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Anxiety and the Holidays: When Worrying Gets Out of Control

By Mary Lizabeth Aquavia, Medical Director, Women’s Health Program

Many of us dream of that perfect holiday season when our decorated home looks immaculate and our family members are on their best behavior around the Christmas dinner table. In most cases, we’re able to settle for something less than perfection on both counts.

But for people with generalized anxiety disorder (GAD), the holidays can be especially difficult. The raised expectations and added social pressures, family tensions, financial concerns and other stressors that come with the season are not so easy to bear. The pressure people with GAD feel to make the holiday perfect can be overwhelming.

The good news is that, with treatment, people with GAD can enjoy the holidays as much as people who do not suffer from the condition – and better cope with the challenges of daily life during the rest of the year!

What is GAD?

GAD is one of the most common mental disorders. It is approximately twice as common in women as in men. In fact, the lifetime prevalence of GAD in women is estimated to be anywhere from 5-12%. GAD in adults is primarily associated with prior traumatic experiences such as poverty, recent adverse life events, chronic physical or mental illness, loss of or separation from a parent, lack of parental support during childhood, and a family history of mental problems.

Approximately 66% of people with GAD have at least one concurrent disorder, such as depression, panic disorder, social phobia, or other phobias. GAD may also be associated with increased rates of substance abuse and post-traumatic stress disorder (PTSD).

Symptoms of GAD

Everyone experiences anxiety at some point in their lives, including worrying about everyday concerns such as money, family, or health issues. But these same stressors can make people with GAD feel excessively worried or nervous – to the point where they are unable to control their anxiety and have difficulty functioning in their day-to-day lives.

People with GAD may also exhibit these common symptoms: scanning the environment around them for cues and threats, feeling restless, having trouble relaxing, and having difficulty concentrating. Other symptoms include having trouble getting to sleep or staying asleep, irritability, headaches, pain in the neck, shoulders and back, and feeling fatigued all the time. They may even worry about what they perceive to be the potentially dangerous consequences of their excessive worrying.

Treatment Options

People who exhibit these symptoms should talk to their doctor, who will do a physical exam and evaluate the patient’s health history to make sure their symptoms are not caused by an unrelated physical problem.

While GAD is considered a chronic illness, may patients recover with psychotherapy or medication therapy – or a combination of the two.

If a GAD patient and their doctor decide that medication therapy is the best option, the patient may be prescribed a selective serotonin reuptake inhibitor (SSRI). SSRIs are commonly used to treat depression but have also been found to be effective for people with GAD.

Another treatment option is cognitive behavioral therapy (CBT), during which a therapist will work with the GAD patient to strategize ways that can help them break the cycle of worry. For some patients, combining CBT with medication is the best treatment approach.

Lifestyle Changes to Relieve GAD

Making certain lifestyle changes can also help GAD patients alleviate their symptoms, including reducing or eliminating their consumption of caffeine or alcohol.

Aerobic exercise, yoga, meditation, and mindfulness-based stress reduction have also been shown to be effective augmentative treatments for people with GAD. The controlled breathing practiced in yoga and meditation helps calm anxiety or hyperactivity of the mind. Mindfulness emphasizes staying in the present moment, the here and now, rather than trying to anticipate what may or may not occur in the future, which can bring on anxious thoughts.

There are several apps that I recommend to my patients who are interested in practicing mindfulness and meditation, including CalmHeadspace, and Buddhify.

Remember: If you’re feeling overwhelmed this holiday season, you’re not alone. Getting ready for family celebrations at this time of year can be a full-time job – on top of your regular full-time job! – even for people who do not suffer from GAD.

So, manage your expectations, ask for help when you need it, and stay in the present.

Happy Holidays!