Generalised Anxiety Disorder (GAD) | Symptoms, Causes and Treatment
Generalised anxiety disorder is ongoing worry that’s difficult to control and that affects everyday life. The worry moves from one thing to the next rather than settling on a single fear. It’s one of the most common anxiety disorders, one of the most frequently missed, and it responds well to treatment set out in national guidance.
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What is generalised anxiety disorder?
Most anxiety conditions have a subject. Social anxiety is often about being judged. Health anxiety is about illness. A phobia has an object.
Generalised anxiety disorder doesn’t work like that. The worry attaches to whatever is available: work, money, family, health, something you said last week, something that might happen next year. Resolve one worry and another moves into the space. The content shifts. The worrying does not.
The other defining feature is that the worry feels uncontrollable. Most people can set a worry aside for a while. In GAD, attempts to stop tend to produce more worrying, often about the worrying itself.
It’s frequently missed, and the reason is worth knowing. People with GAD often present to a GP with physical symptoms or with concerns about their health, and the underlying pattern of widespread, shifting worry only becomes apparent across several appointments. NICE specifically directs clinicians to consider GAD in people who attend frequently, who seek reassurance about physical symptoms, or who worry repeatedly about a wide range of different things.
Left untreated, it tends to persist, and the disability associated with it is comparable to that of long-term physical health conditions.
Symptoms of generalised anxiety disorder
Psychological
worry most days that is hard to control or switch off
a sense of dread, or that something bad is going to happen
difficulty concentrating, or losing your thread
irritability
feeling on edge or unable to settle
going over conversations and decisions repeatedly
needing reassurance, then needing it again
Physical
tiredness that sleep does not fix
muscle tension, jaw clenching, headaches
difficulty falling asleep or staying asleep
stomach problems, nausea, changes in appetite
a racing heart, breathlessness or dizziness
restlessness
It’s common to have more than one anxiety disorder at once, so GAD often appears alongside panic attacks, social anxiety or health anxiety.
What does generalised anxiety feel like?
People often describe it as background noise that never quite switches off. There is rarely a dramatic moment. It is the sense of scanning ahead for problems, of not being able to enjoy something because you are already thinking about what comes next, and of being tired in a way that rest does not touch.
Many people with GAD do not think of themselves as anxious at all. They think of themselves as a worrier, or as someone who likes to be prepared, and often have not considered that it might be treatable.
How is generalised anxiety disorder diagnosed?
GAD is diagnosed by a suitably qualified professional following a full assessment that looks at what you worry about, how long it has been going on, how much control you feel you have over it, what physical symptoms you have, and how it is affecting work, sleep and relationships.
Assessment also checks for the conditions that commonly sit alongside GAD, particularly depression, other anxiety disorders and alcohol use, since these change what treatment is appropriate.
If you’re looking for a comprehensive assessment with a dedicated and caring team, please don’t hesitate to get in touch with Regal Private Therapy Practice by email today.
The GAD-7 is a short questionnaire used to measure the severity of generalised anxiety symptoms. It asks about how often you have been bothered by a set of anxiety symptoms over the past two weeks, and produces a score used to indicate whether symptoms are mild, moderate or severe.
Two things are worth understanding about it. It measures severity, it doesn’t make a diagnosis, and a score on its own means very little without the clinical picture around it. It’s also used to track change over time, which is often its most useful function: comparing scores across a course of treatment gives you something concrete when progress feels hard to judge from the inside.
What is the GAD-7?
What causes generalised anxiety disorder?
There is no single cause. Contributing factors typically include a family history of anxiety problems, temperament, prolonged stress, difficult or unpredictable early experiences, and sometimes a long-term physical health condition.
As with other anxiety conditions, more is known about what keeps GAD going than about what starts it, and the maintaining factors are more useful to work with anyway.
Two in particular matter. The first is the belief that worrying is protective, that thinking a problem through in advance will prevent it or prepare you for it. That belief makes worry feel necessary rather than optional. The second is avoidance of uncertainty, through checking, reassurance-seeking, over-planning and putting off decisions. Each reduces discomfort briefly and increases intolerance of uncertainty over time.
Treatment for generalised anxiety disorder
Treatment in the UK follows NICE guideline CG113, which sets out a stepped care model. Treatment starts at the least intrusive level likely to help and steps up only if needed.
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Recognising GAD, providing clear information about it, and monitoring symptoms. For some people, understanding what is happening is enough to change how they relate to it.
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If symptoms have not improved, NICE recommends one or more of the following, guided by your preference:
Individual non-facilitated self-help, working systematically through written or electronic materials over at least six weeks, with minimal practitioner contact
Individual guided self-help, supported by a trained practitioner, usually five to seven weekly or fortnightly sessions of 20 to 30 minutes
Psychoeducational groups
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For GAD with marked functional impairment, or that has not improved at step 2, NICE recommends a choice between a high-intensity psychological intervention and medication.
