Introduction

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe.

Everyone has feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam or having a medical test or job interview. During times like these, feeling anxious can be perfectly normal.

However, some people find it hard to control their worries. Their feelings of anxiety are more constant and can often affect their daily life.

Anxiety is the main symptom of several conditions, including:

The information in this topic deals with generalised anxiety disorder (GAD) and anxiety in children.

Generalised anxiety disorder (GAD)

GAD is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event.

People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue.

GAD can cause both psychological (mental) and physical symptoms. These vary from person to person, but can include:

Read about the symptoms of GAD.

When to see your GP

Although feelings of anxiety at certain times are completely normal, see your GP if anxiety is affecting your daily life or causing you distress.

Your GP will ask about your symptoms and your worries, fears and emotions to find out if you could have GAD.

Read more about diagnosing GAD.

What causes GAD?

The exact cause of GAD isn't fully understood, although it's likely that a combination of several factors plays a role. Research has suggested that these may include:

  • overactivity in areas of the brain involved in emotions and behaviour
  • an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood
  • the genes you inherit from your parents – you're estimated to be five times more likely to develop GAD if you have a close relative with the condition
  • having a history of stressful or traumatic experiences, such as domestic violence, child abuse or bullying
  • having a painful long-term health condition, such as arthritis
  • having a history of drug or alcohol misuse

However, many people develop GAD for no apparent reason.

Who is affected?

GAD is a common condition, estimated to affect up to 5% of the UK population.

Slightly more women are affected than men, and the condition is more common in people from the ages of 35 to 59.

How GAD is treated

GAD can have a significant effect on your daily life, but several different treatments are available that can ease your symptoms. These include:

There are also many things you can do yourself to help reduce your anxiety, such as:

  • going on a self-help course
  • exercising regularly
  • stopping smoking
  • cutting down on the amount of alcohol and caffeine you drink

Read how stopping smoking can improve your health.

With treatment, many people are able to control their anxiety levels. However, some treatments may need to be continued for a long time and there may be periods when your symptoms worsen.

Read more about:

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Symptoms

Generalised anxiety disorder (GAD) can affect you both physically and mentally.

How severe the symptoms are varies from person to person. Some people have only one or two symptoms, while others have many more.

You should see your GP if anxiety is affecting your daily life or is causing you distress.

Psychological symptoms of anxiety

GAD can cause a change in your behaviour and the way you think and feel about things, resulting in symptoms such as:

  • restlessness
  • a sense of dread
  • feeling constantly "on edge"
  • difficulty concentrating
  • irritability

Your symptoms may cause you to withdraw from social contact (seeing your family and friends) to avoid feelings of worry and dread.

You may also find going to work difficult and stressful and may take time off sick. These actions can make you worry even more about yourself and increase your lack of self-esteem.

Physical symptoms of anxiety

GAD can also have a number of physical symptoms, including:

Anxiety triggers

If you are anxious as a result of a phobia or because of panic disorder, you will usually know what the cause is. For example, if you have claustrophobia (a fear of enclosed spaces), you know that being confined in a small space will trigger your anxiety.

However, if you have GAD, what you are feeling anxious about may not always be clear. Not knowing what triggers your anxiety can intensify your anxiety and you may start to worry that there will be no solution.

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Diagnosis

See your GP if anxiety is affecting your daily life or is causing you distress.

Generalised anxiety disorder (GAD) can be difficult to diagnose. In some cases, it can also be difficult to distinguish from other mental health conditions, such as depression.

You may have GAD if:

  • your worrying significantly affects your daily life, including your job and social life
  • your worries are extremely stressful and upsetting
  • you worry about all sorts of things and have a tendency to think the worst
  • your worrying is uncontrollable
  • you've felt worried nearly every day for at least six months

Talking to your GP about anxiety

Your GP may ask you questions about:

  • any physical or psychological symptoms and how long you've had them
  • your worries, fears and emotions
  • your personal life

You may find it difficult to talk about your feelings, emotions and personal life. However, it's important that your GP understands your symptoms and circumstances, so the correct diagnosis can be made.

You're most likely to be diagnosed with GAD if you've had symptoms for six months or more. Finding it difficult to manage your feelings of anxiety is also an indication that you may have the condition.

