Generalized Anxiety Disorder

  • Tara Andresen

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Have you been feeling worried most of the time for at least 4 weeks?

We all feel worried sometimes.  Normal anxiety is adaptive. It is an inborn response to a perceived threat and can result in worrying as well as a racing heart, sweating, shaking etc. However, for some people worry is very hard to control, occurs most of the time and impairs daily function. In this case a person might be considered to be experiencing pathologic anxiety.

Anxiety is a normal adaptive system in the body that tells us when we are in danger.  This means that treating anxiety does not involve eliminating it, but rather managing it. Anxiety becomes a problem when we perceive exaggerated danger. When we think we are in danger, even if we are not, our body reacts as if we are in danger.

There are a number of risk factors for developing an anxiety disorder including:

  • Family history of anxiety
  • Chronic physical illness
  • Substance use disorders
  • Parental behaviour (ex. controlling, overprotective, less affectionate parenting)
  • Stressful events

Anxiety can start early in life, beginning in the teen years and early twenties. Anxiety is a risk factor for depression and substance abuse in adulthood.  The lifetime prevalence of anxiety disorders is almost 29%. There are a number of different anxiety disorders including social anxiety (12.1%), PTSD (6.8%), Generalized Anxiety Disorder (GAD) (5.7%), panic disorders (4.7%) and Obsessive Compulsive Disorder (OCD) (1.6%).  This article will focus on generalized anxiety disorder (GAD).

Generalized Anxiety Disorder (GAD) is characterized by long term, intense and excessive worry.  It is a chronic, relatively common disorder. With GAD, worry is accompanied by the following:

  • Feeling restless
  • Feeling tired
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance

While some worry or nervousness is normal and can actually be beneficial, anxiety becomes problematic when it disrupts our lives, affecting our behaviours, thoughts, emotions and physical health.

The main trigger of anxiety is uncertainty or not being 100% sure about something. However, since almost everything in life is uncertain, in GAD there is always something that is triggering worry thoughts and physical symptoms.

There are two types of GAD worries:

  1. Worries about current problems (ex. What if I don’t have enough money to pay the bills?” What if my argument with my friend means we never speak again?”)
  2. Worries about hypothetical situations (ex. What if the plane I am on next month crashes?”)

Solutions to improve GAD are multifaceted and include a combination of effective conventional and naturopathic therapies. Naturopathic treatments for anxiety include dietary and lifestyle changes along with non-pharmacological medicine. In addition, a Naturopath can recommend psychotherapy support. Naturopathic treatments can also often be combined safely with certain anxiety reducing medications to improve outcomes more than medication alone. Treatment in both naturopathic and conventional medicine aims to support certain brain chemicals that when out of balance, trigger anxiety. These include serotonin, gaba and cortisol.

Here are some of the key components of a multifaceted treatment plan for those with GAD:

1. Exercise

Moderate to vigorous physical activity done for 150 minutes per week has been shown to significantly improve GAD symptoms. The exercise can be cardio or resistance training. However, it needs to be done for 10 weeks at a minimum to see full effects.

How does exercise help?

  • Reduces the body’s sensitivity to anxiety
  • Improves sleep – poor sleep is often prevalent among those with GAD
  • Increases endorphins – feel good brain chemical

2. Breathing Exercises

Research has shown that excess carbon dioxide (CO2) exposure can trigger anxiety and panic. It does so by altering the pH balance in the brain, making the brain more acidic. Some people are more genetically predisposed to this sensitivity to brain pH reductions. Shallow breathing can trigger this cascade because less carbon dioxide is being expelled when we take short breaths.

To improve CO@ expulsion, deep breathing from the diaphragm level is needed. Exhaling should be longer than inhaling and to see best results deep breathing needs to be done for at least 10 mins but preferably 20 mins.

3. Non-pharmacological Medicine

There are many herbal and nutraceutical treatment options that can effectively improve GAD symptoms.

Some of the top herbal options include Piper Methysticum (kava kava), oral Lavandula Angustifolia (lavender) capsules, Scutellaria Lateriflora (skullcap), Passiflora Incanata (passionflower) and Withania Somnifera (ashwagandha). Nutraceutical supplements include 5-HTP and L-Theanine among others.

When taking these herbal or nutraceutical supplements, we always recommend that a person consults a Naturopath. A Naturopath will help select the best herb or herbs on an individual basis and can recommend the appropriate dosing required to achieve a therapeutic outcome. Also, there can be interactions between herbs and between herbs and medications so it’s best to consult with a Naturopath from a safety point of view.

Piper Methysticum (kava kava)

Piper Methysticum aka kava kava has been well studied and shown in many randomized control trials to significantly reduce anxiety symptoms. It does this by upregulating Gaba, a calming brain chemical that we produce to relax the nervous system.  Kava reduced anxiety symptoms without sedating effects. It is available in capsule or liquid forms. Some studies have also found that it can help with depression.

Lavandula Angustifolia (oral lavender oil)

Oral lavendar capsules are relatively new as a nutraceutical and show excited promise for anxiety treatment. Several good quality studies have shown that oral lavender oil was as effective as the medication lorazepam, without the associated sedating side effects that can interfere with driving. Lavender oil improved restlessness, disturbed sleep and other physical anxiety effects.  Also, lavender oil has no addictive effects or withdrawal effects. It can be discontinued without the need for titration. In addition, oral lavender oil has been found to have a profound effect on depression that is experienced as well in those with anxiety. It is important to note that lavender oil needs to be taken for 2 weeks before seeing effects.

Passiflora Incanata (passionflower)

Passionflower has some good research behind it’s non-sedating anti-anxiety effects and can be used acutely with effects occurring within 30 minute of consumption. Also, studies in a Cochrane Review revealed no current evidence of any safety concerns with this herbal supplement.

Scutellaria Lateriflora (skullcap)

Sutellaria Lateriflora is helpful for reducing anxiety and tension as well as worrying.  There are a few studies that support its use for GAD but more are required.

Withania Somnifera (ashwagandha)

Clinically, Withania works well to calm the nervous system. There is some research to support its anti-anxiety and stress-reducing effects. It is generally safe and can be taken with anti-depressant medication.


5-HTP works by increasing serotonin production and as a result has anti-anxiety effects. Clinically, it can work well for those with co-morbid depression. However, more studies are required to assess its anti-anxiety effects.


L-theanine is found in green and black tea as well as in oral supplement form. It is an amino acid derivative and has been shown to change the brain’s chemical activity resulting in calming effects. More specifically, it increased alpha brain waves. It can also help a person to stay focused on a task when consumed in tea form. Studies have shown that L-theanine increases serotonin, dopamine and glycine.

Naturopathic medicine offers a wide variety of treatment options to ease the symptoms of a wide variety of stress and anxiety concerns including Generalized Anxiety Disorder.  In some cases treatment may also be a mix of conventional medication with safe and effective naturopathic treatment.  A Naturopath will first do a full assessment and then put together an individualized treatment plan to effectively address your health concerns.

If you would like to find out more,  book a FREE 15 min Info Session with Dr. Tara Andresen today at one her NDcare Naturopathic Clinics in Toronto.

To find out more about how a Naturopath treats stress and mood concerns, including anxiety and panic disorders, book a FREE 15 min Meet the Naturopath info session with Dr. Tara Andresen today at one her NDcare Naturopathic Clinics in Toronto.