Generalised Anxiety Disorder (GAD)

Generalised Anxiety Disorder

What Is Generalised Anxiety Disorder?

Generalised anxiety disorder (GAD) is a type of anxiety disorder where a person may feel chronic and excessive worry. The symptoms could negatively impact daily functioning and social life. 

In other types of anxiety disorders, such as social anxiety (which occurs in social situations), GAD manifests as a constant state of worry and fear. 

GAD occurs in a range of issues, such as:

The diagnostic criteria for GAD mention that the symptoms should last for over six months. These specific criteria are important to evaluate other physical and mental health conditions. 

GAD can manifest at any age, although a significant proportion experience onset during childhood or adolescence. The condition often coexists with other mental health disorders and may be triggered by stressful life events. 

While GAD is often a chronic condition, its impact on daily life can vary in severity. 

If you suspect you are experiencing symptoms of GAD, consult a professional Therapist for a personalised therapeutic plan.

Generalised Anxiety Disorder Symptoms

Generalised anxiety disorder manifests psychologically and physically, each with its own symptoms. 

Psychological Symptoms of GAD

Physical Symptoms of GAD

Generalised Anxiety Disorder Causes

GAD arises from a complex interplay of biological, psychological, and environmental influences. While its exact cause remains elusive, it is widely accepted that a blend of these factors contributes to its onset and progression.

Biological and Psychological Causes

Both biological (ie genes) and psychological factors can contribute to the causes of GAD. 

People with a family history of anxiety disorders (eg social anxiety)  are more likely to develop GAD. 

Additionally, imbalances in the neurotransmitters (eg serotonin and dopamine) could also cause generalised anxiety disorder. For example, menstruators may usually have GAD, as irregular menstrual cycles may cause imbalances in serotonin. 

Psychological factors, such as cognitive distortions (ie unrealistic beliefs) and maladaptive coping mechanisms, can increase the symptoms.

For example, people with the cognitive distortion called ‘catastrophising’ or ‘black-and-white thinking’ may worry excessively about various things such as finances, physical appearance, what other people think about them, and so on. 

Catastrophising is the tendency to imagine and fixate on the worst possible outcomes in a situation.

Black-and-white thinking, also known as all-or-nothing thinking, is when people view viewing in extreme, either/or categories. If a student scores less on an exam, they might believe that they are worthless.

Both cognitive distortions can contribute to emotional distress or GAD.

Other Causes

Environmental triggers, including high-stress situations or traumatic events, can cause GAD. Occupational stress, relationship issues, or financial instability can all contribute to the onset of symptoms.

Lastly, societal and cultural norms can indirectly influence GAD. Societies that place high value on achievement and productivity may inadvertently create conditions that lead to anxiety disorders.

For example, hustle culture glorifies ceaseless work and equates productivity with self-worth. Individuals may feel immense pressure to succeed at all costs.

The constant message that “time is money” can lead people to overwork themselves, neglect self-care, and perpetually worry about falling behind. This societal norm can exacerbate or even trigger GAD.

Generalised Anxiety Disorder Treatment

Some of the effective treatment plans for GAD involve a combination of cognitive-behavioural therapy (CBT) and medications. 

Additionally, lifestyle changes, such as regular exercise and mindfulness techniques, can also help manage the symptoms. 


Psychotherapy is also known as talk therapy. Online psychotherapy in Singapore is especially helpful as you can benefit from professional support from the comfort of your home. 

Research shows that CBT, in particular, is a structured and scientific tool that can help reduce or manage the symptoms of GAD. 

In other words, CBT helps identify the exact causes of your anxiety (whether it is negative experiences, negative thoughts, or environmental factors). Furthermore, you can also learn effective tools and skills to manage your symptoms independently.

Cognitive Behavioural Therapy (CBT)

CBT is an evidence-based treatment and is often the first line of intervention for GAD. The therapy is structured around the premise that thoughts, feelings, and behaviours are interconnected. 

By identifying and challenging irrational thought patterns, you can alter your emotional responses and behaviours, thereby reducing anxiety.

