Understanding Generalized Anxiety Disorder in Veterinary Professionals

In previous MentorVet posts, we have discussed how veterinarians can experience high levels of stress which can lead to burnout in veterinarians. In this article, we look at another risk factor for burnout and other stressors: generalized anxiety disorder or GAD.

Generalized anxiety disorder is a medical condition that affects approximately 4-7% of adults in the US (Obiamaka & Heering, 2021). GAD is characterized by specific criteria including excessive anxiety and worry that interferes with one’s ability to perform their day to day activities, including work.

The veterinary career can be stressful, and stress may exacerbate symptoms of anxiety. One study found high levels of anxiety, depression, and stress among veterinary students (Nahar et al., 2019). In a 2017-18 study, veterinary house officers reported high levels of burnout and mild levels of anxiety and depression (Chigerwe, et al., 2021). With the advent of COVID-19, research on the effects of COVID-19 on GAD and other stressors among veterinarians will be explored in a future article.

This article will discuss recognizing generalized anxiety disorder in veterinarians and the intervention and prevention strategies that address it.

What is generalized anxiety disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5, 2013), an adult diagnosed with GAD is characterized by “excessive anxiety and worry occurring more days than not,” with three or more of the following symptoms: “restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance” (p. 222). These symptoms must also be present at least six months or longer and “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” (DSM-5, 2013, p. 222).

Many veterinary professionals may feel stressed or worried from time to time, but for those with GAD, the worry is often excessive, unrealistic, or out of proportion. Veterinarians and support staff with GAD may be restless or irritable or find it difficult to concentrate. These symptoms may also interfere with the ability to effectively work and help animals.

As part of the diagnostic assessment, the symptoms of GAD cannot be attributed to the physiological effects of mood-altering substances, medication, another medical condition, or another behavioral health diagnosis (DSM-5, 2013). GAD can be diagnosed by either a psychiatrist, a primary care physician, or a licensed mental health professional, preferably one who specializes in anxiety disorders such as a psychologist or social worker. GAD is also the most common type of anxiety disorder with a median age of onset of 30 (Obiamaka & Heering, 2021) and frequently co-occurs with other with other behavioral health diagnoses, including alcohol and substance misuse.

What are the risk factors of generalized anxiety disorder?

GAD is thought to arise from the interaction of biological and environmental factors. GAD risk factors include:

·      Being female

·      A family history of mood or anxiety disorders

·      Life stressors

·      Early-childhood trauma

·      Poor coping skills

·      Poor social support (Schub & Gilreath-Osoff, 2018).

Females account for two-thirds of patients diagnosed with GAD, and pregnancy and postpartum are also considered to be additional risk factors (Schub et al., 2018).

What are the symptoms of generalized anxiety disorder in veterinarians?

Symptoms of generalized anxiety may vary and can include both physical or behavioral symptoms.

1. Behavioral symptoms

Some of the behavioral symptoms of GAD include:

·      Excessive anxiety and worry

·      Trouble relaxing

·      Poor coping skills

·      Performance anxiety

·      Irritability

·      Difficulty concentrating (Obiamaka & Heering, 2021)

2. Physical symptoms

The physical symptoms of GAD are varied, but some of the more frequently reported symptoms include:

·      Changes in appetite

·      Nausea

·      Dizziness

·      Trembling

·      Headaches

·      Muscle tension

·      Sleep disturbance (Schub, et al., 2018)

How can veterinarians address generalized anxiety disorder?

If you are a veterinary professional who has symptoms of GAD or you suspect that you might have GAD, we recommend discussing this with a mental health professional. Mental health professionals will be able to provide you with individualized guidance on how to move forward with your mental health. There are several ways to treat GAD, including psychotherapy and medication management.

Psychotherapy

Talk therapy or psychological counseling involves working with a mental health professional to decrease your anxiety symptoms. Cognitive behavioral therapy (CBT) has been found to be effective for a range of behavioral health problems, including GAD.

