Mar 18, 2025
Generalized Anxiety Disorder: Symptoms, Causes, and Treatment
Do you find yourself worrying constantly, even when there’s no clear reason to? Generalized Anxiety Disorder (GAD) can feel like an endless loop of unease, tension, and persistent "what if" thinking. Unlike situational stress, GAD involves anxiety that spreads across many areas of life and is difficult to manage.
At Midpoint Counseling, we understand how overwhelming this kind of worry can be. This guide will help you understand what GAD is, what causes it, and most importantly, how to treat it effectively.
QUICK FACTS
- GAD typically develops gradually over several years, not suddenly.
- Worry is often used as an ineffective strategy to manage uncertainty.
- Treatment focuses on building tolerance to feelings of uncertainty and discomfort.
- GAD is a very treatable mental health condition.
CORE CONCEPTS
What is Generalized Anxiety Disorder?
Generalized Anxiety Disorder (GAD) is a difficulty managing feelings of uncertainty across many different parts of your life. This typically feels like being constantly keyed up, on edge, or tense.
Essential Features of GAD:
Excessive worry about a variety of issues
Worries are hard to control
Present most days for 6+ months
Interferes with work, school, family, social, or leisure time
Muscle tension, fatigue, and other bodily aches
Negatively affects mood, concentration and sleep
When these conditions are met, the anxiety is considered to have become “disordered.”
About 5.7% of adults in the U.S. experience generalized anxiety disorder at some point in their lives.1
GAD appears to come on gradually over the course of several years rather than suddenly, so it can be difficult to detect when it first starts becoming a problem.
Most of the time it’s apparent by early adulthood, but there are also childhood factors associated with its later development.2 Sensitivity to negative emotion and difficulty managing it are examples of such factors.
GAD tends to be chronic and can last for many years if it’s not treated. Although the severity may decrease as one gets older, the longer it goes untreated the greater the risk of developing other issues like depression.
Midpoint Counseling provides anxiety treatment for adults across Washington. Reach out today for more info.
THE SCIENCE BEHIND ANXIETY
Biological Factors that Contribute to GAD
Although there’s no brain scan that can diagnose anxiety disorders, research has identified biological factors associated with GAD:
Variations in the body’s serotonin transporter gene. This is linked to hyperactivity of the brain’s “fear network,” which contributes to anxious thinking and hypervigilance.3, 4
Reduced ability of the peripheral nervous system to return to baseline levels after a stressful event. This makes it harder to adapt to stressors compared to non-anxious people.5
Increased inflammation in the brain and a decreased ability for it to repair itself after the wear and tear of stress.6
Brain chemistry and genetics influence anxiety, but they aren’t its only causes.
CONTEXTUAL INFLUENCES ON GAD
Environmental Factors in Generalized Anxiety
Environmental factors include everything that happens around the body that influence anxiety. The following are common experiences associated with the development of generalized anxiety disorder:
Experiences in utero before you were born
Childhood upbringing
Stress in the family
Trauma history
Personal relationships
Sociopolitical factors
Personality development
The brain develops into your 20s7, making it vulnerable to the effects of stress for a long time.
Chronic stress in the environment takes a heavy toll on the body, and when it’s not resolved it changes how the nervous system responds to new uncertain or ambiguous situations. This can lead to a prolonged cycle of worry and unease that’s hard to manage without help.
THE TRAP OF MENTAL OVERPLANNING
Why Worry Feels Productive
Worry, unlike problem solving, is unstructured and chaotic. The problem is that it’s hard to tell the difference when we’re feeling anxious! We feel productive in all our thinking, but get nowhere.
Worry can feel like problem-solving, but provides only an illusion of control.
The rationale is that if we think about the uncertain situation enough, we’ll eliminate the uncertainty! If we contemplate the future enough, we’ll figure it out! And if we’re vigilant enough, we won’t be caught off guard!
Rather than resolving problems, worry reinforces anxiety.
The future is never as knowable as we’d like. If we do happen to “figure things out,” it’s only at a great personal cost to our time, energy, and emotional resources. And the relief only lasts until the next situation forces us to start all over. We never feel more confident in our abilities or better equipped to handle the unknown.
Midpoint Counseling provides in-person and virtual therapy for generalized anxiety. Contact us to learn how we can help.
EVIDENCE-BASED APPROACHES TO GAD
3 Targets for Treating Generalized Anxiety
There are three core targets for treating generalized anxiety disorder. Those who work to let go of worry as a strategy and aim for these targets are much more likely to experience relief compared to those who don’t.
1. Build your tolerance for uncertainty.
The goal is flexibility that allows you to continue doing meaningful things without needing to have all the answers. When you don’t have this, life becomes about eliminating ambiguity, rigidly controlling situations, fixating on negative possibilities, and over-preparing to prevent their occurrence. Intolerance of uncertainty and overestimations of risk are at the heart of most issues with anxiety and why they’re so important to bring within healthy limits.
2. Increase your tolerance for discomfort.
This is the most researched factor underlying all problems managing anxiety. It refers to your personal threshold for being with uncomfortable physical and emotional sensations before interpreting them as bad or in need of attention. The lower your threshold, the more fixated you’ll be on signals from your body rather than building mastery over the situation that caused the trouble.
3. Strengthen your confidence in your abilities.
Difficulties navigating feelings of uncertainty and discomfort can naturally bring doubt to your abilities to cope. If you don’t trust that you can handle certain challenges, it becomes harder to risk new healthy behavior. This target involves cultivating your power and influence over problematic anxiety so that you no longer have to resort to worry, avoidance, or other unhelpful strategies.
RELIEF STARTS WITH THE RIGHT SUPPORT
How Therapy Helps with Generalized Anxiety Disorder
Anxiety can be tough to manage on your own! That’s where the help of a trained therapist comes in. While there are many approaches to these problems, some have more evidence supporting their efficacy than others.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is currently considered one of the most effective treatments for adult anxiety disorders.8
CBT consists of scientifically informed interventions that help by:
Supporting greater understanding and empathy for current challenges
Addressing thoughts that have been distorted by GAD
Providing strategies to manage discomfort and uncertainty
Promoting behavior changes that support long-term recovery
In 2020, the American Medical Association published an analysis of 69 trials on the long-term outcomes of CBT on anxiety-related disorders. These were then compared to the outcomes from supportive therapy, relaxation training, psychoeducation, and placebo medication. This was over 4,000 people who were observed over time, and after 12 months post-treatment, anxiety symptoms were still lower in those who received CBT compared to the other treatments.9
The response rate of generalized anxiety disorder to CBT across published studies lies between 47% and 75%, making it one of the most treatable mental health conditions.10
FINDING SUPPORT
Break Free From Worry
Breaking free from chronic tension and unease means aiming for new targets. New skills and strategies for responding to the uncertainties of life can help bring anxiety that’s gotten out of hand back under healthy control. If you’ve been struggling with worry, consider reaching out to us at Midpoint Counseling. We’re here to help you find greater balance and freedom from the overwhelming symptoms of generalized anxiety.
References:
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Generalized Anxiety Disorder. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/generalized-anxiety-disorder
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Lijster, J. M., Dierckx, B., Utens, E. M., Verhulst, F. C., Zieldorff, C., Dieleman, G. C., & Legerstee, J. S. (2017). The Age of Onset of Anxiety Disorders. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 62(4), 237–246. https://doi.org/10.1177/0706743716640757
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Lonsdorf, T. B., & Kalisch, R. (2011). A review on experimental and clinical genetic associations studies on fear conditioning, extinction and cognitive-behavioral treatment. Translational psychiatry, 1(9), e41. https://doi.org/10.1038/tp.2011.36
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Klucken, T., Alexander, N., Schweckendiek, J., Merz, C. J., Kagerer, S., Osinsky, R., Walter, B., Vaitl, D., Hennig, J., & Stark, R. (2013). Individual differences in neural correlates of fear conditioning as a function of 5-HTTLPR and stressful life events. Social cognitive and affective neuroscience, 8(3), 318–325. https://doi.org/10.1093/scan/nss005
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Hoehn-Saric, R., & McLeod, D. R. (1988). The peripheral sympathetic nervous system. Its role in normal and pathologic anxiety. The Psychiatric clinics of North America, 11(2), 375–386.
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Hou, R., Garner, M., Holmes, C., Osmond, C., Teeling, J., Lau, L., & Baldwin, D. S. (2017). Peripheral inflammatory cytokines and immune balance in Generalised Anxiety Disorder: Case-controlled study. Brain, behavior, and immunity, 62, 212–218. https://doi.org/10.1016/j.bbi.2017.01.021
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Arain, M., Haque, M., Johal, L., Mathur, P., Nel, W., Rais, A., Sandhu, R., & Sharma, S. (2013). Maturation of the adolescent brain. Neuropsychiatric disease and treatment, 9, 449–461. https://doi.org/10.2147/NDT.S39776
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Otte C. (2011). Cognitive behavioral therapy in anxiety disorders: current state of the evidence. Dialogues in clinical neuroscience, 13(4), 413–421. https://doi.org/10.31887/DCNS.2011.13.4/cotte
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van Dis, E. A. M., van Veen, S. C., Hagenaars, M. A., Batelaan, N. M., Bockting, C. L. H., van den Heuvel, R. M., Cuijpers, P., & Engelhard, I. M. (2020). Long-term Outcomes of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Systematic Review and Meta-analysis. JAMA psychiatry, 77(3), 265–273. https://doi.org/10.1001/jamapsychiatry.2019.3986
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Bandelow, B., Boerner J, R., Kasper, S., Linden, M., Wittchen, H. U., & Möller, H. J. (2013). The diagnosis and treatment of generalized anxiety disorder. Deutsches Arzteblatt international, 110(17), 300–310. https://doi.org/10.3238/arztebl.2013.0300
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Jason Peruchini, LMFT
Jason Peruchini is a licensed psychotherapist and anxiety treatment professional who helps people address issues in mental health to live better lives.
