Asian cultures tended to exhibit a collectivist culture, a culture that considers individual actions as reflecting the group rather than the individual, while American cultures tend to possess an individualist culture, which depicts individual actions as reflecting only the individual. This explains why Japan and Korea has specifically TFK while, on the other hand, American society has social anxiety. Regardless of the variations of anxiety disorders in different countries and cultures, it seems to me that a main similarity between all anxiety disorders is that they are a definite issue that affects the daily lives of its victims. Now with a general background about anxiety disorders, I move onto the focus of this paper: Generalized Anxiety Disorder (GAD).
GAD is an anxiety disorder that is not associated with a specific source, unlike social anxiety and specific phobia. Those who are affected excessively worry about multiple and differing circumstances, whether miniscule or large, and they have difficulty controlling their distress. A person with GAD will overwhelmingly stress about one situation, but after the situation is relieved, they will shift their excessive anxiety to another unrelated circumstance, hence why the disorder is termed “generalized”. GAD can cause people to experience restlessness, “zoning out”, irritability, muscle tensions, sleep disturbances, headaches, dizziness, digestive issues, trembling, and shortness of breath (Jacofsky, Santos, Khemlani-Patel, and Neziroglu, Fugen, “Generalized Anxiety Disorder (GAD)”; Glasofer and Gans, “What Does Anxiety Feel Like?”). However, not everyone with GAD experiences amount of apprehension and symptoms the same way; there is a spectrum.
People with mild or slight to moderate GAD can enjoy a worthwhile life, but they may not jump on opportunities that are beneficial or desired such as relationships or job promotions or live life to their fullest potential due to their anxiousness. Those who are diagnosed with severe have major difficulties in their daily life and doing simple activities, such as leaving their homes, due to their extreme worry (“Understand the Facts.”). Different age ranges also lead to different GAD experiences. Adults with GAD tend to possess extreme anxiety about their career, taking care of their family, and managing their funds while children focus pessimistically more on their schooling, their plans, mistakes in the past, and embarrassment from peers (“Jacofsky, Santos, Khemlani-Patel, and Neiziroglu “Generalized Anxiety Disorder (GAD).”).
GAD has a high rate of comorbidity with other anxiety disorders or other mental disorders in general. In other words, most of the time, people with GAD are also diagnosed with other disorders, especially major depressive disorder, panic disorders, and social anxiety disorder. It is also said that GAD is associated with having one of the highest, if not the highest risks of suicidal actions and contemplation, highlighting the necessity of treatment and diagnosis of those who have GAD (Patriquin and Matthew, “The Neurobiological Mechanisms of Generalized Anxiety Disorder and Chronic Stress.”). Before talking about the treatments of generalized anxiety disorder, I believe it is important to understand the causes and roots behind the disorder.
However, there is no one specific factor that can be pinpointed to be the sole reason for GAD, and a clear picture about the causes of GAD has not formed yet. There are multiple components to the existence of GAD in people, 30% to 50% caused by biological factors and 50 % to 70% caused by environmental factors, and many studies have attempted to narrow down these causes and understand the activity of the brain with GAD (Patrinquin and Matthew, “The Neurobiological Mechanisms of Generalized Anxiety Disorder and Chronic Stress.”). It is well known from multiple studies that the amygdala, the part of the brain that is approximately the size of an almond and impacts people’s emotional experiences, plays a significant role in GAD.
The amygdala is highly activated when a person sees a negative trigger and experiences GAD related symptoms (Martin, Ressler, Binder, and Nemeroff, 549-575). In one Stanford study, the researchers discovered that regions of the amygdala associated with complicated feelings, thoughts, and alertness, the basolateral amygdala and centromedial amygdala, were not properly connected to the brain regions that regulate what stimuli is considered important enough to react. This impaired connectivity may be the reason why GAD patients have trouble deciphering what is necessary to worry about and causes them to have excessive anxiety about even the smallest situations (Pappas, “Brain scans show distinctive patterns in people with generalized personality disorder in Stanford Study.”). Along with the amygdala, issues with the hippocampus, the part of the brain associated with memories and emotions is also suspected to create GAD symptoms.
