Generalized Anxiety Disorder Treatment

Generalized Anxiety Disorder (GAS) is one of the most common anxiety disorders: About 8% of people can be diagnosed with the symptoms of this anxiety syndrome during their lifetime. In addition, more than 90% of those affected have another mental illness, usually an additional anxiety disorder (eg panic disorder) or depression. Many sufferers also suffer from irritable bowel syndrome, so these patients primarily visit a gastroenterologist. After treatment of the irritable bowel syndrome (IBS), however, the symptoms of the anxiety disorder persist or the symptoms only become apparent afterwards.

What is Generalized Anxiety Disorder?

People with generalized anxiety disorder suffer from a constant sense of anxiety and tensionin terms of everyday events and problems. Concerns relate to different areas that other people worry about, such as being seriously ill or having an accident. In people with a generalized anxiety disorder, however, such concerns are much more pronounced than with other people, so that everyday life can be severely impaired. 

It is normal to worry about certain situations: someone who works for a company that is in a bad mood, maybe worries about their job. However, people with generalized anxiety disorder worry excessively, even if there is no particular danger. They also have little or no control over their worries.

The diagnosis of “generalized anxiety disorder” applies when there is at least 6 months of concern and tension regarding everyday events and various physical and psychological symptoms , for example:

  • palpitation
  • sweats
  • Tingling in the stomach
  • dizziness
  • Afraid to go crazy or die
  • Feeling of heat or cold
  • muscle tension
  • difficulty concentrating
  • irritability
  • falling asleep

Those affected often try to avoid triggers for the fears (eg reports of accidents) or try, for example, to reassure their relatives that they are well and that nothing will happen. As relatives often experience the worries as stressful, conflicts can arise.

How Common Are Generalized Anxiety Disorders?

About 5 out of 100 people develop generalized anxiety disorder during their lifetime. Women are about twice as likely to be affected as men. While other anxiety disorders usually occur in adolescence or early adulthood, this is rather rare in generalized anxiety disorders. Generalized anxiety disorders often occur between the ages of 35 and 45 for the first time. 

Are there different shapes or gradients?

Most people who suffer from generalized anxiety disorder also have other mental illnesses. Most common are affective disorders (eg, depression ), other anxiety disorders, and somatoform disorders .

If, in addition to the generalized anxiety disorder, other illnesses occur at the same time, the disorder is more likely to have a chronic course. If left untreated, there is a high risk that it will persist for a long time, with frequent variations in severity: many patients experience periods when they are symptom free, but around half of them recur later Complaints. Many people also spend several years looking for help.

How does a generalized anxiety disorder develop?

There are several causes and explanations for how and why an anxiety disorder can develop:

Influences that one inherits ( genetic influences ) can play a role in the development of fears.

In people with a generalized anxiety disorder, you can detect more activity in certain areas of the brain than other people. Presumably, in people with anxiety disorders, messenger substances in the brain , which provide relaxation, are less present or may have a worse effect.

Some people who develop an anxiety disorder did not have a secure attachment as children to their parents or other close caregivers. They have sometimes experienced the behavior of their close caregivers as unpredictable.

For people with generalized anxiety disorder it is often more difficult to bear than for other people that one has no “absolute safety” (example: in traffic, at work). They are very sensitive to stimuli that could pose a threat . Ambiguous stimuli (ie events that may be harmless or threatening) are more likely to be considered threatening . Sufferers believe that they can not change or control things, which in turn triggers fear.

Many sufferers assume that they can protect themselves through worries of disappointment or avert a misfortune. Behind these positive assumptions about worries lies the idea: Who as a precaution is afraid that something might happen, will not be disappointed, if it really should happen.

How to find out if you have a Generalized Anxiety Disorder?

If the symptoms and signs described here are correct, generalized anxiety disorder may be the reason. Then it is highly recommended to see a doctor or psychotherapist . An anxiety disorder rarely disappears “by itself” again.

In a conversation, a doctor or psychotherapist will ask about the individual complaints, the general state of health, the family history and after physical illnesses and check whether a generalized anxiety disorder exists. Questionnaires help the therapist to assess the severity of the illness and to clarify whether other psychological problems are the cause. A physical examination can clarify if the symptoms – especially the physical symptoms – have physical causes.

