Anxiety disorders are now considered to be the most common and pervasive mental disorders in the United States — and many other parts of the world too. During any given year, it’s estimated that one type of anxiety disorder called generalized anxiety disorder (or GAD) affects about 6.8 million American adults, or 3 percent of the population. Unfortunately, GAD is known to be the least successfully treated type of anxiety disorder.
What is the main difference between generalized anxiety disorder and phobic disorder, or other anxiety disorders? When someone has GAD, they worry about a wide range of topics, not one specific “stressor,” as is the case with phobic disorders. GAD is also characterized by ongoing worrying and anxiety that is not limited to a short period of time — but rather that lasts for months or even years.
While GAD can be difficult to treat, there’s still plenty of hope, thanks to both medications and natural remedies for anxiety like a healthy diet, exercise and mind-body practices.
What Is Generalized Anxiety Disorder?
The definition of generalized anxiety disorder (GAD), according to the Anxiety and Depression Association of America, is “a condition characterized by persistent and excessive worry about a number of different things. People with GAD may anticipate disaster and may be overly concerned about money, health, family, work or other issues.”
Like with other anxiety disorders, people who struggle with GAD deal with a sense of uncontrollable and excessive worry. The amount of worrying that people with GAD do about a topic seems to be unwarranted, as they expect the worst to happen even when there isn’t any evidence that it will. Some of the biggest sources of worry among people with GAD can include: performance at work or in school, catastrophes and natural disasters like earthquakes or war, finances, job security, health, relationships, children and family as well as other people’s opinions.
In order to diagnose someone with GAD, doctors use the criteria listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), which is the handbook used by healthcare professionals in the United States and much of the world to diagnose psychiatric conditions.
Generalized anxiety disorder is diagnosed when a person finds it difficult to control worry on more days than not for at least six months. The person must also display at least three or more of the generalized anxiety disorder symptoms described below.
Generalized Anxiety Disorder Symptoms
How do you know if you have GAD? Symptoms of GAD can fluctuate depending on someone’s level of stress and what is going on in their life. The most common generalized anxiety disorder symptoms include:
- Worrying and feeling nervous, irritable or “on edge” and lasting more than six months. This emotional distress may feel like a sense of impending danger or sometimes panic. The worry feels out of control and doesn’t feel manageable, even if the person recognizes it is excessive and harmful.
- Difficulty tolerating uncertainty or new situations
- Difficulty concentrating or focusing on tasks at school, work, home, etc.
- Trouble sleeping
- Being easily startled
- Physical symptoms like an increased heart rate, rapid breathing, chest pains, sweating and trembling
- Difficulty eating and swallowing normally
- Headaches, muscle aches and pains
- Gastrointestinal (GI) problems like stomach pains or diarrhea
- Higher risk for problems like irritable bowel syndrome, ulcers, migraines, chronic pain, insomnia and heart-health issues
People who have generalized anxiety disorder are also more likely to deal with other mental health issues, such as: substance abuse, phobias, panic attacks, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), depression and suicidal thoughts.
It’s believed that rates of missed diagnoses and misdiagnosis of GAD are high, because many people attribute their symptoms to physical illnesses or causes.
Causes and Risk Factors
There isn’t one known cause of GAD, but rather a number of factors that seem to contribute to the condition (and anxiety disorders in general). These include: genetics, family history and background, biological factors, life experiences such as trauma and lifestyle factors like diet, drug/alcohol use, exercise and sleep.
Generalized anxiety disorder is one of the most common mental disorders. Over the course of someone’s lifetime, they have about a 5 percent to 9 percent chance of developing GAD at some point. What puts you at a greater risk for experiencing GAD?
Potential generalized anxiety disorder causes and risk factors include:
- Disturbances in several parts of the brain that regulate fear, such as the limbic system, amygdala, hippocampus and pre-frontal cortex. As the Teen Mental Health Organization describes it, “generalized anxiety disorder is a disruption in how your brain controls the signals it uses to identify danger and initiate action to help you avoid it.” Disturbances in noradrenergic, serotonergic and other neurotransmitter systems are believed to play a role in the body’s response to stress, such as by causing low serotonin levels.