To help with the diagnosis, your GP may carry out a physical examination or blood tests to rule out other conditions that may be causing your symptoms, such as:

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Treatment

Generalised anxiety disorder (GAD) is a long-term condition, but a number of different treatments can help.

Before you begin any form of treatment, your GP should discuss all your treatment options with you. They should outline the pros and cons of each and make sure you are aware of any possible risks or side effects.

With your GP, you can make a decision on the treatment most suited to you, taking into account your personal preferences and circumstances.

If you have other problems alongside GAD, such as depression and drug or alcohol misuse, these may need to be treated before having treatment specifically for GAD.

Initial treatment

At first, your GP may suggest trying an individual self-help course for a month or two to see if it can help you learn to cope with your anxiety.

This will usually involve working from a book or computer programme on your own (you will be given advice about how to use the book or programme before you start), with only occasional contact with your doctor.

Alternatively, you may prefer to go on a group course where you and a few other people with similar problems meet with a therapist every week to learn ways to tackle your anxiety.

See self-help tips for anxiety for more information on these treatments.

If these initial treatments do not help, you will usually be offered either a more intensive psychological treatment or medication. These are described below.

Psychological treatment

If you have been diagnosed with GAD, you will usually be advised to try psychological treatment before you are prescribed medication.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is one of the most effective types of treatment for GAD. Studies of different treatments for GAD have found that the benefits of CBT may last longer than those of medication, but no single treatment is best for everyone.

CBT helps you to understand how your problems, thoughts, feelings and behaviour affect each other. It can also help you to question your negative and anxious thoughts, and do things you would usually avoid because they make you anxious.

CBT will usually involve meeting with a specially trained and accredited therapist for a one-hour session every week for three to four months.

Your therapist should carry out CBT in a standardised way according to a treatment manual, and they should receive regular supervision to support them in providing the most effective treatments.

Mindfulness and applied relaxation

Mindfulness and applied relaxation are alternative types of psychological treatment that can be as effective as CBT in treating GAD.

Mindfulness works by focusing your awareness on the present moment and by acknowledging and accepting certain feelings. Being mindful can reduce anxiety caused by the fear of actual situations or sensations, or anticipated ones. It helps to counter the sense of "tunnel vision" that may develop during anxiety. Although mindfulness originates from Buddhism, it doesn't require you to change or take on any religious beliefs.

Applied relaxation focuses on relaxing your muscles in a particular way during situations that usually cause anxiety. The technique needs to be taught by a trained therapist, but generally involves:

  • learning how to relax your muscles
  • learning how to relax your muscles quickly and in response to a trigger, such as the word "relax"
  • practising relaxing your muscles in situations that make you anxious

As with CBT, applied relaxation therapy will usually mean meeting with a therapist for a one-hour session every week for three to four months.

Medication for anxiety

If the psychological treatments above have not helped you or you would prefer not to try them, you will usually be offered medication.

Your GP can prescribe a variety of different types of medication to treat GAD. Some medication is designed to be taken on a short-term basis, while other medicines are prescribed for longer periods.

Depending on your symptoms, you may require medicine to treat your physical symptoms as well as your psychological ones.

If you are considering taking medication for GAD, your GP should discuss the different options with you in detail, including the different types of medication, length of treatment, side effects and possible interactions with other medicines before you start a course of treatment.

You should also have regular appointments with your doctor to assess your progress when you are taking medication for GAD. These will usually take place every two to four weeks for the first three months, then every three months after that.

Tell your GP if you think you may be experiencing side effects from your medication. They may be able to adjust your dose or prescribe an alternative medication.

The main medications you may be offered to treat GAD are described below.

Selective serotonin reuptake inhibitors (SSRIs)

In most cases, the first medication you will be offered will be a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). This type of medication works by increasing the level of a chemical called serotonin in your brain.

Examples of SSRIs you may be prescribed include:

  • sertraline
  • escitalopram
  • paroxetine.

SSRIs can be taken on a long-term basis but, as with all antidepressants, they can take several weeks to start working. You will usually be started on a low dose, which will gradually be increased as your body adjusts to the medicine.

Common side effects of SSRIs include:

These side effects should improve over time, although some – such as sexual problems – can persist.

If your medication isn't helping after about two months of treatment, or if it's causing unpleasant side effects, your GP may prescribe an alternative SSRI.

