At some point in one’s life, anxiety may be something they may have the deal with. Generalised Anxiety Disorder is a chronic condition that causes one to feel anxious about different situations and issues, rather than one specific event. According to the Diagnostic and Statistical Manual of Mental Disorders (2013), Generalised anxiety disorder (GAD) is an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. This article will explore what General Anxiety Disorders are and how they may affect an individual in the workplace.
Causes of generalised anxiety disorders
The exact causes of General Anxiety Disorders are not fully understood, although it is probable that a combination of several factors plays a role. Genes are said to contribute about a third of general anxiety disorder (Hettema, Neale & Kendler, 2001). An individual is estimated to be 5 times more likely to develop GAD if they have a close relative with the condition. This anxiety could be in particular response to a stressor one may encounter.
Generalised anxiety disorders may also be induced by substance abuse. Prolonged use of benzodiazepines may worsen underlying anxiety, with evidence, however, that reduction of benzodiazepines can lead to a reduction of anxiety symptoms (Graham, Lindsay & Powell, 1998). Similarly, long-term consumption of alcohol is related to anxiety disorders, with evidence that prolonged abstinence may result in a disappearance of anxiety symptoms (Junghanns & Wetterling, 2000). Nonetheless, it can take up to two years for anxiety symptoms to return to normal in about a quarter of people recovering from alcoholism (Cohen, 1995).
In a study conducted in 1988–1990, illness in approximately half of the patients attending mental health services at British hospital psychiatric clinics, for conditions such as panic disorder or social phobia, was determined to be the result of alcohol or benzodiazepine dependence (Cohen, 1995). In these patients, anxiety symptoms worsened during the withdrawal phase, and gradually disappeared when they stopped taking benzodiazepines or alcohol.
Generalised anxiety disorder symptoms
GAD is a common condition, estimated to affect up to 5% of the UK population (Cohen, 1995). Slightly more women are affected than men, and the condition is more common in people from the ages of 35 to 59 (Hettema, Neale & Kendler, 2001). Generalised anxiety disorder symptoms vary from person to person. Some people may have only 1 or 2 symptoms, while others have a lot more. GAD can cause a change in an individual’s behaviour and the way they think and feel about things, resulting in symptoms such as:
- Persistent worrying or anxiety about several areas that are out of proportion to the impact of the events.
- Overthinking plans and solutions to all possible worst-case outcomes.
- Perceiving situations and events as threatening, even when they are not.
- Difficulty handling uncertainty.
- Indecisiveness and fear of making the wrong decision.
- Inability to set aside or let go of a worry.
- Inability to relax, feeling restless, and feeling keyed up or on edge.
- Difficulty concentrating, or the feeling that your mind "goes blank".
- Trouble sleeping
- Muscle tension or muscle aches
- Trembling, feeling twitchy
- Nervousness or being easily startled
- Nausea, diarrhoea or irritable bowel syndrome
- A noticeably strong, fast or irregular heartbeat (palpitations)
Generalised anxiety disorders at work
Having an anxiety disorder can make a major impact in the workplace. People may turn down a promotion or other opportunity because it involves travel or public speaking; make excuses to get out of office parties, staff lunches, and other events or meetings with co-workers; or be unable to meet deadlines. In a national survey on anxiety in the workplace by the Anxiety Disorders Association of America (2006), people with anxiety disorders commonly cited these as difficult situations: dealing with problems; setting and meeting deadlines; maintaining personal relationships; managing staff; participating in meetings, and making presentations.
Job stress has professional consequences. On the job, employees say stress and anxiety most often impact their:
Workplace performance (56 %)
Relationship with co-workers and peers (51 %)
Quality of work (50 %)
Relationships with superiors (43 %) (Anxiety Disorders Association of America, 2006),
Treatment options for generalised anxiety disorders
Treatment for generalised anxiety disorders is based on how the condition is affecting one’s ability to function in daily life. The two main treatments for generalized anxiety disorder are psychotherapy and medications. A sufferer may also benefit from a combination of the two. It has been noted that Cognitive Behavioural Therapy (CBT) is significantly more effective in reducing depression severity, and its effects are more likely to be maintained in the long term, whereas the effectiveness of medications tends to lessen if medication is discontinued (Gould, et.al., 1997).
