The core symptom of GAD is chronic worrying
_{^{Smith & Segal, 2020).}} 

• Muscle tension
• Restlessness
• Fatigue
• Difficulty concentrating
• Sleep disturbance
• Irritability/on edge
• **Only one of these symptoms is required in children

The anxiety of GAD is diffused—a general feeling of dread or unease that colors your whole life. ^{_{(Smith & Segal, 2020).}} 

• 2.7% of US adults  18 years or older had GAD
• Prevalence higher in females(3.4%) than males (1.9%)
• Degree of impairment ranged from mild to serious with an estimated 32.3% serious impairment, 44.6% moderate impairment, and 23.1% mild impairment

• 2.2% of U.S adolescents aged 13-18 have had GAD
• 0.9% had severe impairment(determined by DSM-IV)
• Higher prevalence among adolescent females (3%) than for males(1.5%)

• Overly perfectionist or insecure
• Tend to "redo tasks because of excessive dissatisfaction with less-than-perfect performance"_{^{(American Psychiatric Association, 2013).}} 
• Seek reassurance and approval
• Require excessive reassurance about their performance 

One-third of the risk is due to genetic factors
_{^{(American Psychiatric Association, 2013).}}

• Patient complains that her whole body aches, her heart beats fast, “Pounds like it's going to burst.”
• Can't catch her breath
• Chest tightness 
• Tense for no reason at work and at home
• Worries a lot—about everything “never know when something bad is going to happen…like her husband getting hurt or children making a bad choice.”
• Gets easily upset
• Can't sit still
• Finds it hard to work—can’t concentrate. 
• More than just worries—feels like she is going crazy.

• Patient worries excessively: Are the kids dressed right for school or why is her husband late.. “usual things.”
• Worries all day long, almost every day
• Experiences strong feelings worrying about little things: becomes paralyzed, will “collapse on the couch with fear,” start shaking.
• Hasn't been in the office for nine months due to excessive worrying
• Acknowledges that she doesn’t worry about big things like cancer or heart attacks.
• Restless—can’t sit still.
• Feels "on edge."
• Never had a panic attack
• Low energy—exhausted
• Mind goes blank

• Get plenty of sleep
• Eat healthy, well-balanced meals
• Limit consumption of alcohol and caffeine
• Count to 10, slowly and repeat if necessary 
• Embrace humor--laughing is healing. 
• Learn the triggers
• Talk to someone
• Accept what you cannot control.
• Exercise daily
• Replace negative thoughts with positive ones
• Look at your worries from a different perspective--engage in realistic thinking. 
• Do your best, without aiming for perfection (since it is not possible)
• Learn how to calm down quickly by  making use of one or more of your physical senses
  1. Sight
  2. Sound
  3. Smell
  4. Taste
  5. Touch 
  6. Movement 

• Cognitive Behavioral Therapy (CBT): targets thoughts, physical symptoms, and behavior

• Antidepressants: Selective serotonin reuptake inhibitors(SSRIs) and Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Anti-anxiety: Benzodiazepines(for severe, paralyzing anxiety) and Buspirone.

"we have to do the work ourselves to understand what is going on inside of us"

"They way you cope, or handle things, has a direct impact on how much anxiety you are experiencing"

1. Feeling in control of your life.
2. Forgiving yourself
3. Having purpose and meaning in life-- "you will know the why for your existence and will be able to bear almost and how."

• Engages you mentally so that your mind doesn't wander and worry
• Separates you from the causes of your anxiety
• Employs your information-gathering skills

• “What if” fears about situations far in the future
• Perfectionism, excessive self-criticism, and fear of making mistakes
• Feeling that they’re to blame for any disaster, and their worry will keep tragedy from occurring.
• The conviction that misfortune is contagious and will happen to them
• Need for frequent reassurance and approval

• Worry excessively about everyday things 
• Have difficulty controlling their feelings of nervousness or worries  
• Be easily startled
• Have a hard time swallowing/feel a lump in their throat
• Sweat a lot/have hot flashes
• feel lightheaded or out of breath
• Tremble or twitch 
• Experience headaches, muscle aches, unexplained pain, GI issues

• Restlessness
• Easily fatigued
• Difficulty concentrating/ drawing a blank
• Irritability
• Muscle tension
• Sleep disturbance 

Onset rarely occurs prior to adolescence
_{(Beesdo et al. 2010, as cited American Psychiatric Association, 2013).}

• Trembling, twitching, shakiness, and muscle aches or soreness associated with muscle tension. 
• Somatic symptoms such as sweating, nausea, and diarrhea
• Exaggerated startle reaction 
• Autonomic hyper-arousal such as accelerated heart rate, shortness of break, and dizziness are less prominent than other anxiety disorders.
• Irritable bowel syndrome, headaches, or other conditions associated with stress

• Anxiety disorder due to another medical condition 
• substance/medication-induced anxiety
• Social anxiety disorder
• Obsessive-compulsive disorder
• Posttraumatic stress disorder
• Depressive, bipolar, and psychotic disorders

1. Education
2. Monitoring
3. Physical control strategies
4. Cognitive control strategies 
5. Behavioral strategies

• Difficulty relaxing or sitting still/enjoying quiet time.
• Difficulty focusing
• Putting things off/avoiding things due to feeling overwhelmed
•  Avoiding situations that trigger anxiety

• Neverending worries
• Uncontrollable anxiety--feeling there is nothing you can do to stop worrying.
• Intrusive thoughts
• Difficulty tolerating uncertainty
• A pervasive feeling of apprehension or dread

• Muscle tightness, body aches, tension
• Difficulty falling asleep or staying asleep.
• Feeling on edge/jumpy.
• Stomachaches, nausea, diarrhea 
• Palpitations, dry mouth, sweating