General anxiety disorder is a mental illness that is driven by worry

General anxiety disorder is a mental illness that is driven by worry. People who suffer from this disease usually go through a worry cycle. The individuals feel like they have lost control of their own emotions and their social lives become impaired in different ways. Most are usually aware that their anxiety is more severe than the situation justifies but are not able to regulate their minds. Every experience and anxiety are unique in some way. GAD is a relatively new mental disorder that many researchers are trying to come up with scientific proof for the cause of this disorder. There is enough validity to demonstrate the disorder of GAD to be considered a mental illness, but the criteria are being questioned by researchers. Studies have concluded that with medication and therapy the individual can alleviate the majority of their symptoms. Social workers can assist GAD clients on micro, mezzo, and macro level to educate and advocate for the clients to bring awareness to this disorder and take away the negative stigma of GAD and other mental disorders.

Overview of the Disorder
General anxiety disorder has many characteristics, but the main feature is excessive worry. It is a disorder that has a cognitive focus on feeling extremely nervous, sleep disturbance, irritability, tension, and restlessness. This anxiety can cause overwhelming fear and worry even when there is little to no reason for the individual to feel anxious (National Institute of Mental Health, 2016). The individual might anticipate disaster or feel threatened to the point where they are no longer capable of controlling his or her worry. The mental disorder can cause someone to have suicidal ideation and significant impairment. GAD can lead to other mental disorders such as major depressive disorder, panic disorders, PTSD, and social anxiety disorder (Lindal & Stefansson, 1993). GAD cause significant distress to the daily lives of individuals. The symptoms of GAD can sound familiar to many because most people experience a high degree of anxiety during specific periods of their lives. What classifies an individual with GAD is the severity and duration of the symptoms (National Institute of Mental Health, 2016). The cause of this disorder varies from person to person, and the triggers are different for everyone. The cause of anxiety can be a variety of different components that can provoke anxiousness in a person. It can be environmental, biological, or an upbringing factor that creates the perfect storm for anxiety to develop (National Institute of Mental Health, 2016). The biological factor can play a role in an individual’s cause of GAD due to genetics. Anxiety can run in families, and this disorder can be passed down from one generation to another (Lindal ; Stefansson, 1993). The environmental factor can include the places one has been, all the experiences the client has gone through, and their upbringing. All these forms of experiences can play a crucial role and create a trigger to GAD (National Institute of Mental Health, 2016).
GAD affects millions of people, and it is prevalent in the United States. GAD has a high chance of recurrence in a person’s life and could transpire for many different reasons that could or could not be known (Weisberg, 2009). The disorder can recur due to the existence of another comorbidity, status of family relationships, stress at work, financial difficulties, medical concerns, drug use, etc. The disorder occurs twice as often in women as it does in men. About 6.8 million adults have GAD and 3.1% of the population each year have been diagnosed with this mental disorder in the United States and 3% in Australia (Weisberg, 2009). Compared to other countries, Europe has proven through meta-analysis studies that GAD has a higher prevalence up to 6.9%. Studies also show that white Americans with low income, widowed, divorced, or separated also have a higher prevalence of GAD. The groups that have a lower risk of GAD are African-Americans, Asians, and Latinos (Weisberg, 2009). What could also influence specific studies are the different types of criteria each country has for each disorder. GAD typical onset is during adulthood and it occurs between the ages of 20-47 years. Individuals with GAD are three to five times more likely to see their primary care physician. There are only 36.9% of individuals that receive treatment (Weisberg, 2009).
Current Research
GAD is a reasonably new disorder that was identified in the 1980’s. The legitimacy of the disorder is still questioned, and the criteria have been challenged (Weisberg, 2009). Researchers have found that the brain activity changes in anxiety disorders due to the chemicals in the brain. Imaging has shown that individuals who suffer from anxiety disorders show different brain activity than those without anxiety. Individuals also show abnormalities in the flow of blood and metabolism in different areas of the brain. Studies have shown that with proper treatment, the symptoms of GAD can be improved (Binder, Martin, Nemeroff, ; Ressler, 2009). Researchers are paying attention to the amygdala, a pair of almond-shaped pieces of gray matter that help process memory, fear, and emotion and are implicated in anxiety disorders like GAD (Binder et al., 2009). The amygdala is a communication hub between the parts of the brain that process sensory signals. The signal can indicate that a threat is present, causing fear in response. This was recently discovered, and this knowledge will help scientist improve the symptoms of GAD patients (Binder et al., 2009).
The University of Stanford created a similar study that was close to revealing neural pathways going to and from subsections in this region. People with GAD presented a different pattern in the brain from that of people without GAD. This could mean that individuals with GAD have a more difficult time differentiating truly worrisome situations from mild irritation. The researcher also found the amygdala was connected to a cortical executive-control network to expand cognitive control over emotion (Etkin, Greicius, Menon, Prater, ; Menon, 2009). GAD might be explained by the cognitive control connection that is defined by obsessive worry. Researchers are not able to confirm the connection of abnormalities and whether the extreme worrying frames the brain by reinforcing particular neural pathways. The researchers also hope to assist with the disorder of depression to use these tools to help discover unanswered questions (Etkin et al., 2009). However, the patterns unveiled through neurological scans could one day help many other mental disorders and assist with better treatments in the future. These studies can conclude that researchers are getting closer to the cause of GAD (Etkin et al., 2009).
A most recent news article that was done in 2017 regarding the use of smartphones and the