- Being someone who deals with emotional hyper-reactivity, sensitivity to negative or contrasting emotions and dysfunctional attempts to cope with emotional shifts
- Having a family history of mental illness, especially anxiety disorders
- Having an issue with substances, drugs or alcohol
- A history of trauma or assault
- Having a temperament that is timid or negative, or a history of depression
- Having a history of chronic medical illnesses or other mental health disorders
- Being a woman
- Being a child, teen or middle-aged (severe anxiety affects about 6 to 13 percent of all children and teens)
- Living in an industrialized country
- Being of European descent
GAD Diagnosis and Conventional Treatment
The American Psychiatric Association first introduced the diagnosis of generalized anxiety disorder in the 1990s. Medical doctors, clinical psychologists or other trained health providers can diagnose someone with GAD if they meet certain criteria, specifically if they display other symptoms in addition to worrying — like restlessness, fatigue, difficulty concentrating, muscle tension and sleep disturbances.
Is there such thing as a generalized anxiety disorder test? There isn’t one single test that is used to diagnose GAD. Psychiatrists/doctors/therapists will often make a diagnosis based on a conversation with a patient about their symptoms, as well as a physical exam to rule out other health problems that may be causing anxiety.
The number one symptom that a doctor will look for is if the patient’s worrying is out of proportion to the actual concern/event and is greater than that experienced by most people without GAD.
Unfortunately, even with psychotherapy and other conventional treatment strategies, 30 to 60 percent of patients with GAD do not achieve remission after treatment. Fortunately, however, natural remedies including relaxation/mindfulness-based interventions have been of increasing interest and seem to be viable options for helping alleviate GAD and a variety of other psychological disorders.
Generalized anxiety disorder treatment options include:
- Therapy, especially cognitive behavioral treatment (CBT). CBT has been shown to help change thoughts, physical symptoms and behaviors among people with GAD that can contribute to anxiety symptoms. Studies show that between 45 percent to 75 percent of people with GAD respond positively to CBT.
- Mindfulness-based approaches, such as Acceptance Commitment Therapy, have also been investigated with positive outcomes for anxiety.
- Medications used to treat anxiety, which can include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), the serotonergic medication called Buspirone, sedative medications like benzodiazepines or antidepressants. When medications are used, they are usually given in combination with therapy. The downside to using medications for GAD is that they can take several weeks to start working, and they can also cause side effects, such as weight changes, headaches, nausea or difficulty sleeping.
- Relaxation techniques (also called mind-body practices) like exercise, meditation, yoga or acupuncture.
4 Potential Natural Treatments for Generalized Anxiety Disorder
1. Therapy (Especially CBT)
Therapy is useful for helping to “train” your brain to better control your thoughts and emotions, which then can affect how you behave and react to situations that cause anxiety. CBT has been found to be especially beneficial for people with GAD, including children and teens.
Cognitive behavioral therapy is regarded as the psychotherapy with the highest level of evidence for anxiety disorders for several reasons. It works by restructuring thought patterns (changing the way someone thinks about his or her fears) and through exposure to things/situations that cause anxiety. By gradually exposing someone to their fears, they can come to learn that the outcome is not as bad as they may have expected. CBT can also help someone learn effective strategies for coping with fear and ways to communicate better with others or to ask for help, which has been shown to improve quality in life in those with anxiety.
2. Relaxation Practices
Relaxation therapies/practices are considered natural “arousal decreasing techniques,” meaning they can help to manage emotional both symptoms of fear and physical arousal. This can include physical feelings like a rapid heart rate, rapid breathing, sweating, etc. or emotions like overwhelm, racing thoughts, etc. Mind-body practices are also associated with a decrease in stress hormones (like cortisol and adrenaline), improved sleep quality and a boost in productivity.
Research suggests that relaxation techniques that may be beneficial for people with anxiety include biofeedback therapy, mindfulness or other types of meditations, deep breathing techniques, massage therapy and acupuncture.
Many studies, including a 2013 randomized control trial published in the Journal of Clinical Psychiatry, have found evidence that mindfulness meditation lasting for about eight weeks or longer has beneficial effects on generalized anxiety disorder symptoms, such as improving stress reactivity and coping mechanisms. Participants in mindfulness programs have been found to experience a reduction in a number of anxiety and distress ratings and a greater increase in positive self-statements.
Mindfulness training and other mind-body practices seem to work to lower anxiety by increasing awareness of present-moment experiences, including thoughts, emotions and bodily sensations, while holding a gentle and accepting attitude towards oneself, with helps with emotion regulation and decision making. Those who practice relaxation techniques have also been shown to ruminate less over negative thoughts and their performance, and to treat themselves with more kindness and less self-judgment.
