What is Generalised Anxiety Disorder (GAD)?

Generalised Anxiety Disorder (GAD) is a common anxiety condition characterised by persistent, excessive worry about a wide range of everyday issues – such as work, health, finances, family or world events – that is difficult to control and out of proportion to the actual risk.

To meet diagnostic criteria (DSM-5-TR), this worry typically:

• Occurs on most days for at least six months

• Feels very hard to switch off

• Is accompanied by at least three physical or cognitive symptoms (for example, restlessness, fatigue, poor concentration, irritability, muscle tension or sleep disturbance)

• Causes significant distress or interferes with work, relationships, or day-to-day life

It is more than being “a worrier” – GAD is a recognised mental health condition, and effective, evidence-based treatments are available.

How common is GAD?

Recent UK data indicate that anxiety is both common and increasing:

The latest Adult Psychiatric Morbidity Survey for England (2023–24) found that one in five adults (20.2%) had a common mental health condition, with GAD the single most prevalent disorder (7.5%).
NHS England Digital

In 2022/23, an average of 37.1% of women and 29.9% of men in the UK reported high levels of anxiety. Anxiety is especially common in younger adults: around 28% of 16–29-year-olds report some form of anxiety difficulty.
These figures highlight that if you are living with persistent anxiety, you are far from alone, and it is not a sign of weakness or personal failure.

How does GAD typically present?

People with GAD often describe feeling as if their mind is “constantly on”, scanning for problems and “what if?” scenarios. Common experiences include:

1. Persistent worry and “what if” thinking

Worrying about multiple areas of life (health, work performance, relationships, finances, safety)

Thoughts like “What if something goes wrong?”, “What if I’ve missed something?”, “What if I can’t cope?”

Difficulty controlling or switching off worry, even when you recognise it may be excessive

2. Physical symptoms

Restlessness, feeling “on edge” or keyed up

Muscle tension (often in the neck, shoulders or jaw)

Fatigue and low energy

Racing heart, stomach discomfort, sweating, or feeling shaky

3. Cognitive and emotional symptoms

Difficulty concentrating or feeling as though the mind goes blank

Irritability or feeling emotionally “on a short fuse”

A sense of dread or foreboding, as if something bad is about to happen

4. Sleep difficulties

Trouble falling asleep because of racing thoughts

Waking in the night worrying

Waking unrefreshed, as if sleep has not been restorative

5. Impact on day-to-day life

Procrastination or avoidance (e.g. delaying emails, avoiding phone calls, putting off decisions)

Over-preparation or “checking” (re-reading messages, repeatedly seeking reassurance, excessive list-making)

Strain on relationships, work performance and overall quality of life

If you recognise several of these signs, especially if they have been present most days for at least six months, it may be helpful to seek a professional assessment.

What causes GAD?

There is no single cause. GAD usually develops through a combination of biological, psychological and environmental factors.

1. Biological and genetic factors

Large epidemiological studies show that anxiety disorders, including GAD, tend to run in families, suggesting a genetic vulnerability.

Differences in how the brain’s stress-response systems function (for example, the amygdala and prefrontal cortex) and in neurotransmitter systems (such as serotonin and GABA) are associated with increased anxiety.

Chronic physical health conditions and inflammatory processes can increase vulnerability; for example, a 2025 study found that people with autoimmune conditions had significantly higher rates of anxiety and other mental health conditions than those without.
The Guardian

2. Personality and thinking style

Certain traits and thinking styles can make GAD more likely, such as:
MSD Manuals
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A tendency towards perfectionism or very high self-standards

Intolerance of uncertainty (“I must know exactly what will happen”)

A habit of catastrophising – assuming the worst-case scenario

A strong sense of responsibility and fear of making mistakes

These styles are not “faults” – they often develop as understandable attempts to cope – but they can become rigid and anxiety-promoting.

3. Life experiences and stress

Long-term stress at work, financial pressures, caring responsibilities or relationship difficulties can all contribute.

Experiences of trauma, early loss, inconsistent caregiving or growing up in a highly critical or anxious family environment can shape how we interpret threat and safety in adulthood.
MSD Manuals

Recent UK data suggest broader social stressors – including economic insecurity, the impact of the COVID-19 pandemic and climate-related concerns – are contributing to rising rates of anxiety, particularly in young people.

4. Maintaining factors

Once GAD has developed, certain patterns can keep it going, including:

• Avoidance (of situations, conversations or decisions)

• Reassurance-seeking (repeatedly asking others if things are okay)

• Safety behaviours (e.g. over-checking, over-planning, constantly googling symptoms)

• Beliefs such as “worry keeps me safe” or “if I don’t think everything through, something terrible will happen”

• Cognitive Behavioural Therapy (CBT) specifically targets these maintaining patterns.

How is GAD diagnosed?

