Life continually throws worries our way—be it troubling economic news or the pressure of an upcoming work review. Add to that the concerns about your loved ones, like a parent’s health or a child’s school performance, and it’s easy to feel overwhelmed.
Will I lose my job? What if the doctors discover something serious? How will my child handle the national exams this year?
These are the voices of anxiety and worry, keeping us awake at night and preoccupied during the day. Though they may be unwelcome, they serve a purpose and are part of our emotional landscape.
Differentiating anxiety and worry
Anxiety is our natural response to stress, designed to protect us from real threats. Imagine our ancestors encountering a tiger in the wild—anxiety would trigger their “fight-or-flight” response, enabling them to react quickly and stay safe from danger.
Today, our brains still use this ancient survival system to handle modern stressors. While a missed deadline isn’t life-threatening, the primitive part of our brain doesn’t always make that distinction. So it triggers our body’s fight-or-flight response, causing our heart rate to accelerate as if we’re preparing for combat.
Worry, on the other hand, isn’t a physical reaction but a mental chatter about what might go wrong or how we’ll handle it. For example, we might worry about our boss’s reaction to a late submission or how we’ll explain ourselves. Think of worry as a mental rehearsal, preparing us for potential issues.
It’s normal to experience anxiety and worry now and then, but there’s a difference between feeling motivated by a deadline and being overwhelmed by anxiety that hampers our ability to act. Similarly, there’s a distinction between worrying about a potential reprimand and spiralling into fears of losing our job and struggling to provide for our family.
How can you determine if your anxiety and worry are typical or indicate something more significant? Here are three key factors to consider:
- Duration: How long have you been experiencing these feelings of anxiety and worry?
- Symptoms: Are your anxiety and worry showing up in physical, psychological, emotional, and behavioural ways?
- Severity: How much do these feelings affect your overall quality of life?
Do I have Generalised Anxiety Disorder (GAD)?
Often, anxiety and worry are short-term and should pass once the stressful situation is resolved. But when they don’t go away, and instead become excessive and persistent, they may indicate the presence of Generalised Anxiety Disorder (GAD).
Between 2010 and 2016, the prevalence of lifetime GAD in Singapore nearly doubled from 0.9% to 1.6%, with a spike in cases among youths between 18 to 34 years old. Yet, more than half of the individuals with 12-month GAD did not seek help promptly.
Based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), GAD may be diagnosed if:
- The anxiety and worry occur more days than not for at least six months, about a number of events or activities (such as work or school performance).
- You find it difficult to control the worry.
- The anxiety and worry are associated with three or more of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months):
– Restlessness or feeling keyed up or on edge
– Being easily fatigued
– Difficulty concentrating or mind going blank
– Irritability
– Muscle tension
– Sleep disturbance - The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
More importantly, the disturbance should not be attributed to the physiological effects of a substance or another medical condition. It should also not be better explained by another mental disorder, such as:
| Condition | Characterised by anxiety and worry about… |
| Panic Disorder | Having panic attacks |
| Social Anxiety Disorder | Negative evaluation by others |
| Obsessive-compulsive Disorder | Obsessive thoughts and/or compulsion to perform repetitive behaviours |
| Separation Anxiety Disorder | Separation from attachment figures |
| Posttraumatic Stress Disorder | Reminders of traumatic events |
| Anorexia Nervosa | Gaining weight despite being underweight |
| Somatic Symptom Disorder | Physical complaints |
| Body Dysmorphic Disorder | Perceived appearance flaws |
| Illness Anxiety Disorder | Having a serious illness |
| Schizophrenia or Delusional Disorder | Content of delusional beliefs that isn’t grounded in reality |
Given that GAD can be confused with various other mental health conditions, self-assessment alone is not sufficient. If you suspect you might have GAD, it’s important to seek a formal evaluation from a mental health professional.
GAD diagnosis at Intellect Clinic
In Singapore, Generalised Anxiety Disorder (GAD) can only be diagnosed by clinical psychologists and psychiatrists. Notably, only psychiatrists have the authority to prescribe medication.
At Intellect Clinic, our clinical psychologists diagnose GAD by using the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) and the GAD-7 (Generalised Anxiety Disorder-7) to understand your symptoms, and carefully consider whether your symptoms might be linked to another mental health condition.
Should they need to rule out any underlying health issues or the effects of medications and substances, they might refer you for a medical evaluation.
GAD treatment at Intellect Clinic
If you are diagnosed with GAD, our team at Intellect Clinic will collaborate with you on a treatment plan. This involves evidence-based approaches such as:
1. Cognitive Behavioural Therapy (CBT)
CBT is a structured, evidence-based approach that focuses on identifying and modifying unhelpful thoughts and behaviours. Research has shown that CBT significantly improves outcomes for patients experiencing anxiety symptoms within 12 months after completing treatment, compared to control groups.
When managing Generalised Anxiety Disorder (GAD), CBT techniques such as cognitive restructuring are crucial in addressing core beliefs and underlying fears that fuel anxiety.
For example, a core belief like “I must never make mistakes, or I’ll be a failure” can intensify the underlying fear of judgement and rejection. In CBT, your clinician will work with you to challenge this belief by examining evidence that contradicts it and developing a more balanced perspective. This might involve reframing the belief to something like, “Making a mistake is not the end of my career; it’s an opportunity to learn, and everyone makes errors.”
To address the underlying fear of judgement and rejection, your clinician may also introduce behavioural experiments where you deliberately make a minor mistake and observe the actual outcomes. By directly confronting and testing these fears, you reinforce more adaptive core beliefs.
This process helps restructure the core beliefs that contribute to chronic worry, leading to more constructive ways of thinking and behaving, and ultimately alleviating feelings of anxiety.
2. Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy (ACT) is a mindfulness-based approach that encourages individuals to embrace their internal experiences, including uncomfortable thoughts and feelings, without judgement and commit to actions aligned with their values.
Research indicates that ACT has comparable effects on reducing anxiety symptoms as Cognitive Behavioral Therapy (CBT), according to both clinician assessments and patient self-reports.
In managing Generalised Anxiety Disorder (GAD), ACT techniques like cognitive defusion help create psychological distance from distressing thoughts. For example, if you often think, “I’m not capable of handling this,” you will learn to view these thoughts as temporary events in the mind rather than fixed realities. This reduces their impact and power over you. Techniques might include visualising these thoughts as passing clouds or leaves floating down a stream.
By recognising that these thoughts are transient and not necessarily true, you can focus more on actions that reflect your core values. For instance, even if you feel anxious about leading a sustainability project, you might choose to commit to it because protecting the environment aligns deeply with your values, rather than letting anxiety dictate your choices. This shift from avoidance to value-based action is central to ACT’s approach in reducing anxiety and enhancing overall wellbeing.
Learn to manage anxiety and worry and Intellect Clinic
At Intellect Clinic, we practise evidence-based treatment and tailor intervention plans based on individuals needs and differences. Our clinicians utilise an eclectic therapeutic approach to address your presenting issues related to GAD symptoms as well as emotional difficulties.
Our psychotherapy sessions are priced at $220 (Singapore dollars) per hour and held across four clinics in Marina One, Tanjong Pagar, Woodleigh, and Tembeling. If medication is deemed beneficial for you, we will refer you to a partner psychiatrist within Intellect Clinic’s network. In such cases, some treatment sessions may take place at their clinics.
Reach out to us today for an appointment in the same week.
