A client has a diagnosis of generalized anxiety disorder. Her physician has prescribed buspirone 15 mg daily. The client says to the nurse, “Why do I have to take this every day? My friend’s doctor ordered Xanax for her, and she only takes it when she is feeling anxious.” Which of the following would be an appropriate response by the nurse?

Generalized anxiety disorder involves excessive, uncontrollable worry that persists for at least six months and interferes with daily functioning. It presents with restlessness, muscle tension, and impaired concentration. Suppression of thoughts, such as trying to "forget worries," is maladaptive and prevents emotional processing. Effective treatment includes cognitive behavioral therapy and anxiety-reducing techniques like relaxation training and exposure to triggers through guided therapy.

Rationale for correct answers

C. The desire to forget worries suggests avoidance, not processing. This shows the client needs to verbalize emotions to reduce internal tension and improve long-term coping.

Rationale for incorrect answers

A. Insight involves recognizing the impact of anxiety and understanding patterns. Avoidance behavior, like trying to forget, lacks self-awareness and does not reflect insight.

B. Improved coping is shown by active management such as cognitive restructuring or relaxation. Forgetting worries is a passive, ineffective defense that hinders emotional resolution.

D. Treatment success includes functional improvements and adaptive coping. Avoiding thoughts contradicts therapeutic goals of confronting and managing anxiety consciously.

Take Home Points

• Avoidance of anxiety triggers is a common but ineffective defense mechanism in GAD.
• Emotional verbalization is essential for processing and managing anxiety disorders.
• Insight involves recognizing the nature of one’s condition and its effects on behavior.
• Effective coping in GAD includes cognitive and behavioral strategies, not suppression.

Generalized anxiety disorder (GAD) is a chronic psychiatric condition characterized by excessive, uncontrollable worry occurring more days than not for at least six months. This worry is about a variety of events or activities and is associated with at least three somatic or psychological symptoms, such as restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and disturbed sleep. These symptoms cause significant distress or impairment in functioning.

Rationale for correct answers

B. Restlessness or feeling keyed up is a hallmark feature of GAD and reflects persistent psychomotor agitation due to chronic anxiety.

C. Difficulty controlling the worry is a defining characteristic of GAD, where the client finds it hard to stop or manage anxious thoughts.

D. Irritability is a common psychological symptom of chronic anxiety and stems from prolonged internal tension and hyperarousal.

E. Muscle tension is a typical somatic symptom of GAD, resulting from continuous physical arousal and stress response.

Rationale for incorrect answers

A. Expansive mood and pressured speech are not features of GAD; they are more indicative of manic episodes seen in bipolar disorder and not related to the anxious and apprehensive mood found in GAD.

Take Home Points

• GAD involves excessive worry lasting ≥6 months with impaired control over anxiety.
• Common physical symptoms include restlessness, fatigue, and muscle tension.
• Psychological symptoms often include irritability and poor concentration.
• GAD must be differentiated from mood disorders like bipolar disorder based on mood and speech characteristics.