While everyone has experienced feeling anxious at times of high stress, worry or anticipation, some people having feelings like this more than they feel they should.

As a group, anxiety disorders includes generalised anxiety disorder, panic attacks, agoraphobia, social anxiety disorder, and post traumatic stress disorder.

Generalised anxiety disorder (GAD) is by far the most common, and is characterised by persistent worrying about everyday life and events that people find hard to control. While most people worry about things like finances, relationships, health and family, these worries tend not to interfere in the function of everyday life.

However people with GAD often describe their level of worry as excessive, and feel they blow things out of proportion. It often results in effecting their work, social life, and sometimes getting physical symptoms and high levels of emotional distress.

In every given year about 3% of people are diagnosed with GAD, and there is a 9% lifetime risk of developing it.

One core feature is an intolerance of uncertainty about the future, and worrying about worrying.

The symptoms tend to fluctuate over time, and people do experience remissions – periods of 3 months or more without any worries.

What causes anxiety?

Being afraid of a threatening event is an absolutely normal response. A big final exam coming up, seeing a snake on a walking trail, being physically confronted by an aggressive animal. Our body tenses up, breathing rate increases, heart begins to race, and we’re ready to take flight (or fight).

In people with anxiety they begin to perceive everyday events as threatening, and as such they are in a pervasive and constant state of worry. And if they don’t learn to cope, these events can be perceived as major threats.

Symptoms of anxiety:

Excessive worrying that lasts for months, plus some or all of the following:

  • Feeling restless, keyed up, or on edge
  • Being easily tired
  • Having difficulty concentrating, or having your mind go blank
  • Being irritable
  • Having tense or sore muscles
  • Having difficulty falling asleep, staying asleep, or having restless, unsatisfying sleep
  • Over-planning
  • Excessive list making
  • Seeking reassurance from others

Managing anxiety

Cognitive Behavioural Therapy

Getting better means getting control of your anxiety. The key components are;

  • Learning skills to manage anxiety and taking control of your thoughts, feelings and behaviour
  • Actively identifying and challenging behaviours and thoughts
  • Relaxation training


Some medications such as anti-depressant medications have shown to be helpful in managing symptoms, however are often only effective as long as they are taken. They may play a role in controlling significant anxiety while the CBT process is beginning.

Benzodiazepines were previously used extensively, but have been shown not to be helpful in the long term and have a highly addictive potential.


The fight or flight response is experienced as a set of symptoms

  • Shortness of breath – breathing rate increases
  • Nausea – blood being redirected from the gut to the muscles
  • Cold sweat – sweating increases
  • Palpitations – heart rate increases
  • Shaking and trembling – muscle tension increases
  • Things look unreal – pupillary dilatation
  • Selective attention – mental arousal to focus on specific tasks

Management of the fight or flight response – there are 2 things that need to occur

  • Solve the problem that is making you anxious
  • Control your level of anxiety so that you can problem solve

One common way of dealing with this is to avoid situations that seem threatening, but if you do this the anxiety will be worse the next time you face that situation. The best strategy is to confront the feared situation. Usually, things go better than you thought. And if they don’t you learn valuable coping skills by confronting your fears.


When you find yourself worrying, ask yourself the following questions:

Is Your Worry Reasonable?

Is the thing you fear really likely to happen? How can you be sure? Is there another possible explanation or outcome? Are you trying to predict things in the distant future that you can’t possibly know anything about? If it does happen, how much will it really matter? How would someone else see this worry?

What Is The Effect Of Thinking The Way You Do?

If your worry has some basis, but there is nothing you can do about it right now, then see if you can accept the worry and let it go. This can seem difficult for expert worriers, but try to say “There’s nothing I can do to change this right now, thinking about it will only make me more upset. I’ll accept the worry and get busy with something else for now”.

Is There a True Problem To Be Solved?

If there is a realistic problem, then you may need to focus on finding solutions for it. Good problem solving can be thought of as helpful or adaptive worry.

Try The Six-Step Structured Problem Solving Technique

  • Write down exactly what you believe the main problem to be
  • Write down all possible solutions, even bad ones
  • Think about each solution in practical terms
  • Choose the most practical solution
  • Plan how you will carry that solution out
  • Do it

Did that help you solve the problem? If not, have you learnt a better way of defining it? if so, write down the new problem and do the six steps again. This is as good as medication for many people.

The most important thing to remember about anxiety is that it’s not your fault.

Anxiety is made worse by life’s stressors, and has characteristic symptoms that affect a person’s thoughts, feelings, and everyday functioning.

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