Generalised anxiety disorder (GAD): when worry won’t switch off

Generalised anxiety disorder (GAD) is a common mental health condition where you feel anxious about lots of different things, much of the time, and find the worry hard to control. The NHS explains that it is more likely to be GAD if you feel anxious most of the time and it affects your everyday life. It often comes with physical symptoms such as tension, tiredness and poor sleep. GAD is treatable, and talking therapies such as cognitive behavioural therapy (CBT) are usually recommended first.

Key points

• Everyone worries sometimes. GAD is when worry is frequent, wide-ranging and difficult to control, and it affects daily life.
• The Royal College of Psychiatrists estimates that GAD affects around 1 in 25 people in the UK.
• Common symptoms include restlessness, poor concentration, irritability, tiredness, muscle tension and trouble sleeping.
• Worry can feel helpful or protective, which is part of why it is hard to let go of.
• NICE recommends CBT or applied relaxation, and in England you can refer yourself to NHS Talking Therapies.
• See your GP if you think you might have GAD, or if treatment is not helping.

What is generalised anxiety disorder?

Anxiety is a normal human response to threat or uncertainty. It can sharpen your focus before an exam or prompt you to deal with a problem. The Royal College of Psychiatrists notes that anxiety becomes a problem when it is very strong, goes on all the time, or gets in the way of daily life.

With GAD, the worry is not about one particular thing. It might move from your health to your family, from money to work, from something you said yesterday to something that might happen next year. As soon as one worry settles, another can take its place. The Royal College of Psychiatrists describes worries in GAD as often out of proportion to the situation and hard to control.

The NHS says a GP may diagnose GAD if you often worry about a wide range of things, the anxiety affects your daily life, you find the feelings hard to control, and you have felt anxious much of the time for at least 6 months. Only a health professional can make a diagnosis, but you do not need a diagnosis to seek support.

What are the symptoms of GAD?

The NHS lists the main symptom as feelings of stress or worry that affect your daily life and are difficult to control. Other symptoms may include:

• Difficulty sleeping.
• Feeling restless or irritable, or finding it hard to concentrate.
• Getting tired easily.
• Feeling tense.
• Stomach problems.
• A more noticeable or unusual heartbeat (palpitations).
• Feeling lightheaded or dizzy.
• Low mood or depression.

The Royal College of Psychiatrists adds a sense of dread, as if something awful is about to happen. It also notes that physical symptoms can lead people to fear they have a physical illness, which then adds to the anxiety. If that pattern is familiar, our guide on health anxiety may be useful. Any new or changing physical symptoms are worth checking with your GP.

The NHS also notes that it is common to have more than one type of anxiety at the same time, such as GAD alongside panic attacks or a specific phobia.

What causes GAD?

There is usually no single cause. The NHS lists factors that can make GAD more likely, including having another anxiety disorder, close relatives with anxiety or other mental health conditions, stressful or traumatic experiences such as bullying, a painful long-term health condition, and a history of drug or alcohol misuse. The Royal College of Psychiatrists describes GAD as coming from an interaction of genes, life experiences and current circumstances, with everyday stresses and major life events both able to trigger anxiety.

Why won’t my worry switch off?

Worry is a way of trying to prepare for, or prevent, things going wrong. It can feel as if worrying keeps you ready, or as if you would be caught off guard if you stopped. At the same time, worry can feel exhausting and out of control. Holding both of these at once makes it very hard to put worry down.

Worry also tends to focus on “what if?” questions that cannot be answered in the present. Because there is no clear solution, the mind keeps circling, and the relief of a moment of reassurance does not last. This looping, going-nowhere quality is something many people with GAD recognise.

Avoidance can play a part too. The NHS advises against avoiding situations that make you anxious, and suggests slowly building up the time you spend in them, because avoiding things can keep anxiety going over time.

What can I do to help myself?

The NHS suggests things you can try, including:

• Talking about your feelings with a friend, family member, health professional or counsellor.
• Trying recommended self-help books, online tools or courses based on CBT.
• Learning to relax with calming breathing exercises, such as a short breathing exercise, or activities like yoga or pilates.
• Getting enough sleep, exercising regularly and eating regular meals.
• Cutting down on caffeine, which can disrupt sleep and make anxiety harder to manage.
• Focusing your energy on what you can influence, rather than on things you cannot change.

NHS Every Mind Matters also describes “worry time”: setting aside a short, regular slot each day to write down your worries and look at them, and gently postponing worries that pop up at other times until then. It can feel strange at first, but it gets easier with practice.

What treatment is available for GAD?

NICE sets out a stepped approach. For many people, the first steps are information, monitoring and low-intensity support such as guided self-help or psychoeducational groups. If GAD has not improved, or is having a significant effect on your life, NICE recommends a choice between a high-intensity psychological therapy or medication, based on your preference.

The psychological therapies NICE recommends for GAD are CBT and applied relaxation, usually around 12 to 15 weekly one-hour sessions. Medication, usually an SSRI antidepressant, is something to discuss with your GP. NICE advises that benzodiazepines should only be used as a short-term measure during a crisis.

In England, adults can refer themselves directly to NHS Talking Therapies without seeing a GP. Your GP can also help, and may refer you to a community mental health team if you need more specialist support.

How therapy with me can help

As an integrative psychotherapist registered with the BACP, I work with adults living with anxiety, including constant, hard-to-control worry. Using CBT-informed ideas, we can notice how your worry works, what it is trying to protect you from, and what keeps it going. Drawing on person-centred and psychodynamic approaches, we can also explore what lies underneath it, such as pressures from the past, a strong sense of responsibility or difficulty with uncertainty. Sessions are in Farringdon, Central London, or online, in English or Turkish.

If you are in crisis, call 999, go to A&E, call NHS 111, or contact Samaritans on 116 123 (free, 24/7).

If worry has been running your days for a while, you are welcome to get in touch to arrange an initial consultation. We can talk about what has been happening and whether working together feels right for you.