Though talk therapy and medication are first-line treatments for GAD, you may also find relief with certain home remedies and lifestyle changes.
But it can be hard to live with excessive, hard to control, and stubborn worry.
Maybe your symptoms keep you up at night. Maybe the worry arises first thing in the morning as you wake up. Or maybe it feels like you’re rarely worry-free.
People with GAD experience excessive worry more days than not, sometimes worrying from 3 to 10 hours a day.
But you’re not alone — even though you might sometimes feel like it. According to data from the Centers for Disease Control and Prevention (CDC),
Whatever the causes of anxiety may be, there are many GAD treatments available, along with coping tools that can help you prepare for your next doctor’s appointment.
Psychotherapy, or “talk therapy,” is one of the most effective treatment options for GAD.
Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) are the two most common recommendations.
Cognitive behavioral therapy (CBT)
The first-line treatment and gold standard for treating anxiety is CBT.
CBT for GAD is a multimodal treatment, meaning that it includes various components that target the different symptoms of the condition — physical, cognitive, and behavioral.
Overall, CBT aims to help you reduce your anxiety and worrisome thoughts, effectively cope with stress, and calm your nervous system.
You and your therapist will work together on creating a treatment plan that’s best for you.
CBT typically consists of 8 to 15 hourlong sessions, but the number of sessions depends on the severity of your symptoms, whether you have other co-occurring conditions, and the number of treatment components your therapist will be using.
CBT often includes homework outside your therapy sessions, so your therapist will ask you to practice different strategies in your day-to-day life and report back.
In CBT, your therapist often starts by educating you about GAD and how it manifests. You’ll also learn to observe and monitor your symptoms. Think of yourself as a scientist who’s studying your thoughts, feelings, and actions, or as a journalist gathering information and trying to identify patterns.
In CBT, you may also learn progressive muscle relaxation and other techniques to reduce the physical symptoms of GAD.
You’ll also challenge unhelpful thoughts that spark and exacerbate your anxiety. For instance, you may overestimate that something terrible will happen and underestimate your ability to cope with a difficult situation.
You’ll learn to change your worries into problems you can solve and create actionable plans.
As avoidance tends to make anxiety worse, you’ll gradually confront situations and activities that you tend to avoid, such as situations with an uncertain outcome.
Lastly, you and your therapist will want to come up with a relapse prevention plan. It’ll include the strategies you’ll continue to practice, along with a list of early warning signs and a plan to effectively navigate those signs. You’ll also identify future goals.
Typically, CBT is conducted face-to-face with a therapist. However,
ICBT usually involves following a treatment program that’s available online while receiving support from a therapist via calls, text, or email.
Acceptance and commitment therapy (ACT)
The second-line treatment for GAD is acceptance and commitment therapy.
In ACT, you learn to accept your thoughts without trying to alter or reduce them.
ACT also helps you focus on the present moment and your surroundings, as well as take action on your values, instead of letting your anxiety dictate your decisions and your days.
Your healthcare provider can prescribe several types of medications to help with your GAD, including:
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin-norepinephrine reuptake inhibitors (SNRIs)
- buspirone (BuSpar)
- tricyclic antidepressants (TCAs)
- monoamine oxidase inhibitors (MAOIs)
- atypical antipsychotic medications
- other medications used off-label, such as beta-blockers
These types of medications are described in more detail below.
Keep in mind that many people with GAD don’t respond to the initial medications they try. The next treatment your healthcare provider prescribes will depend on your specific symptoms, treatment history, and preferences.
SSRIs and SNRIs
When it comes to medications, the first-line treatment for GAD is a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI).
These medications are also highly effective for depression, which is important because depression commonly co-occurs with GAD. This means that taking an SSRI or SNRI can decrease symptoms of both conditions.
Many experts recommend psychological treatments (often CBT), along with an SSRI or SNRI as the first-line treatment for people with GAD. However, therapy may be tried alone first depending on individual needs and severity of anxiety symptoms.
