms can include “Racing Heart, dry mouth, upset stomach, muscle tension, sweating, trembling, and irritability” (Harvard Health Publishing, Harvard Medical School, Published June 2011). These psychical symptoms have a somatic relationship with the psychological effects of GAD. One thing that has been shown is that GAD is almost twice as prevalent in women then it is in men. The risk for developing GAD appears to be highest in late adolescence to middle adulthood but can appear at any time. According to the Anxiety and Depression Association of America, “GAD is diagnosed when a person finds it difficult to control worry on more days than not for at least six months and has three or more symptoms”. The combinations of the psychological effects along with the physical symptoms make GAD a very disruptive and possibly debilitating mental health issue.

From a biological perspective, a higher likelihood of developing GAD has been found in those that have family members that suffer from it. Although it has yet to be determined why some family members will develop the disorder while others will not. A major biological consideration is the fight or flight response. Those suffering from GAD could have an unbalanced fight or flight response, and that stress reaction is a contributing factor in both what they think, and the somatic relationship that causes the physical symptoms. Another biological consideration is a possible imbalance in the hormones produced by the brain and the possibility of an over sensitive amygdala.

From a Sociocultural perspective, GAD can present a major problem. First of all, we as a society look at those with any mental health issue differently. People with GAD can experience others having a lack of confidence in them. They can also experience others possibly viewing them as a burden due to being hindered in their day to day life by their anxiety. On the other side, those with GAD might find it more difficult to interact with people. Social anxiety is one symptom with GAD that can be very prevalent. It can stop the sufferer from going out with friends or engaging in social functions that an otherwise healthy adult would participate in. This can lead to further depression and anxiety further perpetuating the cycle of negative thoughts and feelings.

The treatment modality I would choose to treat GAD is Cognitive Behavioral therapy. CBT has been used extensively for the treatment of GAD as well as a host of other disorders, such as Post Traumatic Stress Disorder, and has been shown to be as effective if not more effective the drug based treatment both in the short term sense as well as in the long term. Cognitive Behavioral Therapy try’s to alter the unhealthy and unhelpful thoughts that people have creep in to their minds. It works to help people recognized their unhealthy habits and reactions they have to their thoughts and feelings. According to the American Psychological Association, CBT operates on the following core principles. “1. Psychological problems are based, in part, on faulty or unhelpful ways of thinking, 2. Psychological problems are based, in part, on learned patterns of unhelpful behavior, 3. People suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives”. (APA Staff 2018)

CBT wants the patient to recognize distortions in their thought patterns and work to find solutions to bring about meaningful change. Instead of letting a thought come in to their head and letting that thought then effect how they react, CBT works to have the patient stop, recognize that thought is occurring, and then address that thought. CBT also works to have patients recognize destructive patterns in their behavior and work to correct those patterns. This is where CBT works to instill problem solving skills. The techniques one can use in order to work through the problems that arise in their head is just one aspect of what makes CBT effective. This is an example of when CBT can be a useful tool to help someone who uses alcohol or tobacco to help with stress. CBT helps the person recognize that in response to their stress, they reach for those vises which wind up just hurting them more.

This comes in to play with Generalized Anxiety Disorder in several ways. First of all, the recognition of unhealthy and unhelpful thoughts is something that can greatly help someone with GAD. Being able to stop and realize the fact the patient is over analyzing a situation and that over analysis is causing a great amount of stress and pain, it huge steps in being able to face what’s wrong and find meaningful solutions to fix those thought patterns. Another situation is the patient’s reaction to those stress patterns. For example, if a patient who suffers from GAD begins to experience a high level of fear and anxiety about a social function that they are supposed to attend, they might shut down and refuse to leave the house. This can be one of the more crippling effects of GAD, social situations can be a huge stressor for anyone suffering from any of anxiety disorders. Utilizing CBT, a person suffering from GAD may be able to recognize the reaction they are having to their feelings and be able to work through their issues in a way that they have learned through CBT and be able to overcome their initial reaction.

There are other aspects of CBT that can help with GAD. Gaining confidences in your own abilities is something I believe a GAD sufferer can come to benefit from greatly. I believe that one of many roots that can cause great anxiety is no being in control or not understanding what might happen with a situation. This to me is more of a confidence issue then some might make it out to be. If someone can develop confidence in themselves, when those thoughts of anxiety flood their head they can use that confidence to talk themselves back down and know in their minds that they are in control and everything will be ok. A lack of confidence can be crippling when it comes to dealing with one’s anxiety issues. Furthermore, According to the American Psychological Association “CBT treatment also usually involves efforts to change behavioral patterns”, these include “Facing one’s fears instead of avoiding them, using role playing to prepare for potentially problematic interactions with others, learning to calm one’s mind and relax one’s body.” (APA Staff 2018)

Facing ones fears instead of avoiding them is a huge step towards being able to correct ones unhealthy thoughts and feelings, especially when it comes to anxiety disorders. One must be able to take a good hard look at themselves in order to fix what ails them. Anxiety tends to make one retreat back to a place in their mind that makes them feel safe. The sufferer must be able to stop themselves from going to that place and instead face what they know scares them. Using role playing to prepare for potentially problematic interactions can really help someone work through social situations. The anxiety that stops someone from going in to social situations is what needs to be overcome.

Gaining confidence in oneself by going through the role playing process can do wonders in terms of bringing the anxiety level down by showing the patient that they can get through whatever is thrown their way. Seeing how social anxiety can be a crippling effect of GAD, this role playing process can be a very important aspect of CBT that can really help the patient. With a lot of things in life, practice can make perfect. Furthermore, the more someone does something the more comfortable that person becomes with it. Repeated exposure to something that can cause great anxiety can help teach someone the best way to deal with it. If someone always avoids something they are not good at, like how to act in a social situation, then they will never develop the skills necessary to ever do it.

