Treating Anxiety

NHS

Generalised anxiety disorder (GAD) is a long-term condition, but a number of different treatments can help. If you have other problems alongside GAD, such as depression or alcohol misuse, these may need to be treated before you have treatment specifically for GAD.

Psychological therapies for GAD

If you have been diagnosed with GAD, you'll usually be advised to try psychological treatment before you're prescribed medication.

You can get talking therapies like cognitive behavioural therapy (CBT) and applied relaxation on the NHS. You can refer yourself directly to an NHS talking therapies service without a referral from a GP.

Guided self-help and cognitive behavioural therapy (CBT)

Your GP or talking therapies service may suggest trying a self-help course to see if it can help you learn to cope with your anxiety. Self-help courses for GAD are usually based on the principles of cognitive behavioural therapy (CBT).

There are several ways you may be offered self-help and CBT:

  • you work through a CBT workbook or computer course in your own time
  • you work through a CBT workbook or computer course with the support of a therapist who you see every 1 or 2 weeks
  • you take part in a group course where you and other people with similar problems meet with a therapist every week to learn ways to tackle your anxiety

If these initial treatments don't help, you'll usually be offered more intensive CBT where you usually have weekly sessions with a therapist for 3 to 4 months, or another type of therapy called applied relaxation or medication.

You can try some self-help cognitive behavioural therapy (CBT) techniques on the Every Mind Matters website. This is not a full CBT course or guided self-help, but it has practical self-help tips and strategies based on CBT techniques.

Applied relaxation

Applied relaxation focuses on relaxing your muscles in a particular way during situations that usually cause anxiety. The technique needs to be taught by a trained therapist and generally involves:

  • learning how to relax your muscles
  • learning how to relax your muscles quickly and in response to a trigger, such as the word "relax"
  • practising relaxing your muscles in situations that make you anxious

As with CBT, applied relaxation therapy will usually mean meeting with a therapist for a 1-hour session every week for 3 to 4 months. Relaxation therapy may not be available in all areas, so you might be offered CBT instead.

Medication

If the psychological treatments above haven't helped or you'd prefer not to try them, you'll usually be offered medication.

Your GP can prescribe a variety of different types of medication to treat GAD. Some medication is designed to be taken on a short-term basis, while others are prescribed for longer periods.

Depending on your symptoms, you may need medication to treat your physical symptoms, as well as your psychological ones.

If you're considering taking medication for GAD, your GP should discuss the different options with you in detail before you start a course of treatment, including:

  • the different types of medication
  • length of treatment
  • side effects and possible interactions with other medicines
  • which medication is best for you if you’re pregnant, planning a pregnancy or breastfeeding

You should also have regular appointments with your doctor to assess your progress when you're taking medication for GAD.

Selective serotonin reuptake inhibitors (SSRIs)

In most cases, the first medication you'll be offered will be a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). This type of medication works by increasing the level of a chemical called serotonin in your brain.

Examples of SSRIs you may be prescribed include:

  • sertraline
  • escitalopram
  • paroxetine

SSRIs can be taken on a long-term basis but, as with all antidepressants, they can take several weeks to start working.

Serotonin and noradrenaline reuptake inhibitors (SNRIs)

If SSRIs don't help ease your anxiety, you may be prescribed a different type of antidepressant known as a serotonin and noradrenaline reuptake inhibitor (SNRI).

This type of medication increases the amount of serotonin and noradrenaline in your brain.

Pregabalin

If SSRIs and SNRIs aren't suitable for you, you may be offered pregabalin. This is a medication known as an anticonvulsant, which is used to treat conditions such as epilepsy, but it's also been found to be beneficial in treating anxiety.

Benzodiazepines

Benzodiazepines are a type of sedative that may sometimes be used as a short-term treatment during a particularly severe period of anxiety. This is because they help ease the symptoms within 30 to 90 minutes of taking the medication.

Although benzodiazepines are very effective in treating the symptoms of anxiety, they can't be used for long periods.

Referral to a specialist

If you have tried the treatments mentioned above and have significant symptoms of GAD, you may want to discuss with your GP whether you should be referred to a mental health specialist.

A referral will work differently in different areas of the UK, but you'll usually be referred to your community mental health team.

These teams include a range of specialists, including: 

  • psychiatrists
  • psychiatric nurses
  • clinical psychologists
  • occupational therapists
  • social workers

An appropriate mental health specialist from your local team will carry out an overall reassessment of your condition. Your specialist will then be able to devise a treatment plan for you, which will aim to treat your symptoms.

As part of this plan, you may be offered a treatment you haven't tried before, which might be psychological treatments or medication.

Alternatively, you may be offered a combination of a psychological treatment with a medication, or a combination of 2 different medications.

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Helplines & Web Chats

Samaritans
Action Mental Health
Association for Post-Natal Illness Helpline
Aware NI - Support Groups
Aware NI - Online Support Groups
Mind - Side by Side Online Community