Your healthcare provider will likely start you on a low dose of an SSRI. While it varies by individual, you’ll often begin to feel the benefits of the medication in 4 to 6 weeks.
If you’re not showing much improvement during that time, your provider will likely increase the dose of the same medication.
If that doesn’t seem to help, that medication will be tapered off, and your healthcare provider will likely prescribe a different SSRI or move on to an SNRI.
The following SSRIs and SNRIs have been approved by the Food and Drug Administration (FDA) for treating GAD:
Your provider may prescribe a medication “off label,” which can still be effective for treating GAD, even though it hasn’t been FDA approved for that condition. One example is the SSRI sertraline (Zoloft).
While the side effects of each SSRI vary, they commonly include:
- weight gain
- sexual problems, such as decreased sex drive, delayed orgasm, or inability to achieve orgasm
The side effects of SNRIs may include:
If you abruptly stop taking an SSRI or SNRI, or sometimes even if you taper off slowly, these medications can produce discontinuation syndrome, which can include flu-like symptoms, dizziness, and insomnia.
To avoid this syndrome, work with your doctor to taper off the medication at a tolerable rate and keep them informed of any side effects.
Some people may not tolerate the side effects of certain SSRIs, either when first starting the meds or as time goes on. Other people may need faster relief from panic attacks or other anxiety symptoms.
If this is the case, your healthcare provider may prescribe a low-dose benzodiazepine for short-term use. Benzodiazepines start working much faster than most medications — within minutes or hours.
Though these drugs are highly effective, they’re prescribed more cautiously due to a high potential for tolerance and dependency. They can also cause sedation and mental impairment.
In general, it’s now recommended that most people avoid long-term use of benzodiazepines.
If you have a history of substance use issues, or begin to notice signs of dependency when taking a benzodiazepine, your healthcare provider may prescribe something else.
Possible alternatives include the antihistamine hydroxyzine (Vistaril) or the anticonvulsant pregabalin (Lyrica), along with an SSRI or SNRI.
Buspirone (BuSpar) is another type of FDA-approved anti-anxiety medication that’s considered well tolerated and effective.
Unlike benzodiazepines, buspirone doesn’t cause physiological dependence, but does take longer (about 4 weeks) to take effect.
Side effects of buspirone may include:
- trouble sleeping
TCAs and MAOIs
Another option if you don’t respond to SSRIs or SNRIs are tricyclic antidepressants (TCAs) or monoamine oxidase inhibitors (MAOIs).
For instance, the TCA imipramine (Tofranil) may help people with GAD who don’t also have depression or panic disorder.
However, TCAs and MAOIs are older types of antidepressants and are prescribed less often because many people can’t tolerate the side effects. TCAs can also cause discontinuation syndrome, when you experience side effects while stopping a medication.
Plus, overdosing can occur with TCAs and result in an increased risk of cardiotoxicity (damage to your heart muscle).
Because of the potential for severe side effects, MAOIs also require dietary restrictions, such as not eating aged cheeses, soy products, or smoked meats. You also have to avoid several medications while taking an MAOI.
Atypical antipsychotic medications
Atypical antipsychotic medications, such as risperidone (Risperdal), may also be prescribed, either alone or in combination with another medication to boost its effects.
Side effects of antipsychotics may include:
- weight gain
- dry mouth
- nausea or vomiting
- low blood pressure
- extrapyramidal symptoms, including tremors, muscle spasms, slower movement, and uncontrollable facial movements like sticking out your tongue or repeatedly blinking
- a reduced number of white blood cells, which may reduce your ability to fight infections
Pregabalin (Lyrica) can also be an effective treatment for GAD. While it’s better tolerated than benzodiazepines, you may still experience tolerance, withdrawal, and dependence.
Side effects of pregabalin include:
Long-term use has been associated with weight gain in some people.
The antihistamine hydroxyzine (Atarax) may also be an effective treatment for some. It may have more sedating effects than benzodiazepines and buspirone, making it a good option for treating GAD-related insomnia.