Symptoms of generalized anxiety Disorder

Unrealistic, constant anxiety – typical signs of generalized anxiety disorder

The generalized anxiety is not limited to specific situations, but refers to many different aspects in the living environment. Hence the term “generalized”. These are exaggerated, unrealistic, ongoing fears and fears that can not be controlled and shut down.

Worries most often relate to the well-being of the family, financial condition, professional success and health. These widespread fears and worries are accompanied by a heightened level of anxiety, which, with constant tension and restlessness, leads to a permanently stressed person. This constant stress has physical consequences: nervousness, headache, insomnia, muscle tension, chronic pain and other symptoms.

Frequent worries and fears

Family members or other relatives (less one yourself) could

  • Injury or ill
  • Be unemployed, get money worries
  • School, study, education did not succeed
  • Not up to the job, have no professional success
  • Get problems in the partnership

Common symptoms

  • Restlessness, “always on the go”
  • Nervousness, irritability
  • Slight fatigue
  • Concentration disorders, “emptiness in the head”, forgetfulness
  • Muscle tension, tremors, “wobbly on the legs”
  • sleep disorders
  • Inability to relax
  • Tension headache

Other symptoms may be added (see the main symptom of anxiety ).


  • Constant demands from relatives who feel bothered.
  • Long-term stress among those affected leads to physical and mental complaints.
  • Increased risk of compulsive disorder and depression.
  • Increased risk of alcohol, drug and drug addiction.

Causes of generalized anxiety Disorder

How generalized anxiety arises and is sustained

A generalized anxiety disorder can have many different causes and triggers including heredity, upbringing, stressful life events, separation anxiety in childhood, changes in the brain. The affected people mentally go through all sorts of disasters without ever finding a solution to avoid these disasters. They are unable to suppress this spiral of thought and worry. They overestimate the probability of danger.

The symptoms usually appear initially in a weaker form already in childhood or adolescence and amplified over time. A first appearance in adulthood is rare. In the course of the disease, the symptoms may be stronger or weaker at times, but overall, there is a high tendency to chronification (transition to a permanent state).

How are Generalized Anxiety Disorder Treated?

As a treatment for generalized anxiety disorder psychotherapy or drugs – especially so-called selective serotonin reuptake inhibitors (SSRI), selective serotonin norepinephrine reuptake inhibitors (SNRI) or the active ingredient pregabalin – in question. The aim of both treatments is to reduce anxiety to a tolerable level. Although so-

called benzodiazepines (medications that calm down quickly) can help in the short term, they should only be prescribed in absolute exceptional cases, as they can make them dependent – unlike the other drugs.

Through psychotherapy, sufferers can learn to deal with their worries and to reduce the accompanying physical and mental discomfort (eg through relaxation techniques) , so that they are no longer so distressing. The best-studied and long-term effective method is cognitive behavioral therapy .

If a patient prefers to be treated with a psychodynamic psychotherapy procedure or the behavioral therapy has not worked, these procedures can also be used. However, they have so far been less well-studied for generalized anxiety disorder than behavioral therapy.

Treatment options for generalized anxiety disorder

A generalized anxiety disorder can determine life and accompanies many people for a long time. But there are different ways to learn how to control fear and return to a normal life. Also, certain medications can help.

People with a generalized anxiety disorder (GAS) are not afraid of very specific things or situations, but are afraid of everything possible. Therefore one speaks also of “generalized” fear. It is psychologically very stressful and also causes various physical symptoms such as dizziness, muscle tension or tachycardia. To be constantly afraid is very exhausting. However, there are several treatments that can reduce anxiety to a tolerable level.

In contrast to other anxiety disorders, generalized anxiety disorder often occurs only in middle adult life. Basically, you can get an anxiety disorder at any age.

What can i do on my own?

Many people with a generalized anxiety disorder do not even get the idea to go to a doctor. They first try to get their fears under control themselves, for example by using books and information from the internet. Some learn relaxation techniques such as progressive muscle relaxation, autogenic training or yoga. The efficacy of such self-management options for anxiety disorders has not been well studied in studies. Relaxation techniques are often used in the context of psychotherapy . How useful they are, if they are used without other aids, you do not know yet.