3. A Healthy Lifestyle
A healthy lifestyle can play a significant role in combating anxiety. For example, exercise is a natural stress reliever, a healthy diet can help to supply essential nutrients that support mental health, as well as decrease inflammation, and getting enough sleep is important for keeping stress hormone levels, especially cortisol levels, under control.
Here are some tips related to diet and lifestyle habits that can help to manage anxiety:
- Most experts feel that maintaining a consistent, regular daily routine is important for people with GAD. Having a regular sleep/wake cycle, eating regular meals and staying organized with a calendar can all be helpful.
- Journaling thoughts and worries as well as finding ways to prioritize tasks and create more down time for rest are also recommended.
- Aim to get 7–9 hours of sleep per night.
- Get regular exercise, especially aerobic/cardiovascular exercise, which can help to release endorphins and lift your mood (bonus if you can exercise outdoors in the fresh air).
- Eat healthy, balanced meals at least three times per day. Avoid going too long without eating, since this can cause low blood sugar and worsen symptoms of anxiety.
- Avoid excessive alcohol, caffeine or sugar intake. Some studies have found that abstinence from alcohol is associated with a lower risk of anxiety, but if you do choose to drink alcohol, stick to no more than one to two drinks per day. Also try limiting coffee or black tea to no more than one or two cups per day, and stop drinking caffeine before noon.
Some of the best foods for people with anxiety include:
- Wild-caught fish (like salmon, mackerel, tuna, white fish and herring), grass-fed beef, organic chicken and eggs
- Probiotic foods like yogurt or kefir, or fermented veggies like sauerkraut
- Leafy greens (like spinach, kale, chard and collard greens), sea vegetables and other fresh vegetables (like celery, bok choy, broccoli, beets and artichokes)
- Nuts and seeds (such as walnuts, almonds, flaxseeds, chia seeds, hemp seeds and pumpkin seeds)
- Fresh fruits (like blueberries, pineapple, banana and figs)
- Healthy fats (like avocado, coconut oil and olive oil)
- Beans and legumes (such as black beans, adzuki beans, chickpeas, fava beans, lentils and peas)
- Unrefined grains (like farro, quinoa and barley)
The reason that eating a nutrient-dense diet that includes a variety of anti-inflammatory foods is important for managing anxiety is because certain nutrients help to produce neurotransmitters that balance your mood and manage your stress response. For example, vitamin B foods, magnesium-rich foods, foods high in calcium and omega-3 foods, as well as getting enough amino acids from protein and fiber from complex carbs has been shown to benefit mental health.
4. Natural Supplements
A number of natural supplements, essential oils and and remedies may be helpful for managing symptoms of anxiety, some of which include:
- Adaptogen herbs like ashwagandha and kava root, which can help maintain bodily homeostasis, keep cortisol levels under control and support the thyroid and adrenal glands
- Magnesium and a vitamin B complex, which are needed to regulate energy levels, blood sugar levels and metabolic processes, as well as many nerve and muscle functions
- GABA, an amino acid and inhibitory neurotransmitter that is mood-boosting, calming and promotes relaxation thanks to its effects on the nervous system
- Essential oils like chamomile oil and lavender oil, which have natural calming properties when inhaled or applied topically to the skin
- Generalized anxiety disorder (GAD) is a condition characterized by persistent and excessive worry about a number of different things that lasts for more than six months.
- The most common generalized anxiety disorder symptoms are: worrying and feeling nervous, irritable or “on edge,” emotional distress and panic, difficulty tolerating uncertainty or new situations, difficulty concentrating, trouble sleeping and physical symptoms like an increased heart rate, rapid breathing, chest pains, sweating and trembling.
- A number of genetic, biological and lifestyle factors can contribute to generalized anxiety disorder. Some potential causes and risk factors can include: disturbances in parts of the brain that regulate fear, emotional hyper-reactivity and sensitivity, family history of mental illness, issues with substance, drug or alcohol abuse, history of trauma or assault, history of chronic medical illnesses or other mental health disorders.
- Conventional treatments for GAD usually include a combination of psychotropic drugs and cognitive behavioral therapy, often coupled with other natural remedies for anxiety too. Other than medications, generalized anxiety disorder treatment options include: CBT (a form of talk therapy), relaxation techniques like meditation, yoga, deep breathing, etc., a healthy diet, exercise, quality sleep, supplements and essential oils.