Learn about anxiety, signs to look for, how your doctor determines if you have GAD and treatment options.
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Found in: Mental Health Conditions
Date: September 2022

About anxiety

Anxiety disorders are a group of mental health conditions that cause frequent, difficult-to-control nervousness, fear, apprehension or worry which is out of proportion to the situation or stressor.

Anxiety disorders affect how people live day-to-day, as they feel the urge to avoid situations that are the focus of this fear. Mild anxiety may feel vague and unsettling and may impact only one or a few areas of your life. Severe anxiety can feel overwhelming and have a serious impact on your ability to function in a number of areas. With the right support and treatment, you can find relief from these symptoms.

Anxiety disorders are different from the normal feelings of fear that every person has at times. We are all “hardwired” to experience fear so that we can act quickly and without thought when we are in danger. This survival response focuses the mind and prepares the body for action (to fight, run away, or freeze). It is our brain’s way of protecting us.

Anticipating possible danger or imagining danger produces the same response in the body as facing real danger. This is where anxiety comes in. Anxiety occurs when we think we are in danger, even if there is no actual danger present. Again, this is a normal part of the human experience. If we have money worries or a sick loved one, we feel stressed and worried. If we see something on TV that is disturbing, such as a terror attack, we feel horror, temporary distress and dismay. Usually, we can then continue with our activities and put it out of our minds. For people experiencing an anxiety disorder, though, this physical response happens often and feels overwhelming and hard to control.

Anxiety disorders are the most common of the mental health conditions. Among them, generalised anxiety disorder (GAD) is the most common, and that is the focus of this page. 

Generalised anxiety disorder (GAD)

People with GAD feel excessive, ongoing, difficult-to-control anxiety and worries about a range of everyday life situations.

If you experience this level of anxiety, you feel worried about many things. You may worry about your finances, your family, your car, your pets – anything can cause concern. Sometimes even thinking about how to get through your day makes you feel anxious. This is mentally and physically exhausting.

Anxiety levels in most people with GAD fluctuate. When their anxiety level is mild, people with GAD can take part in their usual life activities, such as work, school or socialising, without too much trouble. When their anxiety is severe, some people may have difficulty carrying out the simplest daily activities.

GAD comes on gradually and can begin at any time in your life, though the risk is highest between childhood and middle age. As with other anxiety disorders, GAD is two to three times more likely in women than in men. It is also more common in people who are separated, divorced or widowed, those with less education and those who are unemployed. It’s common for people with GAD to also have other conditions such as depression, or other anxiety disorders.

It’s important to remember that GAD is not your personality. Experiencing this condition does not mean you are too serious, a worrier or unable to have fun, or that you have a nervous disposition.

What causes GAD?

There is no single or specific cause of GAD. Evidence suggests that it is likely the result of interactions between biological factors (e.g. genetics, brain structure) and environmental factors (e.g. social learning, negative life events, societal influences and lifestyle factors).

If you have a family member with a history of GAD or one of the other anxiety disorders, you are more likely to develop GAD yourself. This is partly due to genetics and partly due to social learning – that is, if you grew up seeing one of your caregivers experiencing anxiety, you may have taken on some of their behaviours and ways of coping.

Difficult and stressful life events, such as abuse, having an overprotective parent, losing a loved one, divorce, isolation, long-term illness or unemployment can also increase the risk of GAD.

More recently, research has been looking into the impact of societal factors, such as excessive and uncontrolled use of social media, on mental health. Social media interactions can be challenging and negative in nature, leading to feelings of stress and anxiety related to social relationships. This is believed to contribute to GAD and depression. Lifestyle factors such as alcohol and other substance abuse, chronic relationships problems and work stress are also thought to be possible contributing factors for GAD.

Even though you cannot change some factors, such as your genetics or events in your past, there are very effective treatments that can bring you relief from the symptoms of GAD.


Signs to look for (symptoms)

The symptoms of GAD can vary between individuals – your symptoms may look very different from other people’s. They can also vary over time within an individual; for example, you may notice better and worse times of the day. And while stress doesn’t cause generalised anxiety disorder, it can make the symptoms worse.

People with GAD will usually:

  • expect the worst
  • worry excessively about money, health, family or work, when there are no signs of trouble, and find this worry difficult to control
  • be unable to relax, enjoy quiet time, or be by themselves
  • avoid situations that make them anxious
  • be irritable
  • have difficulty concentrating or focusing on things
  • feel edgy, restless or jumpy
  • feel easily fatigued
  • suffer from stomach problems, nausea, diarrhoea
  • suffer from poor sleep
  • need to know what’s going to happen in the future.