Lastly, learning to calm one’s mind and relax one’s body can have huge benefits for overall wellness for a sufferer of GAD. This goes back to the benefits found in Somatic Psychology. Being able to have the mind and body work in unison in order to bring someone’s overall well-being to a place where it needs to be is one of the major goals of CBT. If a person can master how to relax the mind or the body then they have developed the ground work to being able to gain overall mindfulness which is something that GAD can really steal from someone.

CBT really focuses not on specific events in someone’s life that is causing them stress, but more the negative feelings someone will associate with those events. CBT really has the patient become their own psychiatrist, examining their own feelings and find ways to curb those negative reactions. GAD is really all about negative reactions to situations the person finds stressful. CBT can be an incredible useful tool to use to make the person examine why they have those negative feelings to certain situations, and really help to develop a strategy in order to deal with them.

I think a good field of study to use to really dive in to Generalized Anxiety Disorder is Biological and Somatic Psychology. I believe that a big part of GAD is how the mind and the body interact and create a toxic and stressful environment within itself. The mind over reacting to what it perceives as a stressful situation has a direct negative effect on the body and the hormones that are released over and over again can over time have a very negative side effect. However, this body-mind interface can also be utilized as an effective tool in order to combat GAD.

In Dr. Robert Sapolsky’s YouTube lecture “1. Introduction to Human Behavioral Biology”, he is explain the 2 main themes of his class which in this case is Bio 150 at Stanford University. He says “Sometimes the stuff going on in your body can dramatically influence what goes on in your brain”, he then later goes on to say “Sometimes what’s going on in your head will affect every single outpost in your body”. Those major themes of human biology can help us understand some of the effects of GAD. When you look at the hormones that cause the fight or flight response in the body, those stress hormones interact with both the mind and the body to achieve the goal of protecting the person. So a biological psychologist would see GAD as an issue encompassing the entire body and not just as a mental disorder.

The understanding gained by using Biological Psychology can help fuel how we might treat someone using the concepts in Somatic Psychology and it all goes back to stress and how we can mitigate stress and anxiety through both mental health practices along with physical intervention. We already have the understanding of one way to help a person from a psychotherapeutic perspective, in this cause Cognitive Behavioral Therapy, but Somatic Psychology shows us that we can also do things such as exercise or breathing techniques. The CBT helps the patient learn problem solving techniques and coping skills for when they are facing an anxiety inducing situation , but we can use things like exercise and breathing techniques to really bring the heart rate down which will have a profound effect on the stress response that makes GAD so crippling.

It has been shown that an activity such as lifting weights can positively effects the bodies regulations of emotion and hormones. Depression, which is a very common occurrences in those that suffer with GAD and can at times be one of the root causes of GAD, has been shown to be reduced greatly in those who spend some time each day engaging in physical activity. 30 minutes of exercise 3 to 5 days a week can have a very positive effect on both physical and mental health. Also, the breathing technique of in for 4 seconds, hold for 4 seconds, out for 4 seconds, hold for 4 seconds, and repeat has been shown to lower a person’s heart rate and instill a feeling of calm in to them.

Another theme within Somatic Psychology that can be used to at least understand what is going on inside the body can be found in chapter 3 of the book “The Body Remembers” by Babette Rothschild (2000). In part of the chapter, the Sympathetic nervous system and the parasympathetic nervous system, which are both part of the automatic nervous system, are discussed. The book is taking an in-depth view at the systems as to how they relate to PTSD but does show what is going on in the mind of someone experiencing a stress response, which is exactly what GAD is doing.

The Sympathetic nervous system is aroused in times of stress, including during times of rage, desperation, terror, and anxiety. This is the system that is responsible for your fight or flight response and what contributes to the release of the hormones. The parasympathetic nervous system is activated during times of rest and relaxation. It is what brings the sympathetic nervous system back down and brings the body back in to a state of homeostasis, which the state that the body is always trying to stay in. In someone suffering from GAD, they experience an activation of the Sympathetic Nervous system more often than someone should. Sympatric Nervous System activation is accompanied by a faster heartbeat, faster respirations, in increase in blood pressure, increased sweating, and so on. This makes the parasympathetic nervous system try and work overtime to try and get the body back in to homeostasis. This is just one way of understanding the constant battle that is going on with in the mind and hormone levels of a person suffering from Generalized Anxiety Disorder.

Generalized Anxiety disorder can be crippling. The constant back and forth state of being hyped up and then trying to bring yourself back down can be exhausting. Millions of people are affected by either GAD or other forms of anxiety and stress disorders and everyday people are trying to find the best way to treat these conditions. Through my research, I believe the best course of action for most sufferers is to use Cognitive Behavioral Therapy combined with techniques found in Biological and Somatic psychology. I believe CBT sessions combined with physical activity and learning breathing techniques can go a long way in improving someone’s quality of life.

Works Cited

1. American Psychological Association. (2018). Cognitive Behavioral Therapy.
2. Anxiety and Depression Association of America. (n.d.). Generalized Anxiety Disorder (GAD).
3. Harvard Health Publishing, Harvard Medical School. (2011). Generalized anxiety disorder. https://www.health.harvard.edu/staying-healthy/generalized-anxiety-disorder
4. Mayo Clinic Staff. (2020). Generalized anxiety disorder. https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/symptoms-causes/syc-20360803
5. National Institute of Mental Health. (2020). Generalized Anxiety Disorder. https://www.nimh.nih.gov/health/topics/generalized-anxiety-disorder-gad/index.shtml
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