In a typical CBT session for GAD, the therapist first works with the client to identify specific triggers and thought patterns that trigger anxiety. For example, if you constantly worry about losing your job, the therapist will help you dissect this fear, breaking it down into its constituent thoughts, such as, “If I make a mistake, I’ll be fired.”

Once these thought patterns are identified, the next step is cognitive restructuring. The therapist guides you in challenging and replacing these irrational beliefs with more balanced thoughts. 

In the job loss example, a more balanced thought could be, “Everyone makes such mistakes; they are not grounds for termination.” 

The ultimate goal of CBT is to equip you with self-sustaining skills. Homework assignments between sessions often include journaling your thoughts, emotions, and behaviours or practising relaxation strategies like deep breathing or progressive muscle relaxation.

Relaxation Techniques

A certified therapist conducts relaxation techniques such as mindfulness-based therapeutic approaches.

During mindfulness therapy, you may:

  • Engage in progressive muscle relaxation (eg focusing and relaxing specific parts of the body in a structured way)
  • Use cue-controlled relaxation (eg using a specific word or action to trigger immediate relaxation)
  • Learn how to use these techniques when you have anxiety outside therapy sessions

TYHO clients usually opt for weekly sessions over 3 or 4 months. This consistency can help improve the therapeutic alliance and progress.


Medications for generalised anxiety disorder offer a range of options tailored to individual needs. Your psychiatrist can guide you through it, considering factors such as symptom severity, coexisting conditions, and lifestyle.

Two primary categories of medications are commonly used: Selective Serotonin Reuptake Inhibitors (SSRIs) and Benzodiazepines. 

Doctors often recommend SSRIs like fluoxetine or sertraline for long-term management. They aim to balance neurotransmitters in the brain, thereby reducing anxiety symptoms. However, they may take several weeks to become fully effective.

Benzodiazepines such as lorazepam offer quicker relief but are generally prescribed for short-term usage due to the potential for dependency.

Your psychiatrist will discuss:

  • Types of medications suitable for you.

  • Duration of the treatment plan.
  • Possible side effects and interactions with other medications you may be taking.
  • Recommendations if you are pregnant, planning to conceive, or breastfeeding.

Regular follow-up appointments are crucial for monitoring your progress and making necessary adjustments. Typically, these occur every 2 to 4 weeks initially, transitioning to every three months after that.

If you experience side effects, consult your healthcare provider promptly for possible dosage modification or alternative medication options.

Diagnosing Generalised Anxiety Disorder

Therapists diagnose GAD using a comprehensive approach (ie identifying and addressing issues in personal, social, and professional life). 

During the initial session, your psychologist may conduct diagnostic testing or evaluation. During the testing, they may ask you a set of questions to better understand your problems and your personality. 

Your psychologist may use a standardised questionnaire to confirm a GAD diagnosis.

Some of the areas you may be expected to talk about include:

  • Your childhood experiences
  • Your mental health history
  • Medical history 
  • Family history 
  • Current and past relationship
  • Social support
  • Hobbies and interests

The assessments may have several open-ended or close-ended questions. At times, the therapist may also wish to talk to any trusted family member or guardian to assess how you react to situations around you.

Overcoming GAD

Overcoming GAD could involve support from several different areas, such as psychotherapy, medication, and self-care. 

Read the next section for more in-depth information about the three most important self-care tools: Problem-solving, mindfulness, and exercise.

Problem Solving

Problem-solving is a cognitive technique that shifts your focus from worrying or overthinking to actionable and realistic solutions. 

Below are some tips you can follow to solve problems:

Step One: Identify the Problem

Be specific about what is causing your anxiety. Instead of saying, “I’m anxious about work,” you could say, “I’m anxious about meeting the project deadline next week.”

Step Two: Think of Solutions

List all possible solutions without judgement or worry.

Step Three: Evaluate Options

Assess each solution for its advantages and disadvantages. 

