“I couldn’t possibly have an anxiety disorder,” you tell yourself. “I don’t get panic attacks. I’m great in social situations. Sure, I get nervous now and then before a big presentation at work, but who doesn’t? Everyone feels worried and anxious sometimes. Surely this is just the norm.”
But when does it stop being the norm and start being something more? Anxiety disorders are broad and varied, and not all of them involve panic attacks or social anxiety. If you’re constantly fatigued and on-edge, or if the everyday worry impairs your daily functioning and quality of life, you may be experiencing Generalised Anxiety Disorder (GAD).
What is GAD?
Anxiety has a purpose. It’s a natural human response to high-stress situations, an evolutionary defence mechanism our brains developed to help protect us from perceived threats. In fact, not all stress is bad stress. In the words of James Clear, “stress and anxiety were useful emotions because they helped us take action in the face of immediate problems.”
Often, anxiety is only short-term. Any feelings of apprehension, worry, or nervousness should pass once the stressful situation is resolved. But when that worry doesn’t go away, and instead becomes excessive and persistent, it could be a sign to look a little deeper. In the long-term, chronic anxiety of six months may indicate the presence of Generalised Anxiety Disorder (GAD).
SingHealth defines GAD as “uncontrollable worrying, nervousness and tension [that is] often unrealistic or out of proportion”. In other words, that anxiety has snowballed and permeated every other aspect of our life. Worst of all, we can’t seem to “snap out of it”. Singapore’s Ministry of Health cites physical symptoms such as fatigue, muscular tension, numbness, and trembling, resulting in sleeping difficulties, abdominal upsets, dizziness, and frequent irritability.
Between 2010 and 2016, the prevalence of GAD in Singapore nearly doubled from 0.9% to 1.6%, with a spike in cases among young adults between 18 to 34 years old. These individuals have significantly higher chances of being diagnosed with other psychiatric conditions such as depression, bipolar disorder, and alcohol abuse or dependence. Worryingly, only 37.9% of those with GAD promptly sought help for their condition.
Do I have GAD?
How do you know if the anxiety you’re feeling is regular stress, or a symptom of something more? There are two main things to look out for:
- Duration: For how long have you been feeling constantly anxious?
- Severity: How much has it impacted your quality of life?
Here are some self-assessment questions to consider:
- Over the last six months, have there been more days where you felt worried than not?
- Has the worry you’ve experienced seemed irrational or out of proportion to you, yet you can’t seem to control yourself or “reason away” that worry?
- Do you feel more tired than normal, even on the days you’ve gotten adequate sleep?
- Have you had more difficulty concentrating at work or school than usual?
- Have you experienced any physical symptoms such as tightness in your chest, a feeling of choking, or a pounding heart?
- Have you felt disengaged from social situations or your relationships?
- Do you find it difficult to calm down or shut off your worry even after the things you were worried about have been resolved?
Additionally, the Generalised Anxiety Disorder Assessment (GAD-7) can help you get a sense of your risk level.
With that said, self-assessment should never replace a formal diagnosis. If you suspect that you’re experiencing a mental health condition, be sure to get evaluated by a mental health professional. After all, GAD is only one of many under the umbrella of anxiety disorders—which also includes specific phobias, panic disorder, separation anxiety disorder, social anxiety disorder, and more—and it’s possible to mistake one for another.
It’s even possible you don’t have GAD at all, even if you scored high on the self-assessment questionnaire. Certain medical conditions, like hyperthyroidism, may mimic the symptoms of GAD. Speaking to a professional ensures that you undergo all the necessary mental and physical evaluations for accurate diagnosis and treatment.
Why is it important to get diagnosed for GAD?
Even though mental health awareness has improved tremendously in recent years, it’s normal to fear being diagnosed with a mental health disorder. A 2017 study found that 46.2% of youths between 14 to 18 years old still find it “embarrassing” to be diagnosed with a mental illness, citing their worry of being seen as “weak” and being ostracised by others.
Think of it this way: The case for a mental health diagnosis isn’t far off from that for a physical health condition. You can’t address a broken heart valve until you get a CT scan, and knowing where the wires are crossed is the first step to healing GAD. A diagnosis can guide effective treatment and mitigate a risk of relapse—and the clarity it brings can even be empowering.
Where can I get diagnosed for GAD in Singapore?
Singapore’s public healthcare system offers psychiatric services, including GAD diagnosis, in multiple avenues.
Some polyclinics provide assessment, medication, and psychotherapy, we recommend calling ahead to the polyclinic you intend to visit to learn more.