Children and young people

If a child has GAD, their worries focus on their family, school and what could happen in the future, especially with their parents.  

Children and teens often do not recognise the symptoms of GAD in themselves, so the support and advocacy of an adult who knows them well is important.  

As well as many of the symptoms that appear in adults, children with GAD may have:

  • a fear of making mistakes
  • “what if” fears about situations far in the future
  • a feeling that they’re to blame for any disaster, and that their worry will keep tragedy from occurring
  • a need for frequent reassurance and approval
  • physical symptoms such as frequent stomach or headaches.

How the doctor or mental health professional determines if you have GAD (diagnosis)

There is no single test to diagnose GAD. Your health professional (doctor, psychiatrist or clinical psychologist) will make an assessment based on whether you (or your child) have some or all of the typical symptoms, and the length of time you have had them.

They are likely to say you have GAD if:

  • you’ve experienced excessive anxiety and worry (about a number of events or activities), occurring more days than not, for at least six months
  • this worry is difficult to control, causes you significant distress, and affects your ability to function in important life areas (e.g. socially, at work or at school)
  • you have three or more of the following symptoms (or, for children, one or more):
    • restlessness, feeling keyed up or on edge
    • being easily fatigued
    • difficulty concentrating or mind going blank
    • irritability
    • muscle tension
    • sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

Treatment options

Treatment of GAD can involve a number of aspects, each of which is tailored to your individual need. These may include therapy, medication or a combination of both.  

While there are many things you can do to support your own wellbeing, getting help from a medical professional is important.

Therapy, such as talking therapies

Talking therapies are very useful in treating anxiety, including for children and young people. Your doctor should be able to explain what is available locally and give you information to help you decide which type of talking treatment is most suitable for you.

One option that is often effective in treating GAD is Cognitive Behaviour Therapy (CBT), which looks at how your situation, feelings, thoughts, behaviour and physical being interact with each other to contribute to your anxiety. There is a focus on changing unhelpful thought patterns and behaviour (e.g. avoidance) to help you better understand and manage your anxiety.

If you try CBT or another therapy and find it doesn’t work for you, remember there are many other options. Keep exploring different types of therapy or therapists until you find the right match.


Your doctor may prescribe medication. Finding the right medication can be a matter of trial and error – there is no way to predict which medication will be effective and tolerated (have fewer troublesome side effects) by any one person.

If you are prescribed medication you are entitled to know:

  • the names of the medicines
  • what symptoms they are supposed to treat
  • how long it will be before they take effect
  • how long you will have to take them for and what their side effects are (short and long term)
  • what the process of stopping taking them could look like.

Even if you’re pregnant or breastfeeding, medication might be an option. It is best to discuss with your health provider what might be on offer for you.

Before medication is prescribed for children and adolescents, an assessment by a psychiatrist specialising in child and adolescent mental health problems should be undertaken. Your doctor will help you find an appropriate psychiatrist.

Talk to your doctor if you are considering stopping treatment, and work with them to find some compromise that will ensure continuing wellness but address your concerns about the treatment.

It is very important that any decision to stop medication is made with the support of a knowledgeable doctor.

Other strategies to support recovery

Psychoeducation (providing education)

Education about GAD can be extremely important to help you, your family/whānau and supporters.

Your doctor should give you information about your condition, and advice on lifestyle factors (e.g. healthy eating, good sleep, regular exercise and reduced use of caffeine, tobacco and alcohol). They may also suggest different ways to handle anxiety and discuss any complications which could occur.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

They are not treatments for GAD, but they may enhance your life and help you to maintain wellbeing. 

In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Physical health

It's also really important to look after your physical wellbeing. Make sure you get an annual check-up with your doctor, and do what you can to reduce stress, get enough sleep, eat a balanced diet and exercise. 

Being in good physical health will also help your mental health.

Other strategies to help GAD

People with GAD have found these techniques helpful to support their wellbeing:

  • using fidget toys to keep your hands busy
  • speaking to other people with anxiety, e.g. in peer support groups 
  • learning and practising breathing techniques
  • going for a walk, dancing or taking a break when you feel anxiety building   
  • slowing down – reducing the number of activities, commitments and responsibilities in your life 
  • talking to supportive people at work or school so they understand the impact GAD has on you.

Thanks to Natasha de Faria, clinical psychologist, and members of the Thriving Madly peer support network in Christchurch for reviewing this content. Date last reviewed: September, 2022.

Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.