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association with depression and anxiety. Researchers were trying to figure out if anxiety and

depression symptoms were greater when using the smart phone process use versus the social use

of the smartphone. Social use is when the smartphone is used to network with others such as text

messages and social networking. Process use of a smartphone is when the individual is using

non-social features for example entertainment, news, and relaxation (Elhai, Levine, Dvorak ;

Hall, 2017). Researcher were stating in the study that the use of smartphones use may be a

mechanism for relations between problematic smartphone use and poor mental health. The result

of this study discovers that smartphones use is associated with depression and anxiety with the

process use of a smartphone (Elhai, et al., 2017)

Evidenced Based Treatments
New research is showing how Citalopram can be effective for individuals that have GAD. This drug has been known to help with major depressive disorder, and now research is proving that Citalopram can also be effective with GAD. This is the first study for GAD patients and the use of Citalopram. Citalopram is an antidepressant drug that is selective in the SSRI class. The department of psychiatry research did a study to examine the brain stimulation with functional magnetic sonority imaging to worry before and after treatment with Citalopram (Hoehn-Saric, Schlund, ; Wong, 2004). A controlled investigation has established that symptoms that include worry respond better to antidepressants with serotonin. Citalopram can also treat a variety of other anxiety disorders, including OCD, panic disorder, PTSD, and social phobia. The clinical results of this experiment showed significant improvement in reducing anxiety symptoms and the intensity of worries inactivation in the prefrontal and limbic regions of the brain. It was shown to be effective in 75% of patients with GAD (Hoehn-Saric et al., 2004).
The integration of motivational interviewing and cognitive-behavioral treatment has also shown to be effective in treating GAD. CBT teaches different ways of behaving, reacting, and interpreting circumstances to circumstances, which can reduce worry and anxiety. CBT is a collaborative approach to treatment where the therapist and the client work together to create a healthier lifestyle for the client (Antony, Constantino ; Westra, 2016). Since GAD can create irrational beliefs, the focus for the therapist with CBT is to help bring the clients into a state of increased awareness of their beliefs, thoughts, and relationship between identified misapprehensions and their emotional states. CBT is helpful in many ways for clients that have GAD, but it is not flexible when it comes to the clients ambivalence as it arose in the conduct of CBT. CBT is also limited in real-world clinical interventions (Antony et al., 2016). MI fills in the missing gaps for CBT. MI creates opportunities for clients to resolve and explore their fears of change and confront the ambivalent views of worry. In the proposed study it demonstrates that with the integration of MI and CBT have shown a significant amount of improvement on both the client’s determination for change and clinician assessment of GAD diagnostic distinction (Antony et al., 2016).
Implications for Social Work Practice on Micro, Mezzo and Macro Levels

Social workers can assist clients through therapy and interventions on a micro level. Therapy

that includes CBT and MI will help the client to focus on a specific skill that pinpoints negative

behaviors and thoughts, then replaces them with positive ones. Cognitive restructuring is a great

way to help examine unusual patterns and teach the client affected ways to process their

situation or problem (Antony et al., 2016). The social worker can collaborate with the client to

focus on lifestyle changes, relaxation techniques, and coping skills that can help reduce stress

and help the client have a centered and balanced life (Cuijpers et al, 2016).

On a mezzo level, support groups can be an effective treatment in addition to the client’s individual therapy. Support groups give the opportunity for clients with GAD to gather and offer each other helpful ideas to cope or just overall support (Jones, Page, ; Wilson, 2004). When social workers direct support groups, clients can learn to cope with their anxiety. Individuals with GAD might feel misunderstood, and through group therapy, clients might realize that they are not alone. Group therapy also provides clients with the opportunity to share their stories, and it helps them connect with others. The research was done in West Australia on the effect of support groups and how they can benefit people who suffer from anxiety disorders. There is evidence that support groups are an effective form of treatment (Jones et al., 2004).

On a macro level, social workers can advocate for the awareness of GAD and cost-
effective treatments for client’s. About 6 million-people suffer from GAD each year, but less than half receive treatment, which suggests that many of these individuals may be self-medicating instead of getting the treatment that they need (Weisberg, 2009). That is why it is important to bring awareness to GAD and educate people on the importance of receiving treatment, and provide resources on where they can receive help.

Conclusion
GAD is a mental disorder that can cause significant impairment in a person’s life. However, hope is not lost for those who seek professional help. There are antidepressant and other medications that can create balance in the brain and help create normal functioning in nerve cell pathways. Therapy is another way to help individuals with coping techniques and restructuring their point of view to a healthier and balanced life. Although this disorder is fairly new, there is still an ample amount of research regarding the brain circuitry involving anxiety and fear that can be researched and studied to create a cure for GAD. So far medication and therapy have helped reduce anxiety in client’s. Social workers can assist in many ways and create opportunities on a micro, mezzo, and macro level. Social workers can empower, advocate, and provide resources for those who suffer from this mental disorder. Through these new studies, social workers, therapist, doctors, and psychiatrist can collaborate and, hopefully, find a cure in the near future.

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