Some people resort to herbal sedatives such as valerian, lavender or passion petals. These funds have hardly been researched so far by studies. Many people assume that herbal medicines are better tolerated and safer than other medicines. But they can certainly have side effects and partly influence the effect of other drugs.

Self-treatment can make it take a long time to seek professional help. When an anxiety disorder severely limits everyday life, certain psychotherapies and medications can help.

What happens during a psychotherapy?

There are several psychotherapeutic procedures for treating a generalized anxiety disorder. The best studied and most effective is cognitive behavioral therapy (CBT) .

Cognitive behavioral therapy

A CBT not only has a positive effect on anxiety. It can also relieve other symptoms, such as depression , that can be associated with anxiety disorder. However, since therapy requires a direct examination of one’s own fears, the treatment itself can sometimes be distressing. Generally, adverse effects of psychotherapy have not been well studied in studies so far.

A cognitive behavioral therapy is offered in Germany of behavioral therapists and therapists and covered by public health insurance. It usually consists of weekly sessions over several weeks or months. The cognitive behavioral therapy consists of two parts: a “cognitive” part that deals with the thoughts and feelings, and that deals with the behavior of one.

The goal of the cognitive approach is to change anxiety-causing thought patterns by learning to

  • recognize and question unrealistic fears and worries
  • to estimate the actual probabilities and consequences of anxiety triggers and
  • to deal with uncertainty.

An example of fearsome thought patterns are “catastrophizing” thoughts, such as: drawing extreme, exaggerated conclusions about the extent of the supposedly impending disaster as soon as something disturbing happens. When such thoughts are recognized by the therapist or therapist, they are working to break them down or to better deal with them. Ultimately, CBT helps to think more clearly and to better control one’s own thoughts.

The second part of the therapy is about gradually reducing the anxiety in certain situations and changing the behavior. In doing so, one faces the fear, in order to overcome it gradually. For example, a working mother who is constantly calling nursery school to make sure her child is well could gradually reduce the number of her calls. In order to facilitate such behavioral changes, the therapy also conveys what can help to keep calm – for example breathing exercises or relaxation techniques.

Other psychotherapeutic approaches

The effectiveness of psychotherapy, which is more concerned with the possible causes of anxiety, such as traumatic events in childhood, is not well understood in people with generalized anxiety disorder. The few studies comparing cognitive behavioral therapy suggest that these “psychodynamic” therapies are less helpful than CBT.

What treatments are available?

For the treatment of a generalized anxiety disorder, various drugs are considered. Agents from the group of selective serotonin reuptake inhibitors (SSRIs) are often used.

Selective serotonin reuptake inhibitors (SSRIs)

These drugs belong to the group of antidepressants . They can alleviate anxiety symptoms and help against depressive symptoms that many sufferers have to deal with additionally.

It usually takes 2 to 6 weeks for SSRIs to have an anxiolytic effect. However, they help only a part of the people who take them. Therefore, it may be necessary to try several drugs.

If treatment with SSRIs has improved, it is recommended that you take the medication for another 6 to 12 months and then slowly reduce the dose. Studies indicate that the risk of a relapse is then smaller. However, some people find it difficult to take the medication permanently . One reason can be side effects, another: When you feel better, you can quickly stop taking it.

Possible side effects of SSRI include nausea, insomnia and sexual problems. For example, some people have less desire for sex or no orgasm. In men, ejaculation may be weaker or absent. For most people, however, there are no side effects.

In insomnia or nausea, it is sometimes difficult to say whether the drugs are actually the cause. Because these complaints are generally quite common. Often the body gets used to the active ingredients. Most side effects occur only in the first weeks of use. It may therefore be worthwhile to wait and not stop the treatment immediately if a side effect is noticeable.

