Guide Handbook of Generalized Anxiety Disorder

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However, to receive a diagnosis of PD, the person must not only have unexpected panic attacks but also must experience continued intense anxiety and avoidance related to the attack for at least one month, causing significant distress or interference in their lives. People with panic disorder tend to interpret even normal physical sensations in a catastrophic way, which triggers more anxiety and, ironically, more physical sensations, creating a vicious cycle of panic Clark, , The person may begin to avoid a number of situations or activities that produce the same physiological arousal that was present during the beginnings of a panic attack.

For example, someone who experienced a racing heart during a panic attack might avoid exercise or caffeine. Someone who experienced choking sensations might avoid wearing high-necked sweaters or necklaces.

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The individual may also have experienced an overwhelming urge to escape during the unexpected panic attack. In one tragic case seen by our clinic, a woman suffering from agoraphobia had not left her apartment for 20 years and had spent the past 10 years confined to one small area of her apartment, away from the view of the outside. In some cases, agoraphobia develops in the absence of panic attacks and therefor is a separate disorder in DSM But agoraphobia often accompanies panic disorder.

About 4. In all of these cases of panic disorder, what was once an adaptive natural alarm reaction now becomes a learned, and much feared, false alarm. The majority of us might have certain things we fear, such as bees, or needles, or heights Myers et al. For example, a patient at our clinic turned down a prestigious and coveted artist residency because it required spending time near a wooded area, bound to have insects.

Living with GAD Is a Life of Constant, Irrational Fear

The list of possible phobias is staggering, but four major subtypes of specific phobia are recognized: blood-injury-injection BII type, situational type such as planes, elevators, or enclosed places , natural environment type for events one may encounter in nature for example, heights, storms, and water , and animal type. Most phobic reactions cause a surge of activity in the sympathetic nervous system and increased heart rate and blood pressure, maybe even a panic attack.

However, people with BII type phobias usually experience a marked drop in heart rate and blood pressure and may even faint. Specific phobia is one of the most common psychological disorders in the United States, with Many people consider themselves shy, and most people find social evaluation uncomfortable at best, or giving a speech somewhat mortifying. Yet, only a small proportion of the population fear these types of situations significantly enough to merit a diagnosis of social anxiety disorder SAD APA, SAD is more than exaggerated shyness Bogels et al.

To receive a diagnosis of SAD, the fear and anxiety associated with social situations must be so strong that the person avoids them entirely, or if avoidance is not possible, the person endures them with a great deal of distress. For example, a patient at our clinic compromised her perfect 4.

Fears of negative evaluation might make someone repeatedly turn down invitations to social events or avoid having conversations with people, leading to greater and greater isolation. The specific social situations that trigger anxiety and fear range from one-on-one interactions, such as starting or maintaining a conversation; to performance-based situations, such as giving a speech or performing on stage; to assertiveness, such as asking someone to change disruptive or undesirable behaviors.

Fear of social evaluation might even extend to such things as using public restrooms, eating in a restaurant, filling out forms in a public place, or even reading on a train. Any type of situation that could potentially draw attention to the person can become a feared social situation. For example, one patient of ours went out of her way to avoid any situation in which she might have to use a public restroom for fear that someone would hear her in the bathroom stall and think she was disgusting. If the fear is limited to performance-based situations, such as public speaking, a diagnosis of SAD performance only is assigned.

What causes someone to fear social situations to such a large extent?

An Overview of Generalized Anxiety Disorder

Or, someone might have experienced a social trauma that had lasting effects, such as being bullied or humiliated. Someone else might react so strongly to the anxiety provoked by a social situation that they have an unexpected panic attack. This panic attack then becomes associated conditioned response with the social situation, causing the person to fear they will panic the next time they are in that situation. As many as With stories of war, natural disasters, and physical and sexual assault dominating the news, it is clear that trauma is a reality for many people.

Many individual traumas that occur every day never even make the headlines, such as a car accident, domestic abuse, or the death of a loved one. Yet, while many people face traumatic events, not everyone who faces a trauma develops a disorder. Some, with the help of family and friends, are able to recover and continue on with their lives Friedman, For some, however, the months and years following a trauma are filled with intrusive reminders of the event, a sense of intense fear that another traumatic event might occur, or a sense of isolation and emotional numbing.

They may engage in a host of behaviors intended to protect themselves from being vulnerable or unsafe, such as constantly scanning their surroundings to look for signs of potential danger, never sitting with their back to the door, or never allowing themselves to be anywhere alone. Wrap yourself in a soft blanket. Sit outside in the cool breeze.

Movement — Go for a walk, jump up and down, or gently stretch. Dancing, drumming, and running can be especially effective. For maximum relief of GAD, try to get at least 30 minutes of physical activity on most days. Exercise that engages both your arms and legs—such as walking, running, swimming, or dancing—are particularly good choices.

For even greater benefits, try adding mindfulness element to your workouts. Mindfulness is a powerful anxiety fighter—and an easy technique to incorporate into your exercise program. Rather than spacing out or focusing on your thoughts during a workout, focus on how your body feels as you move. Try to notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of the wind on your skin. The core symptom of GAD is chronic worrying. But, in fact, worrying is self-generated.

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The trigger comes from the outside, but your internal running dialogue keeps it going. You run over the feared situation in your mind and think about all the ways you might deal with it. But more often than not, worrying is unproductive—sapping your mental and emotional energy without resulting in any concrete problem-solving strategies or actions.

How to distinguish between productive and unproductive worrying? This may involve challenging irrational worrisome thoughts, learning how to stop worrying , and learning to accept uncertainty in your life. Deep breathing. This hyperventilation causes symptoms such as dizziness, breathlessness, lightheadedness, and tingly hands and feet.

These physical symptoms are frightening, leading to further anxiety and panic. But by breathing deeply from the diaphragm, you can reverse these symptoms and calm yourself down. The technique involves systematically tensing and then releasing different muscle groups in your body.

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As your body relaxes, your mind will follow. Research shows that mindfulness meditation can actually change your brain. With regular practice, meditation boosts activity on the left side of the prefrontal cortex, the area of the brain responsible for feelings of serenity and joy.

Edited by Gavin Andrews, Alison E. Mahoney, Megan J. Hobbs, and Margo Genderson

A healthy, balanced lifestyle plays a big role in keeping the symptoms of GAD at bay. In addition to regular exercise and relaxation, try adopting these other lifestyle habits to tackle chronic anxiety and worry:. Get enough sleep. Anxiety and worry can cause insomnia , as anyone whose racing thoughts have kept them up at night can attest. But lack of sleep can also contribute to anxiety. Improve your sleep at night by changing any daytime habits or bedtime routines that can contribute to sleeplessness. Limit caffeine.

Generalized anxiety disorder (GAD) - causes, symptoms & treatment

Stop drinking or at least cut back on caffeinated beverages, including soda, coffee, and tea. Caffeine is a stimulant that can trigger all kinds of jittery physiological effects that look and feel a lot like anxiety—from pounding heart and trembling hands to agitation and restlessness. Caffeine can also make GAD symptoms worse, cause insomnia, and even trigger panic attacks.

Avoid alcohol and nicotine. Having a few drinks may temporarily help you feel less anxious, but alcohol actually makes anxiety symptoms worse as it wears off. While it may seem like cigarettes are calming, nicotine is actually a powerful stimulant that leads to higher, not lower, levels of anxiety. Eat right. Going too long without eating leads to low blood sugar—which can make you feel anxious and irritable—so start the day right with breakfast and continue with regular meals.