Step Four: Choose a Solution

Think of a solution that is both practical and achievable in the short term. This might give you immediate relief and increase your confidence in solving the problem. 

Step Five: Develop an Action Plan

Detail the steps for implementing your solution. Include a timeline, required resources, and plans for any obstacles.

Step Six: Monitor and Revise

After using your strategy, reflect on how well your plan worked out. If necessary, make adjustments or try an alternative solution.


Firstly, mindfulness encourages a heightened awareness of the present moment, allowing you to disengage from habitual, unsolicited and anxiety-provoking thoughts.

Moreover, relaxation techniques, for example, focused breathing and body scanning, serve dual purposes: they not only induce a state of physical relaxation but also facilitate cognitive restructuring. 

Consequently, you create a mental space where anxiety reduces by consistently directing your attention to your breath or bodily sensations. In doing so, it helps make room for more healthy thinking patterns.

Furthermore, recent neuroscientific research on functional magnetic resonance imaging (fMRI) reveals that mindfulness practices can rewire neural pathways, reducing long-term anxiety. 

Specifically, mindfulness has been shown to decrease activity in the amygdala, the brain’s ‘fear centre,’ while enhancing activity in areas responsible for cognitive control.

To integrate mindfulness into your GAD management strategy, consider starting with a daily 10-minute session of focused breathing or guided meditation. Apps and online platforms offer a plethora of resources to guide you through these exercises. 

Consistency is key. The benefits of relaxation strategies increase over time, offering a sustainable and effective approach to managing your symptoms.


Try to include exercises in your routine. 

As a matter of fact, scientific studies indicate that exercise can significantly impact your mental well-being. 

For example, they suggest this impact happens in several different areas:

  • Neurotransmitter regulation: Regular physical activity has been shown to elevate serotonin levels (ie ‘feel-good hormone). This increase helps regulate mood shifts and extreme emotions. 
  • Cortisol reduction: Exercise helps regulate cortisol, which is the body’s primary stress hormone. Lower cortisol levels contribute to a calmer mental state.
  • Cognitive reappraisal: Exercise provides a solid outlet for stress. This cognitive shift (from focusing on mental energy to concentrating on physical energy) can help you break the cycle of persistent worry and anxious thoughts.
  • Improved sleep quality: Regular exercise can lead to better sleep patterns.  

20-30 minutes of movement per day is all it takes to notice positive changes in your life after a few weeks! 

Frequently Answered Questions

Is generalised anxiety serious?

GAD is more than just everyday worry; it is a medical issue that requires serious attention. 

The persistent, excessive anxiety can significantly hinder daily functioning, leading to difficulties in concentration and decision-making. 

This often results in decreased work performance and strained interpersonal relationships.

Moreover, GAD elevates the risk of developing other psychological issues, like depression, anxiety, obsessive-compulsive disorder, and even suicidal tendencies. It is also not uncommon for individuals with GAD to also suffer from phobias or panic disorders.

It impacts physical health equally. Researchers link GAD to a range of conditions, including digestive issues like irritable bowel syndrome, chronic pain, and sleep disturbances.

Given its pervasive impact on both mental and physical well-being, it is crucial to consult mental health professionals for diagnosis and treatment options tailored to individual needs. 

Early intervention and support can significantly increase the chances of managing symptoms and improving quality of life.

How to distinguish GAD from other mental health conditions?

People often confuse generalised anxiety disorder with other mental health conditions because of overlapping symptoms.

Unlike situational anxiety, which is triggered by specific events, GAD manifests as a constant, pervasive worry about multiple aspects of life, often without a discernible cause. This worry persists for six months or more, affecting daily functioning and quality of life.

In contrast, conditions like depression primarily include feelings of sadness or hopelessness, although anxiety may be a secondary symptom. Phobias involve intense, irrational fears centred around specific objects or situations, not the generalised worry characteristic of GAD. 

Obsessive-Compulsive Disorder (OCD) may also have anxiety symptoms, however, repetitive behaviours or thoughts aimed at reducing that anxiety distinguish it.

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