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Who should I see first if I think I might have GAD?
The first port of call for anyone who thinks they might have GAD, should be their GP. You can discuss your symptoms with your doctor and they may do tests to check for any underlying medical problems and ask about your family history, your history of any mental distress, current anxieties, recent stresses and daily use of prescription and non-prescription medicines.
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What happens if my GP thinks I might have GAD?
Depending on where you are in the UK, your GP may monitor you for a while and, if there’s no improvement in your symptoms, they will refer you to a community based mental health service known in England as the IAPT (Immediate Access to Psychological Therapies). The name of this service varies, depending on where you are in the country.
An appropriate mental health specialist from your local IAPT team will carry out an overall reassessment of your condition. They may ask about things in your life that may be affecting your condition, such as how much support you have from family and friends. They will also ask you about any relevant treatments you may have had before.
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What healthcare professionals will I come across in the IAPT?
Once you’ve been referred to the community based mental health service, you will be assessed by professionals who will help in deciding the best treatment for you. Depending on where you are in the country, this team of professionals includes psychiatrists, psychiatric nurses, clinical psychologists, occupational therapists and social workers.
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What’s the difference between a psychiatrist and a psychologist?
Depending on where you are in the country, you may be referred to a psychiatrist (medical doctors who specialise in treating conditions such as GAD) or a psychologist (these professionals are also trained in various treatments for conditions like GAD, but they can’t prescribe medications).
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How is the IAPT service organised and what can I expect?
The IAPT service is organised in steps, which aims to provide the appropriate treatment at the right time to get the best outcome for the individual in question. For example, if you start your treatment and it turns out your GAD is not improving, the healthcare professional will discuss ‘stepping up’ your treatment and you can decide if this is the way you want to go. Similarly, if your GAD improves markedly during a specific treatment, you and your healthcare professional can discuss ‘stepping down’ to less intensive therapy.
Central to this approach is that treatment and care should take into account your individual needs and preferences. You should have access to the appropriate information that allows you to reach informed decisions about the care you receive.2 Also, if you agree, families and carers should have the opportunity to be involved in decisions about treatment and care.
Click on the headings below to find out more information about your journey through the ‘stepped care’ of the NHS.
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Step 1 – Identification
This is the step where your GAD is first diagnosed, and it is recognised that there might be a problem. The healthcare professionals responsible for you will continue to assess you to see if your symptoms worsen or improve. In many areas Step 1 is the remit of the GP.
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Step 2 – Low-intensity psychological interventions for GAD
The healthcare professionals have been monitoring your symptoms and it seems your GAD symptoms have worsened slightly. In many places, your GP will refer you to the IAPT. Following an assessment, the IAPT service will offer one or more of the following treatments as a first-line intervention:
• Individual non-facilitated self-help
• Individual guided self-help
• Psychoeducational groups.
These use some of the techniques we looked at in More than Medication. The choice of treatment is guided by your preference and the pros and cons of each will be explained to you or you’ll be provided with the relevant information.
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Step 3 – Treatment options
If the Step 2 interventions have not been enough to adequately improve your GAD – this is where medications might be appropriate. The healthcare professionals in the IAPT will offer either:
• An individual high-intensity psychological intervention (e.g. CBT or applied relaxation)
• Drug treatment.
Again, you can expect to be provided with verbal and written information on the likely benefits and possible disadvantages of each type of treatment (e.g. drug side effects and withdrawal syndromes). You have the final decision on which to choose.
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Step 4 – Referral
In rare cases, a patient’s GAD may not respond to the treatments offered in Step 2 and Step 3. If they are having trouble looking after themselves or are at a higher risk of self harm, the community IATP team may refer them to other specialists within the team who have experience of looking after these patients.
At Step 4, the patient may be offered:
• Any non-medication treatments they have not yet tried
• Combinations of medications and psychological treatments
• Combinations of different medications.
In offering any of these, the healthcare professional will look at the personal circumstances of the patient and assess which treatments are most appropriate.
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What if I have other problems? Will this change the way I’m treated?
GAD is often accompanied by other problems such as depression, phobias, post-traumatic stress and sometimes, substance abuse. For treatment to succeed, it’s important to get help for all the problems you’re dealing with. These other conditions won’t really change your journey through the NHS, but you may be offered different treatments.
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What’s the outlook for me?
GAD is a complex condition which doesn’t necessarily go away, nor does it necessarily get worse. Many people with GAD find their symptoms come and go.
In general, the outlook is good. With appropriate treatment, many people will be able to return to work, take up their hobbies and interests again, and generally feel less burdened by the exhausting worry and restless fatigue that is GAD.