Generalised Anxiety Disorder (GAD): A Comprehensive Overview

Generalised Anxiety Disorder is characterised by excessive, uncontrollable worry about a wide range of everyday concerns — work, health, finances, relationships, and minor matters such as being late or forgetting tasks. Unlike specific phobias or panic disorder, where anxiety is focused on particular triggers, GAD involves a pervasive sense of apprehension and dread that colours virtually every aspect of daily life. The worry in GAD is experienced as difficult or impossible to control and is typically accompanied by physical symptoms including muscle tension, restlessness, fatigue, difficulty concentrating, irritability, and sleep disturbance.

GAD is one of the most common anxiety disorders, affecting approximately six per cent of the UK population at some point in their lives. It typically develops gradually, and many individuals with GAD describe themselves as having been "worriers" for as long as they can remember. Onset is most common in late adolescence or early adulthood, although it can develop at any age. GAD is frequently comorbid with depression, and the two conditions share many symptoms, particularly fatigue, concentration difficulties, and sleep problems.

The cognitive model of GAD, developed by Adrian Wells, identifies two types of worry: Type 1 worry (worry about external events and daily concerns) and Type 2 worry, or "meta-worry" (worry about the worry itself — for example, "Worrying this much must mean something terrible is going to happen" or "I can't stop worrying, I must be losing control"). It is this meta-worry that is particularly characteristic of GAD and that distinguishes it from normal levels of everyday concern.

NICE-recommended treatments for GAD include CBT (which has the strongest evidence base), applied relaxation, and pharmacotherapy (typically SSRIs or SNRIs). Self-help approaches, including guided self-help based on CBT principles, are recommended as a first step for mild to moderate GAD. Therapy for GAD typically involves worry postponement, problem-solving training, cognitive restructuring of worry beliefs, and gradual reduction of reassurance-seeking and checking behaviours.