One of the hippocampus’s important processes for controlling anxiety is pattern separation, which is the ability to distinguish between two similar scenarios as separate. The stress a person with GAD receives from a negative stimulus decreases neurogenesis, the making of new neurons, in the hippocampus and impairs the hippocampus’s ability to perform pattern separation and process sensory information. This diminished state causes GAD affected individuals to respond with enormous worry to a situation that may not be damaging to them. However, studies on this specific function of the hippocampus has not been done, and this speculation has yet to be proven (Scicurious, “The Overgeneralization of Generalized Anxiety Disorder.”). Another abnormality in the brain of a GAD afflicted person is their vagal tone. The vagal tone is a term associated with the functions of the vagal nerve, which is found in the parasympathetic sub-region of the autonomous system of the brain.
A 1995 study found that the vagal tone played a role in the lack of flexibility of the autonomic system, the area of the brain that controls functions of the body unconsciously, in people with GAD. The autonomic nervous system requires flexibility in order prepares a person’s reaction towards a perceived threat and then calm the alertness of the body after the perceive threat is gone. However, the inflexibility makes the “fight or flight” reaction of the autonomic system to remain less variable or fixated, causing a person to be constantly alert and anxious. The study tested 15 GAD individuals and 15 non-anxiety disorder individuals for their initial resting vagal tones, vagal tones after thinking about negative imagery, vagal tones after thing about biggest worries, and final resting vagal tones. Lower vagal tones display higher heart rate and body signs related with alertness while higher vagal tones show the opposite.
The researchers found that GAD individuals had lower vagal tones throughout, even without stimulus, displaying that GAD individuals have chronically lower vagal tones and that vagal tones do affect the anxiety in those with the disorder. However, there were some issues with the study that need to be fixed, such as convenience sampling and possible confounding variable, and the research still needs to be replicated more times to say that this effect is for certain (Borkocev, Lyonfields, and Thayer, 457-466). Impairments in the amygdala, hippocampus, and vagal nerve can lead to symptoms and development of GAD, but some people are genetically predisposed to have these impairments. Findings in a study displayed the mothers who was diagnosed with anxiety disorder had an altered glucocorticoid receptor gene (NR3C1) in their genome and umbilical cord blood. The altered NR3C1 gene is thought to increase the chances of infant’s chances of having GAD.
A study has also shown that those who carry the short allele for serotonin transporter gene (5-HTTLPR) are more susceptible to symptoms of GAD than 5-HTTLPR homozygous long allele carriers. When participants of 5-HTTLPR short allele carriers and 5-HTTLPR homozygous long allele carriers were exposed to frightening faces or faces associated with negative emotion, 5-HTTLPR short allele carriers had amygdala with more hyperactivity than 5-HTTLPR long allele carriers, displaying that the 5-HTTLPR short allele carriers felt more anxiety and alertness towards the faces than compared to the 5-HTTLPR long allele carriers (Patriquin and Matthew, “The Neurobiological Mechanisms of Generalized Anxiety Disorder and Chronic Stress.”). Environmental factors can also play a part in the development of GAD.
I feel the obvious environmental reasons would be from stress and traumatic experiences that may occur in a person’s life, such as the death of a family member or stress from college. A person’s upbringing and culture can also impact a person’s probability of getting GAD. According to the New York Times, there is research that has pointed out domineering and anxious parenting styles can affect cause their children to become more likely to develop anxiety disorder, especially if the children are predisposed to the disorder by their genes. Exposure to social media and smartphones has also been shown in studies to have a positive correlation to anxiety and negative emotions in adolescents (Denezit-Lewis, “Why are American Teenagers Than Ever Suffering From Severe Anxiety?”). In another study, a sample of the U.S population was evaluated to determine the pervasiveness of anxiety disorders in certain races: Asian Americans were found to display the least symptoms for GAD compared to the Hispanics, African Americans, and White Americans sampled, while White Americans displayed to be the ethnicity in the sample with the most GAD symptoms as well as symptoms for SAD and panic disorder.
The results included the following percentages for GAD symptoms: White Americans (8.6%), African Americans (4.9%), Hispanics (4.1%), and Asian Americans (2.4%). These results make sense if we look at the general experiences associated with these ethnicities. Ethnic minorities face racial and minority discrimination, especially African Americans, that lead to more feelings of stress and anxiety that may lead to anxiety disorders. Because Hispanics and Asian Americans are rather newer immigrants than African Americans, they have had less exposure to discrimination and racism, which explains why they experience lesser percentages of GAD symptoms (Hofmann and Hinton, “Cross Cultural Aspects of Anxiety Disorders.”).
