Essential Information for Patient and Family

• Stress and worry have both physical and mental effects.
• Learning skills to reduce the effect of stress and control the worry (not sedative medication) will provide the most effective relief.

Specific Counselling to Patient and Family

• Encourage the patient to practice daily relaxation methods to reduce physical symptoms or tension.
  
  
• Plan short-term activities which are relaxing, distracting, or pleasant. Resume activities which have been helpful in the past
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• Identifying and challenging exaggerated worries can reduce anxiety symptoms.
  • Identify exaggerated worries or pessimistic thoughts (e.g. when daughter is 5 minutes late from school, patient worries she's had an accident).
  • Discuss ways to challenge these negative thoughts using cognitive therapy when they occur (When she starts to worry about her daughter, patient will tell herself "I am starting to get caught up in worry again. She is only a few minutes late and should be home soon.").
    
    
• Structured problem-solving methods may help patients deal with stresses which contribute to anxiety symptoms
  • Identify events that trigger excessive worry (e.g. a young woman presents with worry, tension, nausea and insomnia. These symptoms began after her son was diagnosed with asthma. Her anxiety and excessive worry worsens when he has asthma episodes.)
  • Discuss what the patient is doing to manage this situation. Identify and reinforce things that are working.
  • Identify some specific actions the patient can take in the next few weeks, such as:
    • discuss concerns with parents of other asthma children.
    • meet with nurse/doctor/health professionals and learn about the course and management of asthma
    • write down a plan for management of asthma episodes.
      
      
• Regular exercise is often helpful.

Medication

• Medication is a secondary treatment in the management of generalized anxiety. It may be used, however, if significant anxiety symptoms persist despite counselling.
• Citalopram 20mg per day is of benefit in controlling the excessive worrying.

.Specialist Consultation

• Consultation may be helpful if the disorder does not respond.

What a doctor might say to a person with a generalised anxiety disorder