Cognitive Behavioural Therapy (CBT) is the primary psychological option. NICE specifies that CBT for GAD should consist of 12 to 15 weekly sessions. CBT for GAD works on the worry process rather than on each individual worry: examining beliefs about whether worrying helps, building tolerance for uncertainty, and reducing checking and reassurance-seeking.
Medication is prescribed by a GP or psychiatrist rather than a psychologist. If you choose medication, our team works in collaboration with a range of specialist psychiatrists who can support with prescribing.
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For complex GAD that has not responded to earlier steps, with marked impairment or risk to safety, NICE recommends highly specialist input, usually through secondary care mental health services.
How to stop worrying
This is one of the most searched questions about anxiety, and the honest answer is uncomfortable: you cannot stop worrying by trying to stop worrying. Attempting to suppress a thought reliably makes it more present, and for many people with GAD the effort to stop becomes another thing to worry about.
What helps is changing your relationship with worry rather than eliminating it.
Notice what the worry is doing for you. Most people with GAD hold an unspoken belief that worrying is useful, that it prevents bad outcomes or means they will not be caught out. Examining that belief directly, rather than trying to argue with individual worries, is usually where treatment starts.
Separate solvable from unsolvable. Some worries point at a real decision you could make. Most do not. Treating a hypothetical worry as a problem to be solved keeps you in it indefinitely.
Practise tolerating uncertainty rather than resolving it. Checking, reassurance-seeking and over-planning all work briefly. Each one teaches you that uncertainty is intolerable, which is what keeps GAD going.
Contain it rather than fight it. Setting aside a limited, deliberate period for worrying, and postponing worries to it, is a standard CBT technique and more effective than trying to banish worry entirely.
These are the principles that structured treatment works through properly. If worry has been part of your life for years, working through them with a psychologist can be really helpful in shifting it..
Support for generalised anxiety disorder at Regal Private Therapy Practice
Our Clinical Psychologists provide CBT for generalised anxiety disorder to adults, in line with NICE guidance, in person in London and online across the UK.
The work focuses on the worry process rather than on the contents of any particular worry, which is often a relief for people who have spent years being talked out of individual concerns only for new ones to arrive. That means looking at what worrying is doing for you, building tolerance for uncertainty in small deliberate steps, and reducing the checking and reassurance that keep the cycle running.
Read more about therapy for adults and about cognitive behavioural therapy.
If you need urgent support
If you are struggling to cope or worried about your safety, help is available now. Call 111 and select the mental health option, or contact your GP. Samaritans are available 24 hours a day on 116 123. If you are worried about a child or young person, the YoungMinds Parents Helpline offers free advice. In an emergency, call 999 or go to your nearest A&E.
Frequently asked questions about generalised anxiety disorder
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It can be. Under the Equality Act 2010, a mental health condition is considered a disability if it has a long-term effect on your normal day-to-day activities, which includes things like concentrating, working set hours and interacting with people. Long-term means it has lasted, or is likely to last, 12 months. What matters is the effect on you rather than the diagnosis itself.
This is general information, not legal advice. If you are considering workplace adjustments, Acas and Citizens Advice both publish free guidance.
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It can improve substantially with treatment. Left untreated, GAD tends to be persistent rather than self-resolving, which is one of the reasons it is worth addressing rather than waiting out. Recovery usually looks like worry becoming proportionate and manageable rather than disappearing altogether.
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It is treatable, and it is also more disabling than people expect. Research summarised in the NICE guidance describes the level of disability associated with GAD as comparable to that of chronic physical health conditions. Taking it seriously is not overreacting.
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Anxiety is a normal response to stress and threat that everyone experiences. Generalised anxiety disorder is when worry is present most days, is difficult to control, moves from one subject to another, and affects how you function. The distinction is about persistence, controllability and impact rather than intensity.
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NICE recommends that CBT for GAD consists of 12 to 15 weekly sessions. Lower-intensity options are shorter, with guided self-help usually running to five to seven sessions of 20 to 30 minutes. The right length depends on severity, how long the pattern has been established, and whether anything else is present alongside it.
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References
NICE (2011, last updated 2020). Generalised anxiety disorder and panic disorder in adults: management. Clinical guideline CG113. https://www.nice.org.uk/guidance/cg113
NHS. Generalised anxiety disorder in adults. https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder-gad/
Kendrick T, Pilling S et al. Management of generalised anxiety disorder in adults: summary of NICE guidance. BMJ.
NICE (2012). Evidence Update 22: Generalised anxiety disorder in adults.
GOV.UK. When a mental health condition becomes a disability. https://www.gov.uk/when-mental-health-condition-becomes-disability