- National Healthcare Group Polyclinics (NHGP)
- National University Polyclinics (NUP)
- Singhealth Polyclinics (SHP)
Even if a polyclinic does not offer mental health services, you can still speak to a physician who may refer you to a specialist at a public hospital or another polyclinic.
For those who prefer the private healthcare route, private hospitals such as Raffles Medical Group, Mount Alvernia Hospital, and Mount Elizabeth Hospital offer psychiatric services with no referral required, albeit at higher costs.
If long appointment wait times are an issue for you, we have good news. Intellect Clinic offers same-week appointments in two central locations, making a range of diagnostic assessments, counselling, and therapy services accessible.
Types of GAD treatments in Singapore
GAD can be treated by psychotherapy, pharmacotherapy (medication), or a combination of both.
Psychotherapy
Cognitive Behavioural Therapy (CBT)
CBT, a structured and evidence-based approach to recognising and modifying unhelpful thoughts, is used to treat a wide range of mental health conditions.
In CBT, a therapist works closely with you to identify unhelpful thinking, develop coping strategies like cognitive restructuring (reframing their thoughts), and adopt healthier behaviours.
Studies have shown that CBT can be even more effective when combined with other techniques such as emotion regulation therapy, mindfulness interventions, intolerance of uncertainty therapy, and technological interventions.
Some practices you could encounter during CBT include:
- Cognitive restructuring: To identify cognitive biases and reframe unhelpful thinking patterns. Exercises like the Worry Spiral, for example, can make us more aware of our tendency to catastrophise in the face of uncertainty.
- Behavioural experiments: To change your assumptions and see how that changes your behaviour. If your assumption is that “criticising myself will motivate me to do better”, try replacing it with “praising myself will motivate me to do better” and see if it makes a difference.
- Exposure exercises: To take baby steps towards confronting a feared situation, object, or memory you have been avoiding. This reduces your levels of arousal the next time you encounter the stimulus.
If you’re experiencing mild GAD symptoms or prefer a digital-first approach, you’d be pleased to know that Intellect offers self-guided interventions informed by CBT. The Learning Path titled Anxiety & Worry, for instance, reduced anxiety levels by 45% for nearly half of its users within two weeks.
Acceptance and Commitment Therapy (ACT)
ACT is a mindfulness-based approach that emphasises acceptance of uncomfortable thoughts and feelings—and living a meaningful life in spite of them.
In CBT, a therapist uses experiential exercises to help clients observe their internal experiences without judgement, focusing on forward action instead of struggling to control the anxiety or worry.
Some of the core processes of ACT include:
- Cognitive defusion: To create distance from your thoughts by observing them as transient events rather than permanent truths.
- Values clarification: To distinguish your values from that of others and align your life choices with what truly matters to you.
- Committed action: To practise purposeful behaviour consistently in spite of discomfort and barriers, cultivating authenticity and resilience.
While CBT and ACT are common methods of addressing GAD, the range of possible psychotherapies is vast. At Intellect Clinic, we recognise that individuals are unique and a one-size-fits-all treatment plan won’t cut it. As such, your therapeutic journey will be tailored to you and you alone.
Pharmacotherapy
Selective Serotonin Reuptake Inhibitors (SSRIs)
While also prescribed for depression, SSRIs have been evidenced to alleviate GAD symptoms with relatively few side effects. They help with mood regulation by increasing the levels of serotonin in your brain, and are usually prescribed for a few months. Improvements have been observed in as little as a few weeks but, as always, this can vary across individuals.
Benzodiazepines
Minor tranquilisers, like benzodiazepines, can help ease anxiety symptoms within a relatively short time. However, as their sedative effects pose risks in terms of tolerance, dependence, and withdrawal, psychiatrists tend not to prescribe them for anything other than short-term use.
In Singapore, only psychiatrists are allowed to prescribe medication. If you’re seeing a clinical psychologist at Intellect Clinic and medication is deemed necessary, we may refer you to a psychiatrist within our network while supporting you in psychotherapy.
GAD isn’t just your run-of-the-mill stress
GAD interferes with your daily life, work, and relationships. If you notice that your constant worrying is causing you to lose concentration, sapping the joy out of activities you once loved, or manifesting as physical pain and fatigue, it may be time to consult a professional.
Even if you don’t end up getting diagnosed with GAD, you only stand to gain from reaching out. If your quality of life has been compromised, speaking to a coach, counsellor, or psychotherapist can help you reclaim control over your anxiety and live your best life.
This article was reviewed by Intellect’s Clinical Psychologist Linda Rinn.