When you and your GP decide it's appropriate for you to stop taking your medication, you'll normally have your dose slowly reduced over the course of a few weeks to reduce the risk of withdrawal effects. Never stop taking your medication unless your GP specifically advises you to.

Serotonin and noradrenaline reuptake inhibitors (SNRIs)

If SSRIs don't help ease your anxiety, you may be prescribed a different type of antidepressant known as a serotonin and noradrenaline reuptake inhibitor (SNRI). This type of medicine increases the amount of serotonin and noradrenaline in your brain.

Examples of SNRIs you may be prescribed include:

  • venlafaxine
  • duloxetine

Common side effects of SNRIs include:

  • feeling sick
  • headaches
  • drowsiness
  • dizziness
  • dry mouth
  • constipation
  • insomnia
  • sweating

SNRIs can also increase your blood pressure, so your blood pressure will be monitored regularly during treatment.

As with SSRIs, some of the side effects – such as feeling sick, an upset stomach, problems sleeping and feeling agitated or more anxious – are more common in the first one or two weeks of treatment, but these usually settle as your body adjusts to the medication.

Pregabalin

If SSRIs and SNRIs aren't suitable for you, you may be offered pregabalin. This is a medication known as an anticonvulsant, which is used to treat conditions such as epilepsy. However, it's also been found to be beneficial in treating anxiety.

Side effects of pregabalin can include:

  • drowsiness
  • dizziness
  • increased appetite and weight gain
  • blurred vision
  • headaches
  • dry mouth
  • vertigo

Pregabalin is less likely to cause nausea or a low sex drive than SSRIs or SNRIs.

Benzodiazepines

Benzodiazepines are a type of sedative that may sometimes be used as a short-term treatment during a particularly severe period of anxiety, because they help ease the symptoms within 30 to 90 minutes of taking the medication.

If you're prescribed a benzodiazepine, it will usually be diazepam.

Although benzodiazepines are very effective in treating the symptoms of anxiety, they can't be used for long periods of time because they can become addictive if used for longer than four weeks. Benzodiazepines also start to lose their effectiveness after this time.

For these reasons, you won't usually be prescribed benzodiazepines for any longer than two to four weeks at a time.

Side effects of benzodiazepines can include:

  • drowsiness
  • difficulty concentrating
  • headaches
  • vertigo
  • tremor (an uncontrollable shake or tremble in part of the body)
  • low sex drive

As drowsiness is a particularly common side effect of benzodiazepines, your ability to drive or operate machinery may be affected by taking this medication. You should avoid these activities during treatment.

Referral to a specialist

If you've tried the treatments mentioned above and have significant symptoms of GAD, you may want to discuss with your GP whether you should be referred to a mental health specialist.

A referral will work differently in different areas of the UK, but you'll usually be referred to your community mental health team. These teams include a range of specialists, including:

  • psychiatrists
  • psychiatric nurses
  • clinical psychologists
  • occupational therapists
  • social workers

An appropriate mental health specialist from your local team will carry out an overall reassessment of your condition. They'll ask you about your previous treatment and how effective you found it.

They may also ask about things in your life that may be affecting your condition, or how much support you get from family and friends.

Your specialist will then be able to devise a treatment plan for you, which will aim to treat your symptoms.

As part of this plan, you may be offered a treatment you haven't tried before, which might be one of the psychological treatments or medications mentioned above.

Alternatively, you may be offered a combination of a psychological treatment with a medication, or a combination of two different medications.

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Self-help

If you have generalised anxiety disorder (GAD), there are many ways you can help ease the symptoms of anxiety yourself.

Try a book or online course

When you are diagnosed with GAD, your GP may recommend trying self-help treatments before having more intensive psychological therapy or medication.

Book Prescription Wales is a scheme that aims to help people with mild to moderate emotional problems to make use of high quality self-help books that have been specially selected by psychologists and counsellors working in Wales. A GP or other health professional can prescribe a therapy book which is available to borrow from any branch library across Wales. Sometimes a self help computer programme may be recommended. These schemes will may run for around six weeks or longer. In some cases, you may be closely supported by a trained therapist who you will speak to every week or two, although some treatments only involve minimal or occasional contact with a therapist who will monitor your progress.

