Generalized Anxiety Disorder (GAD) is a common mental health condition characterized by excessive and uncontrollable worries.
Fear is a natural human experience, warning and protecting individuals from threats. However, when anxieties become uncontrollable, they take on a life of their own. Those affected by generalized anxiety find themselves constantly consumed by irrational worries without any particular triggers.
CHMC, our German Clinic for Psychiatry and Psychology, offers diagnosis and treatment for generalized anxiety disorder in Dubai.
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Symptoms of Generalized Anxiety Disorder
Individuals with generalized anxiety disorder experience a continuous stream of unrealistic and exaggerated fears not tied to any immediate danger. As a result, people with GAD live in a constant state of apprehension, fearing everything from unfounded worries about their health and their loved ones’ safety to trivial matters like losing keys. They might also worry about the anxiety itself. The individuals with generalized anxiety live in a constant state of emergency, which impacts their social and professional performance, significantly limiting their life quality.
Generalized anxiety is frequently associated with depression, adding an additional burden on the sufferers.
Physical Symptoms Associated with General Anxiety
In response to anxiety, the body’s release of adrenaline, the “fight and flight” hormone, prepares the individual to master an imaginative danger. People with generalized anxiety develop physical responses typical of the fight-or-flight reaction, such as heart racing, palpitations, sweating, and muscle tension. Additional physical symptoms include dizziness, shortness of breath, and gastrointestinal distress. Constant fears also cause sleeplessness, fatigue, and decreased concentration.
It’s crucial to distinguish generalized anxiety from panic attacks. While in generalized anxiety, the individual is consistently present; panic attacks occur suddenly, “out of the blue,” with symptom-free intervals between the attacks.
Causes of Generalized Anxiety Disorder
The causes of generalized anxiety are only partially understood. They likely involve genetic, psychological, and environmental factors. Evidence also suggests a genetic predisposition, with some families having a higher incidence of anxiety disorders. Some individuals may have experienced traumatic events in childhood or later in life. Such traumas can be caused by losses of significant others or prolonged periods of extreme stress related to social or occupational pressure. Life crises can trigger fears that might evolve into a full-blown generalized anxiety. Additionally, generalized anxiety can be comorbid with other conditions like depression, panic disorder, phobias, or substance abuse.
Prevalence of GAD
Generalized anxiety disorder is a common condition, affecting an estimated 5% of the population at some point in their lives. Women are twice as likely to be affected as men. While the onset typically occurs in mid-adulthood, it can also manifest in childhood or in older age.
Diagnosing Generalized Anxiety Disorder
Diagnosing generalized anxiety disorder can be challenging. Its symptoms may overlap with those of other mental health conditions like phobias, panic disorder, or obsessive-compulsive disorder. Additionally, many affected individuals may experience symptoms more aligned with depression.
The physical symptoms associated with generalized anxiety, such as fears, rapid heart rate, sweating, and muscle tension, can also occur in conditions like hyperthyroidism or be triggered by stimulating drugs, for example, amphetamine.
As a result, reaching a diagnosis of generalized anxiety disorder can be time-consuming, especially if individuals initially seek help due to physical symptoms, perhaps even in an emergency room setting. However, through initial conversations and the necessary diagnostics, professionals can ultimately arrive at the correct diagnosis.
Diagnostic Measures for Generalized Anxiety Disorder
The process of diagnosing an anxiety disorder begins with a thorough evaluation of the patient’s medical history, known as an anamnesis. The anamnesis gathers crucial information about the onset, nature, and severity of the anxiety symptoms. However, before a definitive diagnosis of an anxiety disorder can be made, the psychiatrist must rule out any underlying physical causes. These could include conditions affecting the lungs, cardiovascular system, or central nervous system. Additionally, the presence of other concurrent mental health problems must be assessed.
A comprehensive diagnostic approach involves a physical examination, laboratory tests, and an electrocardiogram (ECG) to detect physical illnesses. Depending on the patient’s medical history, specific symptoms, or preexisting conditions, further investigative tests such as lung function tests, electroencephalograms (EEG), or Magnetic Resonance Imaging (MRI) may be recommended.
A diagnosis of “generalized anxiety disorder” is established when anxiety:
- Persists for at least six months, occurring on most days within that period
- Becomes uncontrollable
- Significantly impairs daily functioning
- Is accompanied by at least three physical symptoms, such as a rapid pulse, trembling, muscle tension, or gastrointestinal problems
Treatment for GAD with Cognitive Behavioral Therapy (CBT) in Dubai
CBT is based on the idea that anxiety disorders, like other mental health conditions, are partly caused by distorted, illogical, or unrealistic thoughts. The goal of CBT is to help individuals develop skills to independently identify, interrupt, and correct these dysfunctional beliefs and thoughts, enabling them to respond more appropriately to different situations.
Key elements of CBT for anxiety treatment include:
- Psychoeducation: Teaching patients about the nature of anxiety and its mechanisms.
- Exposure Techniques: For instance, imagining feared scenarios (in-sensu exposure) to confront and process worries, such as anticipated catastrophes.
- Problem-Solving Strategies: Helping patients tackle specific challenges in a constructive way.
- Therapeutic Relationship: Building a strong, supportive relationship between the therapist and the patient is an essential foundation of therapy.
Numerous randomized clinical trials have shown the effectiveness of CBT for therapy of anxiety. It has been proven superior to waitlist conditions and has specific therapeutic components beyond general placebo effects. Response rates for CBT in studies range between 47–75%, though the exact definition of “response” varies between studies.
