It is likely that most people may experience feelings of anxiety at some points in their life, for example, when sitting exams or attending job interviews. Feeling anxious during times like these is not uncommon. However, some people find it hard to control their worries and experience anxiety on a daily basis. This anxiety could be related to a number of conditions, but people who feel anxious about a wide range of situations and issues, rather than one specific event, could be suffering from generalised anxiety disorder (GAD).
This fact sheet provides information about generalised anxiety disorder, commonly known as GAD, in adults.
What is generalised anxiety disorder?
GAD is a long term condition that causes people to feel anxious about a wide range of situations and issues, rather than one specific event. Symptoms of GAD can be both psychological and physical.
Psychological symptoms of GAD can include:-
- feeling nervous regularly over an extended period
- difficulties in falling asleep
- bad dreams when asleep
- disturbed sleep, for example, waking up worrying
- feeling tense and uptight
- feelings of extreme frustration
- a sense of dread
- feeling tearful
- wanting to escape.
Physical symptoms can include:
- trembling or shaking
- a pounding heartbeat or palpitations (an irregular heartbeat)
- feeling sick
- chest pains
- loss of appetite.
Why do people become anxious
According to Mind, no one knows exactly what causes anxiety problems. Anxiety conditions are not developed or caused by a single factor, there are normally a number of factors that play a role, including personality, difficult life experiences and physical health. Anxiety conditions may develop when one or more stressful events occur in a person’s life. Common triggers include:-
- workplace stress
- pregnancy and giving birth
- family and/or relationship problems
- major emotional shock following a traumatic event
- verbal, sexual, physical or emotional abuse
- drugs and medication.
Chronic health conditions can also contribute to feelings of anxiety. These include health conditions such as:-
- hypertension and heart disease.
Getting a diagnosis
The NHS recommends that if anxiety is affecting a person’s daily life or causing distress they should see their GP. The GP will need to understand the symptoms and circumstances so a correct diagnosis can be made.
Anxiety in pharmacy
Anxiety is the body’s natural response to real or perceived danger. When kept in check, anxiety can be very useful, for example, anxiety concerning inaccurately dispensing a prescription may result in a pharmacist double-checking his or her work, or might lead to the setting up of a safeguarding system to help prevent dispensing errors.The natural response of anxiety becomes a disorder when it is excessive and difficult to control, and causes significant distress and impairment.
At Pharmacist Support we are contacted by pharmacists whose anxiety has led them to re-check their work to the extent that prescriptions are not leaving the dispensary in a timely manner.
Pharmacies should have standard operating procedures (SOPs) in place for checking prescriptions to try to ensure that the chances of errors are minimised. Pharmacists who want to create additional SOPs could seek help from:-
- an organisation such as the NPA or Numark if their employer is a member
- see the RPS’ guidance for members
- see courses offered by the CPPE.
Most trainees have a good experience but we are contacted by some trainees reporting anxiety and work-related stress. Pharmacist Support can help in a number of ways, including arranging to speak to a Listening Friend, or referring to a specialist employment adviser if needed.
The pre-registration year is the culmination of many years of study and it is important that trainees try to make the most of their training and get as much information and support as possible throughout their training year.
Moving away from home to study is for many the beginning of a whole new stage in life. It may mean taking on new responsibilities that were previously held by parents and/or older siblings. For many students, starting university can be a stressful experience. Research commissioned by UniHealth, the UK’s first health and wellbeing messaging platform for university students, revealed that 82% of all respondents suffer from stress and anxiety and 45% have experienced depression.
Only 25% of students said they would seek help with this, the other three quarters quoted reasons such as being too embarrassed, thinking it was a waste of time or not knowing where to find help. A third of students said that they would prefer to receive support via private messages on social media.
Students who are struggling to find their feet at university might find the Unihealth messaging service helpful. This programme takes students through their first year, from preparation in August to exams in May. For further information, see the Unihealth website.
Self-help to ease anxiety
People who are diagnosed with GAD will find that there are many steps that they can take themselves to help ease the symptoms of anxiety. According to the NHS, GPs will normally recommend trying self-help treatments before resorting to more intensive therapy or medication.
Self-help treatments include:-
- reading about anxiety
- trying an on-line course
- using a self-help programme available through an app
- taking regular exercise
- learning to relax
- avoiding caffeine
- avoiding smoking, drinking and drugs
- talking to somebody.