There are a number of different books and courses available that can help you learn to cope with your anxiety, but the National Institute for Health and Care Excellence (NICE) only recommends trying treatments based on the principles of cognitive behavioural therapy (CBT).

CBT is a type of psychological treatment that can help you understand your condition better and how your problems, thoughts, feelings and behaviour affect each other. The aim of CBT-based treatments is to help you learn ways to manage your anxiety by modifying negative or unhelpful behaviour and thoughts.

Exercise regularly

Regular exercise, particularly aerobic exercise, may help you combat stress and release tension. It also encourages your brain to release the chemical serotonin, which can improve your mood.

Examples of good aerobic exercises to try include:

  • walking fast or jogging
  • swimming
  • cycling
  • tennis
  • hiking
  • football or rugby
  • aerobics

You should aim to do a minimum of 150 minutes of moderate-intensity exercise a week. Moderate-intensity exercise should raise your heart rate and make you breathe faster.

Read more information and advice about exercise and getting active for mental wellbeing.

Learn to relax

As well as getting regular exercise, learning how to relax is important.

You may find relaxation and breathing exercises helpful, or you may prefer activities such as yoga or pilates to help you unwind.

Avoid caffeine

Drinking too much caffeine can make you more anxious than normal. This is because caffeine can disrupt your sleep and also speed up your heartbeat. If you are tired, you are less likely to be able to control your anxious feelings.

Avoiding drinks containing caffeine – such as coffee, tea, fizzy drinks and energy drinks – may help reduce your anxiety levels.

Avoid Smoking and Alcohol

Smoking and alcohol have been shown to make feelings of anxiety worse. Drink alcohol in moderation and, if you smoke, try to give up. You can get free help giving up smoking from the NHS.

Only drinking alcohol in moderation or stopping smoking may help to reduce your anxiety.

To reduce the risk of harming your health:

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over three days or more if you drink as much as 14 units a week

Fourteen units is equivalent to six pints of average-strength beer or 10 small glasses of low-strength wine.

Regular or frequent drinking means drinking alcohol most weeks. The risk to your health is increased by drinking any amount of alcohol on a regular basis. To find out if you are drinking too much, download our alcohol tracker.

Support groups for anxiety

Support groups can give you useful advice about how to effectively manage your anxiety. They are also a good way to meet other people with similar experiences.

Support groups often involve face-to-face meetings where you can talk about your difficulties and problems with other people. Many support groups also provide support and guidance over the phone or in writing. Ask your GP about local support groups for anxiety in your area or look up online emotional support services near you.

Understanding your anxiety

Some people find that reading about anxiety can help them deal with their condition. There are many books based on the principles of cognitive behavioural therapy (CBT). These may help you understand your psychological problems better and learn ways to overcome them by changing your behaviour.

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Children

Just like adults, children and young people feel worried and anxious at times. But if your child’s anxiety is starting to affect their wellbeing, they may need some help to overcome it.

What makes children anxious?

Children tend to feel anxious about different things at different ages. Many of these worries are a normal part of growing up.

From about eight months to three years, for example, it’s very common for young children to have something called separation anxiety. They may become clingy and cry when separated from their parents or carers. This is a normal stage in children’s development and tends to ease off at around age two to three.

It’s also common for pre-school children to develop specific fears or phobias. Common fears in early childhood include animals, insects, storms, heights, water, blood, and the dark. These fears usually go away gradually on their own.

Throughout a child’s life there will be other times when they feel anxiety. Lots of children feel anxious when going to a new school, for example, or before tests and exams. Some children feel shy in social situations and may need support with this.

When is anxiety a problem for children?

Anxiety becomes a problem for children when it starts to get in the way of their day-to-day life. “We all get anxious at times, but some children seem to live a life of anxiety, where it’s not short-term and it’s not just an occasional thing,” says Paul Stallard, Professor of Child and Family Mental Health at the University of Bath.

“If you go into any school at exam time all the kids will be anxious but some may be so anxious that they don’t get into school that morning,” says Professor Stallard. “Some will sit in an exam and their mind freezes and they can’t get anything down on paper. This is when anxiety starts to interfere with what children need to do or would like to do in everyday life.”