Other medicines

There are a number of other medications that can be used in generalized anxiety disorder. Many, however, usually come into question only if a treatment with SSRI has not been successful or is not possible for certain reasons:

  • selective norepinephrine reuptake inhibitors (SNRI): These include the active substances duloxetine and venlafaxine. They work in a similar way to SSRIs.
  • Pregabalin: This remedy is used primarily for nerve-related pain. However, it is also approved for the treatment of generalized anxiety disorder. The efficacy of the drug has been demonstrated in several studies. However, it often causes dizziness and fatigue.
  • Opipramol: Opipramol is an antidepressant whose efficacy has been poorly studied and therefore only in exceptional cases in question.
  • Buspirone: This remedy can relieve anxiety symptoms but is not as well studied as other medications. Therefore, it is usually only used when, for example, SSRIs do not work or are not tolerated. Possible side effects of Buspirone are dizziness, nausea and insomnia.
  • Hydroxyzine: This antihistamine drug is also likely to relieve symptoms of generalized anxiety disorder. However, it is also less well studied than other means and is therefore rarely used.
  • Benzodiazepines : Benzodiazepines are sleep aids and tranquilizers that also help to solve anxiety. Their effect sets in quickly, but they can make after a few weeks dependent . Therefore, these agents are not recommended for the treatment of generalized anxiety disorder.
  • Although drugs such as imipramine from the group of tricyclic antidepressants or the neuroleptic quetiapine have been shown in studies to have an effect on generalized anxiety disorder. However, as there are more effective and better tolerated drugs with the SSRIs, these agents are not approved for the treatment of the disorder. Doctors prescribe these medications only if all other treatments have not helped (so-called off-label use).There are relatively few studies comparing drugs directly. There are no clear benefits to a given drug from existing studies. Since not every medication works the same way in every human being, it can be useful to try different medications.

Which treatment is suitable?

Whether you opt for psychotherapy or drug treatment has a lot to do with personal attitudes and needs. Appropriate psychotherapy can be very effective and help to overcome the anxiety. But it requires a lot of initiative and strength, and often you have to wait longer for a therapy place. Depending on the personal situation and the severity of the illness, it may therefore be useful to take medication first. Sometimes it is only possible to start psychotherapy if the symptoms have been alleviated by medication.

Some people do not want to take antidepressants because they fear becoming addicted. Unlike certain painkillers, sleep aids and tranquilizers, however , antidepressants do not make them dependent. Others find it a sign of weakness to use pills to help them overcome their problems. But there is no reason to be ashamed when taking medication for mental illness. To overcome deep fears, medications can be helpful, sometimes even necessary.

However you decide, there are both medications and psychotherapies that can help you cope with a generalized anxiety disorder and live a normal life again.

What can friends or family do?

Close caregivers (eg relatives, partners) are usually affected, as they often involve them in their worries, for example, to assure themselves that nothing bad has happened or is going to happen, and that their caregivers often use it, for example.

It is helpful if family members are well aware of the generalized anxiety disorder. If possible, they should avoid reassuring the person concerned, as this often helps in the short term, but in the long term it helps to maintain the worries.

For well-being it is important that relatives do not restrict themselves too much. For example, they should not renounce activities that give them pleasure because the person concerned would then worry. If the anxiety disorder of the partner, family member or friend is too burdensome, family members can also get help from  self-help groups ,  counseling centers ,  doctors  and  psychotherapists  .

Tips for those affected

Generalized anxiety and cope with their physical symptoms

In principle, you have to do two things: first, the inappropriate and exaggerated worries, and second, the physical anxiety symptoms. Both are interwoven; if one level fails, the other one also strokes their sails.

  • Put yourself a “care diary”. Write down all the worries you have about a day, what they circle, how long they last, what physical reactions and feelings they experience. This helps you to recognize your own concerns and to further process.
  • Check the probability of your ideas z. B .: How likely is a plane crash at all? How likely is it that my husband is sitting on this plane? This also changes your central thought pattern.
  • Choose a specific concern and edit it in detail! What could happen in the worst case, which solutions would be available? Write down the individual solution proposals. You will see that even if you have a catastrophic idea, it will continue to work for you, and your anxiety symptoms will subside.
  • You can now calm down your worries. Dive this up again, think immediately of your elaborated solutions, break off the thoughts of concern (thought-stop).
  • Leave your loved ones alone, do not talk to you constantly to ask for well-being. You will be notified when something happens.
  • Do not cling to your cell phone, leave it at home.
  • Make sure you exercise enough, do sports, find new social contacts.
  • Learn relaxation procedures.
Generalized Anxiety Disorder Treatment
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