Psychodynamic (Psychoanalytic) Therapy
Psychodynamic approaches for treatment of anxiety disorders focus on underlying emotional conflicts, particularly those rooted in insecure attachment and central relationship conflicts. A specialized psychoanalytic focal therapy for anxiety has been developed based on supportive-expressive psychotherapy. This method emphasizes the therapeutic relationship and is often conducted as a short-term therapy with a more active therapeutic stance.
Research on psychodynamic therapy for anxiety is limited. Studies suggested comparable effects between CBT and psychodynamic therapy, though numerical results favoured CBT.
Complementary Treatment for Anxiety Disorders
CBT not only helps reduce anxiety but can also alleviate other issues, such as depression, that often accompany anxiety disorders. However, since the therapy involves actively confronting one’s fears, the treatment itself can sometimes be challenging. In general, the potential side effects of psychotherapy have not been thoroughly studied.
Depending on availability and technical resources, these sessions can also be conducted virtually via videoconferencing.
Medications for Treating Anxiety Disorders
Different medications can be used to treat anxiety disorders. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed.
Selective Serotonin Reuptake Inhibitors (SSRIs)
These medications belong to the group of antidepressants. They can reduce anxiety and depression. SSRIs usually take 2 to 6 weeks to relieve anxiety symptoms. However, they do not help everyone. It may be necessary to try different SSRIs. Escitalopram and Paroxetine are well-studied for anxiety disorders.
If SSRIs help, continuing treatment is recommended to prevent relapse and side effects. Stopping too early or reducing the dose without medical advice can cause issues. Psychiatrists recommend taking SSRIs for 6 to 12 months before slowly reducing the dose.
Longer use may be beneficial, but some struggle to take medication long-term. Many stop taking them when they feel better, which can lead to relapse. It is sometimes hard to tell if symptoms like nausea are due to the medication. These symptoms are common and often disappear as the body adjusts to the drug. Most side effects occur in the first weeks but usually improve over time. It can be worth waiting before stopping treatment due to side effects.
Selective Norepinephrine Serotonin Reuptake Inhibitors (SNRIs)
Selective norepinephrine reuptake inhibitors (SNRIs): Duloxetine and Venlafaxine work similarly to SSRIs. These antidepressants have shown effectiveness for anxiety, but they are not officially approved. However, psychiatrists may prescribe these medications if other treatments have failed (off-label use).
Other Medications Used for Anxiety Treatment
Other medications can be used if SSRIs are ineffective or unsuitable.
- Opipramol: An antidepressant with limited research, used only in rare cases.
- Buspirone: Can reduce anxiety but is less studied than other medications. Used when SSRIs are ineffective or not tolerated. Possible side effects: dizziness, nausea, insomnia.
- Hydroxyzine: An antihistamine that may help with anxiety but is rarely used.
- Benzodiazepines: Fast-acting sedatives that reduce anxiety but are highly addictive. Not recommended for treating generalized anxiety disorder.
Complementary Treatment for GAD
Relaxation techniques, including autogenic training, progressive muscle relaxation, and breathing exercises, can be used for the treatment of GAD not alone but in combination with psychotherapy and/or medication.
Course of Generalized Anxiety
The course of generalized anxiety disorder typically unfolds gradually, with fears and physical symptoms like heart racing and palpitation initially going unnoticed. It’s only over time that these symptoms increasingly encroach upon one’s daily life and well-being.
GAD can be remarkably persistent, often taking years to overcome. During this journey, individuals may experience phases of reduced anxiety. The studies show that approximately one in four individuals had recovered from generalized anxiety spontaneously within 2 years. In the long term, many people do manage their anxieties, and as individuals age, GAD often diminishes naturally.
Living with Generalized Anxiety Disorder
Living with generalized anxiety impacts both professional and personal life. Anxiety impacts the work performance and the social life of the affected individuals. They tend to withdraw socially, retreating to the safety of their homes, avoiding situations that might exacerbate their anxiety or trigger physical symptoms. In extreme cases, generalized anxiety leads to full invalidism.
Opening up about an anxiety disorder is challenging and often limited to the closest circle of family and friends. With therapeutic support, however, it’s possible to share one’s struggles with family members, educating them about the condition and involving them in the treatment.
Seeking professional assistance and support are crucial steps in managing anxiety. It should be stressed out that generalized anxiety is a well-treatable disorder that can be fully curbed under the condition of proper management.
Treatment for Generalized Anxiety Disorder in Dubai. Summary
Generalized Anxiety Disorder (GAD) is a common and serious condition. It is characterized by excessive worry about real dangers, where the likelihood of these dangers occurring is greatly overestimated and the potential negative consequences are imagined as catastrophic. These worries can quickly spread to various aspects of life, such as health, relationships, work, or finances, affecting both the person and their loved ones.
People with GAD often show patterns of avoidance and safety-seeking behaviour. For example, they might postpone or avoid activities they consider risky, such as travelling. These fears often manifest physically, leading to symptoms like restlessness, muscle tension, or difficulty sleeping, which may prompt extensive medical evaluations to rule out physical causes.
Medication for GAD treatment:
- SSRIs and SNRIs are first-line treatments for GAD, with evidence of efficacy and generally manageable side effects.
- Benzodiazepines are useful for short-term relief but carry a risk of dependence and limited use in depression.
- Alternative medications like TCAs are options for specific cases, while others like Quetiapine or Agomelatin are reserved for resistant cases or experimental use.
- Medication should always be paired with psychotherapy for the best outcomes.
Psychotherapy for GAD Treatment
The most researched, evidence-based treatment approach for generalized anxiety is cognitive behavioural therapy (CBT). Recent studies also proved the effectiveness of psychodynamic psychotherapy with even fewer relapses compared with CBT.
At CHMC, we are here to guide you every step of the way. Contact our specialists for professional help with generalized anxiety: