Problems that Usually Need Psychotherapy or Psychiatry Treatment

Generalized Anxiety Disorder or GAD

Many people are chronically or constantly anxious, regardless of their life circumstances. This condition is called Generalized Anxiety Disorder, or GAD. People with GAD may feel anxious because of big problems, small problems, or no problems. With some sufferers the anxiety is focused on specific worries, with others the anxiety may be diffuse and may not be related to any particular concern. People with GAD generally have high baseline anxiety, meaning anxiety under normal circumstances, and their anxiety can rise to extreme levels when serious problems and stresses arise. This condition is quite painful and people who have it have often been suffering from it since childhood or adolescence. People with GAD also have a heightened risk of depression and of other anxiety disorders (as described above), and of abuse of substances such as alcohol or benzodiazepines that help them relax for a little while.

GAD is distinct from the other anxiety disorders because the anxiety is generalized rather than focused on specific targets. Emotional reactions to specific experiences are often learned and can therefore be unlearned, but more general emotional states that are not caused by immediate circumstances frequently have deeper causes. GAD can be biochemical and in such cases medications can be extremely helpful and in fact essential, and we recommend that GAD sufferers see a psychiatrist for a medication consult, especially if they also are experiencing depression.

Deeper causes can also be related to early experiences in life, of course, and psychotherapy can help greatly with such problems. A very rough rule for GAD sufferers to follow is that if you were loved and liked by family and friends and did not have many negative experiences during childhood, then the GAD may well be biochemical and you may primarily need medication.  However, if your childhood or adolescence was unhappy due to unhealthy and damaging relationships then psychotherapy is probably needed. Medication and psychotherapy are not mutually exclusive, however, and in many cases both are needed and both are helpful.

Generalized anxiety and depression are very common, frequently occur together, and often have similar causes that go back to earlier periods in life. For this reason, psychotherapy for GAD is covered in the section Psychotherapy for Anxiety and Depression.

Thomas B. Hollenbach, Ph.D.

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