CBT is typically a short-term treatment that helps the patient identify learned patterns of thinking that are unhelpful as well as distortions in thinking that are creating problems. Some CBT interventions include role play, developing problem-solving skills, and developing an effective treatment strategy. One goal of CBT is to help the patient develop confidence in their abilities to solve their own problems.

Medications

While a detailed discussion on medication management is beyond the scope of this article, a brief description of some medications used in the treatment of GAD is provided. It is important to consult with a physician or psychiatrist to determine if medication management is warranted.

Medication management is another treatment for GAD, including certain antidepressants, such as selective serotonin reuptake inhibitors or the anti-anxiety medication, buspirone. Buspirone is classified as an anxiolytic and interacts with the serotonin neurotransmitter. A patient who is prescribed buspirone does not experience the sedation effects or the memory and cognitive impairment that are found with people who are prescribed benzodiazepines.

Are there ways to prevent generalized anxiety disorder?

Certain mental health conditions cannot always be prevented, but there are actions you can take as a veterinary professional that may reduce or lessen your symptoms. One of the main themes in promoting wellbeing, including reducing symptoms of GAD and other stressors, is taking a preventative approach. You can utilize the following self-care recommendations:

·      Eating a well-balanced meal

·      Limiting or eliminating alcohol products, sugar, and caffeine

·      Exercise several times during the week for 20-30 minutes (e.g., walking and low impact training)

·      Establishing a regular sleep routine

·      Taking some time each day to relax without any interruptions (e.g., meditation, yoga, deep breathing exercises, practicing self-compassion)

·      Journaling when feeling overwhelmed, stressed, or anxious so you’ll have a record of what events may be contributing to your anxiety

·      Establish a strong support network of friends and veterinary mentors

Additional Resources

There may be additional resources at your state and community level, but here are some national resources and the links provided below may serve as a starting point.

·      Anxiety & Depression Association of America- This website provides useful downloadable brochures on GAD and other anxiety disorders in several languages. You can find these resources by visiting ADAA’s website.

·      American Counseling Association- This is a website that provides resources for anxiety, including locating a counselor who treats anxiety, articles on GAD and other anxieties. A subscription is needed to access some of their resources. To learn more, click here to visit the American Counseling Association’s resources on anxiety.

·      National Institute of Mental Health- This is a resource that provides information about GAD and other anxiety disorders as well as a link to clinical trials and research. To learn more, visit the NIMH’s resources on anxiety.

Conclusion

By recognizing the signs and symptoms of GAD, you can begin to develop a wellness plan that will not only address GAD, but also your overall health in all facets of your life. The prevention suggestions and the additional resources offer a starting point. As you develop your plan, you may also incorporate other prevention strategies that reflect your lifestyle and personality. The goal is to reduce or eliminate your anxiety and replace it with a self-care plan that also contributes to your overall wellbeing.

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.

Chigerwe, M., Barter, L., Dechant, J. E., Dear, J. D., and Boudreaux, K. A. (2021). A preliminary study on assessment of wellbeing among veterinary medical house officers. Plos One. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253111

Nahar, V. K., Davis, R. E., Dunn, C., Layman, B., Johnson, E. C., Dascanio, J. J., Johnson, J. W., & Sharma, M. (2019). The prevalence and demographic correlates of stress, anxiety, and depression among veterinary students in the Southeastern United States. Research in veterinary science, 125, 370–373. https://doi.org/10.1016/j.rvsc.2019.07.007

Obiamaka, O. and Heering, H. (2021, July 16). Generalized Anxiety Disorder. CINAHL Nursing Guide. https://www.ebscohost.com/assets-sample-content/SWRC_HealthRelatedAnxiety_QL_SC.pdf

 Schub, T., Gilreath-Osoff, A. and Pravikoff, D. (2018, Aug 24). Generalized Anxiety Disorder in women. CINAHL Nursing Guide. https://eds-s-ebscohost-com.proxy.heal-wa.org/eds/pdfviewer/pdfviewer?vid=2&sid=aa94cdb8-332b-43a3-81eb-10d3fcbd06dc%40redis