Reading about anxiety
People may find that reading about their health condition can help them to understand and manage their condition better. Reading Well is a reading scheme delivered by the Reading Agency in partnership with the Society of Chief Librarians. The aim of the scheme is to enable people to have access to a range of books covering common mental health conditions. The books on the Reading Well list have all been endorsed by health experts and are available to lend in all English libraries. To view the selected titles for anxiety, visit the Reading Well website.
Try an on-line course
NICE recommends a “stepped care” pathway to help people with common problems. The first step in this pathway is psycho-education. Psycho-education aims to help people to understand the nature of their problems. This explores useful tools and techniques for managing problems and builds up coping skills for better emotional well-being. On-line courses are an example of psycho-education. On-line courses are a useful starting point as they can be done anywhere and at any time. For further information on the NHS Therapy for You Stress & Anxiety on-line course, see the Therapy for You website.
Download an app
Some people may prefer the convenience of an app. There are numerous apps for almost any kind of anxiety therapy. Whilst we cannot recommend individual apps, here are a few suggestions from the NHS website to get you started:-
Beat Panic is designed to guide people through a panic attack or raised anxiety using their phone. For further information, see the Beat Panic section of the NHS website.
Learn how to manage feelings like anxiety and depression with Catch It. For further information, see the Catch It section of the NHS website.
My Possible Self
This app helps people to take control of their thoughts, feelings and behaviour. This comprises of a series of simple learning modules to manage fear, anxiety and stress, and tackle unhelpful thinking. There is also a facility to record experiences, enabling people to track their symptoms in order to understand their mental health. For further information, see the My Possible Self section of the NHS website.
Thrive: Feel Stress Free
Thrive: Feel Stress Free helps people to prevent and manage stress, anxiety and related conditions. The game-based app can be used to relax before a stressful situation or on a more regular basis to help you live a happier, more stress-free life. For further information, see the Thrive: Feel Stress Free section of the NHS website.
There are many benefits to an active lifestyle. Obviously it will improve your fitness but being regularly physically active really can make a huge difference to your happiness and wellbeing. It may also help you feel better about your appearance, boost your confidence and improve your self-esteem, energy and sleep, as well as reduce your risk of stress and depression.
Exercise can help manage physical and mental stress. Exercise also releases endorphins, which create feelings of happiness and euphoria. Studies have shown that exercise can even alleviate symptoms among people with clinical depression and those who suffer from anxiety. For this reason, doctors recommend that people suffering from depression or anxiety (or those who are just feeling blue) pencil in plenty of gym or exercise time.
If the thought of visiting a gym is off-putting, try alternatives such as walking, swimming or running. Our Exercise fact sheet has plenty of options for you to consider.
If joining a group makes you feel anxious, how about taking a dog for walk? There is no need to be a dog owner, anybody can join a group such as BorrowMyDoggy. People can enjoy a long walk with a non-judgemental, appreciative companion. For further information, see the BorrowMyDoggy website.
People who suffer from anxiety find it very difficult to relax. There are techniques that can be learned that will aid relaxation. Practising mindfulness is a good starting point in helping people to relax.
According to the NHS, studies have found that mindfulness programmes, where participants are taught mindfulness practices across a series of weeks, can bring about reductions in stress and improvements in mood. In short, everybody can benefit physically, emotionally and mentally from learning mindfulness techniques. It can contribute to greater peace of mind, better sleep and more productivity at work as well as to feeling happier or to having better relationships with others.
The Free Mindfulness Project website has a large range of guided meditation exercises that are free to download. These range from 3 to 35 minutes in length, and most people, no matter how busy, could find time to fit some of these exercises into their day. For further information, see The Free Mindfulness Project website.
For more information on Mindfulness, see our Mindfulness fact sheet.
Using stimulants as a means to cope with anxiety can lead to a loss of a person’s mental ability to control anxiety naturally. When this occurs people lose their ability to cope with anxiety without the aid of stimulants such as drugs and alcohol.
Stimulants come not only in the form of illegal drugs such as cocaine, they can also be a common part of our everyday diets.
One of the most common stimulants is caffeine and whilst most people are aware that caffeine is often found in coffee it can also be found in a range of other products including:-
- energy drinks
- some fizzy soft drinks.
NHS Choices’ recommended limit for caffeine is 400 mg per day for adults. They advise pregnant women to stick to 200 mg (approximately two mugs of coffee) per day. For further details on the amount of caffeine found in certain foods and drinks, see the NHS Choices website.