Severe anxiety like this can harm children’s mental and emotional wellbeing, affecting their self-esteem and confidence. They may become withdrawn and go to great lengths to avoid things or situations that make them feel anxious.

What are the signs of anxiety in children?

When young children feel anxious, they cannot always understand or express what they are feeling. You may notice that they become irritable, tearful, clingy or have difficulty sleeping. They may wake in the night, start wetting the bed or have bad dreams.

In older children you may notice that they:

  • lack the confidence to try new things or seem unable to face simple, everyday challenges
  • find it hard to concentrate
  • have problems with sleeping or eating
  • are prone to angry outbursts
  • have negative thoughts going round and round their head, or keep thinking that bad things are going to happen
  • start avoiding everyday activities, such as seeing friends, going out in public or attending school

See more about the physical symptoms of anxiety.

Why is my child anxious?

Some children are more prone to worries and anxiety than others. Children often find change difficult and may become anxious following a house move or when starting a new school. Children who have experienced a distressing or traumatic experience, such as a car accident or house fire, may suffer with anxiety afterwards. Family arguments and conflict can also leave children feeling insecure and anxious.

Teenagers are more likely to suffer with social anxiety than other age groups, avoiding social gatherings or making excuses to get out of them. “At this age, the good opinion of your peer group is essential,” says Professor Stallard. “The fear is that, if you don’t like the same music or clothes, you will stand out as different and might be ridiculed or not accepted.”

How to help your anxious child

If a child is experiencing anxiety, there is plenty parents and carers can do to help.

First and foremost, it’s important to talk to your child about their anxiety or worries. Reassure them and show them you understand how they feel. If your child is old enough, it may help to explain what anxiety is and the physical effects it has on our bodies. It may be helpful to describe anxiety as being like a wave that builds up and then ebbs away again.

As well as talking to your child about their worries and anxieties, it’s important to help them find solutions, says Professor Stallard. “No one likes to see their child anxious and the tendency is to say, if you’re worried about that sleepover, don’t go. But what you’re doing is saying, if you get anxious about something, it means you can’t do it.

“It’s more helpful to say,’ I hear that you’re worried about this. What can you do that’s going to help?’,” says Professor Stallard. “Focus on exploring solutions with your child, instead of just rehearsing their worries and talking about all the things that could go wrong. Acknowledge your child’s worries, but then help them plan ways to cope with them.”

With younger children you can work together to develop these skills and strategies. “For example, you could say, ‘I’ll take you to the party, knock on the door and talk to the mum or dad, then you can give your friend their present’,” says Professor Stallard. “But as children get older they have to learn these skills and strategies themselves. People can’t be there to sort them out all the time.”

Other ways to ease anxiety in children

  • Teach your child to recognise signs of anxiety in themselves and to ask for help when it strikes.
  • Children of all ages find regular routines reassuring so, if your child is feeling anxious, try to stick to regular daily routines where possible.
  • If your child is anxious because of distressing events, such as a bereavement or separation, see if you can find books or films that will help them understand their feelings.
  • If you know a change, such as a house move is coming up, prepare your child by talking to them about what is going to happen and why.
  • Try not to become anxious yourself or overprotective – rather than doing things for your child or helping them to avoid anxiety provoking situations, encourage your child to find ways to manage them.
  • Practice simple relaxation techniques with your child, such as taking three deep, slow breaths, breathing in for a count of three and out for three.
  • Distraction can be helpful for young children. For example, if they are anxious about going to nursery, play games on the way there, such as seeing who can spot the most red cars. “This is a way of focusing attention away from internal anxiety cues and worries to external, more neutral anxiety-reducing things,” says Professor Stallard.
  • Turn an old tissue box into a ‘worry’ box. Get your child to write down or draw their worries and post them into the box. Then you can sort through the box together at the end of the day or week.

When should we get help?

If your child’s anxiety is severe, persists and interferes with their everyday life, it’s a good idea to get some help. Some children do grow out of anxiety but, if it’s not addressed in childhood, it can continue into adulthood.

A visit to your GP is a good place to start. If your child’s anxiety is affecting their school life, it’s a good idea to talk to their school as well.

Parents and carers can get help and advice around children’s mental health from Young Minds' free parent helpline on 0808 802 5544 (Monday to Friday, 9.30am-4pm).

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 19/09/2017 10:51:19