Plus, beta-blockers such as propranolol are often prescribed off-label to treat anxiety disorders.
Still, beta-blockers and antihistamines are often only taken for anxiety on an as-needed basis or right before an event that may cause anxiety, such as before giving a speech.
Besides psychotherapy and medications, there are several home remedies and lifestyle changes you may want to try to help reduce your GAD symptoms.
Many self-care and complementary strategies can be helpful in your overall treatment plan. Often, they’re combined with first-line treatments such as therapy and medications, but don’t usually replace them.
If you want to give certain home remedies such as essential oils or CBD a try, speak with your healthcare provider first to ensure there isn’t a risk of interactions with your current treatments.
Some essential oils may help with anxiety.
Keep in mind that essential oils shouldn’t be ingested. Instead, they can be inhaled (aka aromatherapy) or applied to the skin topically, as long as they’ve been diluted with a carrier oil.
Is CBD Legal? Hemp-derived CBD products (with less than 0.3% THC) are legal on the federal level, but are still illegal under some state laws. Marijuana-derived CBD products are illegal on the federal level, but are legal under some state laws. Check your state’s laws and those of anywhere you travel. Keep in mind that nonprescription CBD products are not FDA-approved, and may be inaccurately labeled.
Weighted blankets are heavier than regular blankets, weighing between 4 and 30 pounds. They help ground your body, which may reduce anxiety.
Exercise is a significant stress reliever. The key is to participate in physical activities you enjoy, which may be different from day to day.
You may try taking a walk, practicing yoga, dancing, or boxing. Any movement at all can help you feel a little bit better.
If you notice increased feelings of anxiety, breathing exercises can help you feel grounded.
Meditation and mindfulness
Practicing meditation and mindfulness can help reduce your symptoms of anxiety and GAD. These both teach you to be in the present moment and more mindful of your thoughts and feelings.
Anxiety can sometimes make it hard to sleep, but sleep deprivation can also trigger anxiety, making you more sensitive to stressors.
Focus on creating a bedtime routine that consists of the same 3 or 4 activities that you can do at the same time, in the same sequence every night. Think small activities like listening to a guided meditation, sipping some herbal tea, or reading a few pages of a book.
Also, it can help to make your bedroom an inviting, soothing space. Improving your sleep environment and routine can help you feel well-rested and better throughout the day.
Avoid anxiety triggers
Caffeine and other substances can exacerbate anxiety in some people, so it can help to reduce or completely stop drinking coffee, soda, and other caffeinated beverages.
Alcohol and tobacco are other substances that may worsen anxiety. Quitting both drinking and smoking may help reduce anxiety.
If you find it difficult to quit on your own, get help by talking with someone you trust, joining a support group, or asking your healthcare provider for advice.
As an alternative to caffeine, tobacco, or alcohol, you may want to try sipping on some calming herbal tea. For example, research has suggested that lavender tea could help ease symptoms of anxiety in older adults.
There are many excellent books on anxiety from seasoned experts, which you can work through while in treatment.
Many self-help anxiety books contain worksheets, tips, and knowledge that can help you manage your anxiety.
Find what calms you
It can be really helpful to make a list of healthy, calming activities and strategies to engage in every day.
Everyone is different, so finding what calms you may look different and involve some trial and error.
Maybe it’s looking up at the sky, being by water, painting or crafting, going to a park, watching funny movies, dancing around your house, or simply visualizing a safe place.
If you’re ready to discuss GAD and possible treatment options with your healthcare provider, it’s vital to be your own advocate.
Prepare for your visit by jotting down questions you want to ask. Some examples include:
- What medications are an option for me?
- What are the side effects of this medication?
- How long will this medication take to work?
- I’m interested in an alternative therapy, are there any interactions I should know about?
- Is there anything I should avoid on this medication or with this therapy?
- What do I do if I experience severe side effects when I start this medication?
- What can I do in a crisis?
In other words, bring up anything that concerns you. You deserve to speak up and be heard.