People may wish to consider how much caffeine they consume and cut back on certain items. Reducing overall intake can be an important step in decreasing symptoms of anxiety.
People who consume a lot of caffeine may experience withdrawal symptoms when they first cut back on their intake.
For further advice on having a balanced diet, see our Healthy eating fact sheet.
Someone may smoke as a means to reduce anxiety. Research has shown that cigarette cravings are likely to make people feel more irritable and anxious. According to the NHS, when people stop smoking:-
- their anxiety, depression and stress levels are lower
- their quality of life and positive mood improve
- dosage levels for some medicines used to treat mental health problems can be reduced.
For more information on stopping smoking, see the NHS Choices website.
Alcohol in small doses is considered to be a stimulant, although heavy consumption is considered to be a depressant. Having a few drinks may help someone to relax and feel more socially confident. However, people who use alcohol to mask anxiety problems will ultimately become more reliant on it in order to relax.
According to Drink Aware, alcohol can make an anxious person feel worse and drinking alcohol can actually contribute to feelings of anxiety. For further information on alcohol and anxiety, see the Drink Aware website.
People who are concerned that they are drinking too much can find further information, including an online alcohol test and tips for cutting down, at the Don’t Bottle it Up website.
People who are concerned about an addiction to alcohol can find further information on our Help with Alcoholism fact sheet. People can also call our Addiction Support Line on 0808 168 5132.
Drugs come in a variety of categories. Mind lists them as follows:-
- legal drugs- such as caffeine, nicotine and alcohol
- illegal drugs – this means it is illegal to have them or supply them to other people. Most street drugs are illegal
- controlled drugs – these are drugs used in medicine, such as benzodiazepines. It is legal to take controlled drugs if a doctor has given you a prescription for them but is it illegal to have them if not.
People who have severe anxiety may be prescribed a benzodiazepine tranquilliser. Doctors will usually only prescribe them at a low dose for a short period, to help people through a crisis period, as they can cause unpleasant side effects and become addictive. The NHS recommends that people who have been taking benzodiazepines regularly for more than 4-6 weeks should talk to their doctor before stopping.
According to Mind, taking drugs can lead to long term metal health problems such as anxiety, depression or shizophrenia. For further information about how drugs can affect mental health, see the Mind website.
People who are concerned about an addiction to drugs can find further information on our Help with Drug Abuse fact sheet. People can also call our Addiction Support Line on 0808 168 5132.
Talk to somebody
Anxiety is a condition that can close you off to others. Talking to people really can help. Often people are concerned about discussing their worries with family and friends. It is often much easier to speak to somebody anonymously about issues such as anxiety. Here are some suggestions for organisations that offer a listening ear.
Listening Friends at Pharmacist Support
Our Listening Friends are pharmacists who volunteer to offer a listening ear to others in times of need. This service provides callers with the opportunity to talk anonymously and in confidence to a pharmacist about any stresses they are facing in their work or home life.
For further information, see the Pharmacist Support website, or call us on 0808 168 5133.
Anxiety UK is a national charity offering support to those affected by anxiety disorders. Call their helpline on 03444 775 774, or contact them via live chat. For further information, see the Anxiety UK website.
Mind provide advice and support to anybody who is living with a mental health condition. The services it offers include talking therapies and peer support. Call their helpline on 0300 123 3393, or contact them via live chat. For further information, see the Mind website.
No Panic is a charity which helps people who suffer from panic attacks and other anxiety related disorders. The services they offer include advice and support including help for people coming off tranquillisers, step-by-step written recovery programmes and self-help cognitive behaviour therapy. For further information, call their helpline on 0844 967 4848 or see the No Panic website.
The term ‘talking therapy’ covers all the psychological therapies that involve a person talking to a therapist about their problems. According to the NHS, for some problems and conditions, one type of talking therapy may be better than another. Equally, different talking therapies also suit different people.
Whilst counselling is the most common form of therapy, cognitive behavioural therapy (CBT) might work best for people with anxiety. The aim of CBT is to help people to think more positively about life and free themselves from unhelpful patterns of behaviour. A course typically involves around 6 to 15 sessions, which last about an hour each.
For further information on talking therapy, see the NHS Choices website.
Other useful fact sheets
Healthy eating: How to eat healthily fact sheet
Mindfulness: Information about mindfulness fact sheet
Sleep: Advice on sleep fact sheet
Stress: Help with stress fact sheet
Wellbeing: How to bring wellbeing into your life fact sheet
Wellbeing: Further reading list fact sheet