However, what does not make sense to me is the reason why White Americans have a higher percentage of people with GAD symptoms, which the article and study failed to address. I predict that there might be a biological or specific gene that White Americans are more likely to possess that makes them more susceptible to GAD. I also think that it could be because White Americans are usually at the top of organizational structures, so they are exposed to stressful situations that may trigger GAD. Perhaps in the future, researchers will conduct more studies find out more about the specific genes and factors associated with GAD and develop a clearer picture of the disorder’s cause. When observing the prevalence of GAD between genders, women were found to be twice as likely as men to procure GAD (“Understand the Facts.”).
This drastic difference may be due to hormone fluctuations in women that contribute to overall mental health as well as the environmental factor of sexism, which may cause more stress for women (Thorpe, “Why Women are More Prone to Anxiety Than Men, According To A New Study.”). Overall, all the studies have shown that numerous influences affect a person’s susceptibility to GAD, but I think there is still much that is unclear and unknown about the biological, genetic, and environmental components of GAD. Generalized anxiety disorder is not a curable disorder, but there are many treatment options that are available to relieve anxiety symptoms for those specifically diagnosed with GAD, including professional therapy, medications, and self-care methods.
The most effective and most researched kind of treatment for GAD is Cognitive Behavior Therapy (CBT). This kind of therapy aims to assist patients in becoming more acute to their own thoughts and helping patients change or control their anxious thought processes. The treatment consists of addressing the cognition of the patient and then the actions or behavior of the patient. In the cognition stage, the therapist or psychologist tackles the patient’s fear using the following process: (1) identifying and helping the patient realize that certain worries of the patient are unrealistic or unreasonable, (2) determining the probability of the anxiety trigger(s) as well as the worst possible outcome of the trigger occurring, and (3) assisting the patient in managing their fears and anxiety. Afterwards, the behavior stage of the treatment involves the patient actively being exposed to and facing their fears or their anxieties head on and thus gradually changing the way the patient reacts to anxiety-triggering stimuli.
Though there are other possible kinds of treatments, according to PubMed Health, CBT is the best-known therapeutic treatment for GAD. Along with therapy, medications have proven to be an effective treatment for lessening the effects of GAD. The most common medical treatment for GAD is selective serotonin reuptake inhibitors (SSRIs). an anti-depressant, which typically treats depression but works well for gradually decreasing the symptoms of GAD. Two specific and effect SSRIs include Escitalopram and Paroxetine. However, there are side effects of SSRIs that patients should be aware of before and when taking SSRIs such as insomnia, nausea, and inability to have functional sexual intercourse. SSRIs are the first line of defense for treating GAD, but sometimes the inhibitors do not work for certain patients. In that scenario, alternative medications are used for treatment: selective serotonin reuptake inhibitors (SNRIs), pregabalin, opipramol, buspirone, hydroxyzine, benzodiazepines, imipramine, and quetiapine.
Most of the treatments listed have not been studied much or are only to be used if no other medication works to relieve the symptoms, otherwise, SSRIs should be the main medication to treat GAD. Self-care methods are also a way to relieve GAD symptoms, but they are not as effective as therapy and medications. GAD affected individuals can try herbal sedatives such as lavender, valerian, and passion flower and/or yoga and muscle relaxation to soothe the anxiety and any physical discomfort or pain (“Treatment options for generalized anxiety disorder.”). Despite all the possible beneficial treatments, the Anxiety and Depression Association of America (ADAA) stated that of the 6.8 million American adults they found with GAD, only 43.2% of them are receiving treatment (“Understand the Facts.”).
In another survey by the National Comorbidity Survey Replication, they obtained data between 2001 and 2003 that displayed 75% of the 9,282 grownups that had GAD or SAD, social anxiety disorder, had not gotten professional mental help for their disorders in the previous year. Those with GAD had even lower turnout rates for treatment for their mental health than those with SAD. A study on the barriers to treatment of GAD and SAD found that the most common obstacle to obtaining treatment for GAD affected individuals was the desire to be independent, the embarrassment of asking for assistance, the lack of knowledge about places to get treated, and the expenses of getting treated.
Additionally, more than 50% of the people sampled believed that the treatments would not be able to relieve or lessen their GAD symptoms, and ethnic minorities were more likely to recognize obstacles toward their treatment (Goetter, Frumkin, Palitz, Swee, Baker, Bui, and Simon, “Barriers to mental health treatment among individuals with social anxiety disorder and generalized anxiety disorder.”). I think it is important for health institutions to advertise more about the severity of anxiety disorders and about how effective treatments can be for people who seek it. If not, I believe this trend of disbelief and low treatment rates will continue.