In the UK, clinicians typically use criteria based on the DSM-5-TR or ICD-10/11, alongside a detailed clinical assessment. Diagnostic guidelines emphasise:

• Excessive anxiety and worry about multiple areas of life

• Symptoms present on most days for at least six months

• Significant distress or impairment

• Symptoms not better explained by another mental health condition, physical illness, or the effects of substances

Validated questionnaires (such as the GAD-7) are often used alongside a clinical interview, but a formal diagnosis should always be made by a suitably qualified professional.

How can CBT help with GAD?

Cognitive Behavioural Therapy (CBT) is a structured, evidence-based psychological therapy recommended by NICE in the UK as a first-line treatment for GAD.

How effective is CBT for GAD?

Research over several decades has consistently shown that CBT is an effective treatment for anxiety disorders, including GAD: A 2022 meta-analysis focusing on GAD found that CBT produced significant reductions in worry and anxiety and was at least as effective as medication, with better outcomes maintained six months after treatment ended. Recent broader meta-analytic reviews (up to 2025) show medium to large effect sizes for CBT across anxiety disorders compared with control conditions. CBT can be delivered face-to-face, online or in blended formats. Network meta-analysis and recent trials suggest that individual, in-person CBT tends to have the strongest effects, but remote and internet-delivered CBT also show meaningful benefits and can improve access.

What does CBT for GAD typically involve?

While treatment is always tailored to the individual, CBT for GAD at a clinic like ours often includes:

1. Assessment and shared formulation

A careful exploration of your history, current difficulties and goals

Mapping out how thoughts, feelings, physical sensations and behaviours interact to maintain anxiety

Agreeing a shared formulation: a personalised map of how your GAD operates, which guides treatment

2. Psychoeducation

Understanding how anxiety works in the body and mind (the fight-flight response, role of adrenaline and muscle tension)

Learning why worry feels compelling but often does not actually prevent problems

Normalising anxiety as a human response, while also validating how distressing it can be when it becomes chronic

3. Working with worry thoughts

CBT helps you change your relationship with worry by:

Identifying common thinking patterns (e.g. catastrophising, black-and-white thinking, mind-reading)

Gently questioning and testing unhelpful beliefs such as “if I worry, I’m more prepared” or “not worrying is irresponsible”

Developing more balanced, evidence-based alternatives – not positive thinking, but realistic thinking

Differentiating between:

Practical worries (problems that can be acted on) – and learning structured problem-solving

Hypothetical worries (“what ifs” with no immediate solution) – and learning to notice and let go of them

4. Behavioural change and facing fears

Gradually reducing avoidance and safety behaviours (such as constant checking or reassurance-seeking)

Planning graded exposure to situations or decisions that trigger anxiety, in a safe and supported way

Experientially learning that you can cope, that anxiety naturally rises and falls, and that feared outcomes often do not materialise or are manageable

5. Skills for the body: managing physiological arousal

Techniques to reduce physical tension, such as breathing exercises, progressive muscle relaxation and grounding strategies

Sleep-supportive routines and habits (sleep hygiene)

Sometimes integrating elements of mindfulness-based approaches to help anchor attention in the present rather than in future-focused worry

6. Relapse prevention and maintaining gains

Reviewing what you’ve learned and what has helped

Identifying early warning signs of rising anxiety

Creating a personalised maintenance plan so that you can continue using CBT tools long after therapy ends

What does treatment look like in practice?

At The London Psychologist Clinic, CBT for GAD typically involves:

• An initial assessment session to understand your difficulties and clarify whether CBT is suitable for you

• A structured course of weekly or fortnightly sessions (often 8–16 sessions, depending on need)

• Between-session practice tasks to help you apply strategies in real life

• Collaboration with you at every step – you remain the expert on your own life; our role is to provide a specialist framework and tools

For some clients, CBT may be combined with other approaches (for example, compassion-focused therapy or acceptance-based strategies) where appropriate, and we can also liaise with your GP or psychiatrist regarding medication if you wish.

When should I seek help?

You might consider seeking professional support if:

Worry and anxiety have been present most days for several months

You feel exhausted, overwhelmed or stuck in your head

Anxiety is affecting your sleep, work, relationships, or ability to enjoy life

Self-help strategies or reassurance from friends and family are no longer enough

How The London Psychologist Clinic can support you

Our clinicians have specialist training in CBT and other evidence-based therapies for anxiety, and we work with adults experiencing GAD, panic, health anxiety and other related conditions.

If you’re wondering whether what you’re experiencing might be GAD, or you’re simply feeling persistently on edge and would like to understand why, you are welcome to contact us for an initial consultation. We can discuss:

Whether GAD fits your experience

Which treatment options might be most helpful

How therapy can be tailored around your work and life commitments

You do not need to wait until things are “bad enough” – seeking help early can make a meaningful difference to your wellbeing and quality of life.