Cognitive Behavioural Therapy
CBT is a psychological method of treatment that involves a therapist working to understand how a person’s thoughts and feelings influence behaviour. Components of the therapy include exposure strategies to allow the patient to confront their anxieties gradually and feel more comfortable in anxiety-provoking situations. They are also able to practice the skills they have learned. CBT can be used alone or in conjunction with medication.
Components of CBT in treatment of GAD include psycho-education, self-monitoring, stimulus control techniques, relaxation, self-control desensitization, cognitive restructuring, worry exposure, worry behaviour modification, and problem-solving. The first step in the treatment of GAD is informing the patient about the issues and the plan of the solution. The purpose of psycho-education is to provide some relief, de-stigmatization of the disorder, motivation, and accomplishing participation by making the patient understand the program of treatment.
The purpose of the treatment program is to identify signals that provoke the anxiety in the patient. Stimulus control intervention refers to minimizing the stimulus conditions under which worrying occurs. Relaxation techniques lower the patients' stress and thus increase attention to alternatives in feared situations (other than worrying). Deep breathing exercise, progressive muscle relaxation, and applied relaxation fall under the scope of relaxation techniques (Hoyer, van der Heiden, Portman, 2011).
The preferred medications in the treatment of GAD are selective serotonin reuptake inhibitors (SSRIs) (80%), followed by serotonin-norepinephrine reuptake inhibitors (SNRIs) (43%), and pregabalin (35%). Preferred second-line treatments were SNRIs (41%) and pregabalin (36%). (Baldwin, et.al., (October 2012).
Antidepressants, including medications in the selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) classes, are the first-line medication treatments. Examples of antidepressants used to treat generalized anxiety disorder include escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva).
An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective.
In limited circumstances, doctors may prescribe a benzodiazepine for relief of anxiety symptoms. These sedatives are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these medications aren't a good choice if one has had problems with alcohol or drug abuse.
Generalised anxiety disorders may affect the way one lives on a daily basis. They may affect how they relate to others in the workplace and generally one’s quality of work. The good news though, is that this condition is treatable, and this treatment may lead to a better quality of life.
Lindah Mavengere is a Business Consultant at Industrial Psychology Consultants (Pvt) Ltd, a business management and human resources consulting firm.
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Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C.: American Psychiatric Association. 2013. p. 222. ISBN 978-0-89042-554-1.
Hettema, J. M.; Neale, MC; Kendler, KS (2001). "A Review and Meta-Analysis of the Genetic Epidemiology of Anxiety Disorders". American Journal of Psychiatry. 158 (10): 1568–78
Lindsay, S. J. E.; Powell, Graham E., eds. (28 July 1998). The Handbook of Clinical Adult Psychology (2nd ed.). Routledge. p. 173
Wetterling, T; Junghanns, K (2000). "Psychopathology of alcoholics during withdrawal and early abstinence". European Psychiatry. 15 (8): 483–8.
Cohen, SI (1995). "Alcohol and benzodiazepines generate anxiety, panic and phobias". Journal of the Royal Society of Medicine. 88 (2): 73–7.
Gould, Robert A.; Otto, Michael W.; Pollack, Mark H.; Yap, Liang (1997). "Cognitive-behavioural and pharmacological treatment of generalized anxiety disorder: A preliminary meta-analysis". Behaviour Therapy. 28 (2): 285–305
Hoyer, Jürgen; van der Heiden, Colin; Portman, Michael E. (February 2011). "Psychotherapy for Generalized Anxiety Disorder". Psychiatric Annals. 41 (2): 87–94
Baldwin, DS; Allgulander, C; Bandelow, B; Ferre, F; Pallanti, S (October 2012). "An international survey of reported prescribing practice in the treatment of patients with a generalised anxiety disorder". The World Journal of Biological Psychiatry. 13 (7): 510–6.
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