If you suspect or have been diagnosed with Generalised Anxiety Disorder (GAD), finding ways to manage this mental disorder can be challenging. GAD can be draining, and finding the right treatment to help you manage this will require patience and trials.

This article explores how TCM identifies patterns of disharmony, personalises treatments, and integrates centuries-old practices to alleviate anxiety. Discover how TCM can complement modern therapies to promote calm, clarity, and emotional resilience in your life.

What is Generalised Anxiety Disorder (GAD) and How Does it Affect Me?

Generalised Anxiety Disorder (GAD) is a mental health condition characterised by excessive worry and anxiety about various aspects of life, even when there is little or no reason to worry. GAD can be diagnosed when your worrying happens on most days and for at least 6 months. A person's daily functioning and quality of life can be significantly impacted if GAD is not managed well.

Causes for Generalised Anxiety Disorder (GAD)

GAD can result from various factors, including:

Genetics: Research suggests that there is a hereditary component to GAD. Certain genes predispose one to GAD or other mental health disorders.[1].
Brain chemistry: Mechanistically speaking, imbalances in neurotransmitters in charge of our mood, like serotonin and norepinephrine, may contribute to GAD.
Environmental factors: Stressful life experiences such as trauma, abuse, or major life changes can trigger or exacerbate GAD.
Personality: People with certain personality types, such as those prone to perfectionism or who are highly sensitive, may be more susceptible to GAD[2].

What are the Symptoms of Generalised Anxiety Disorder (GAD)?

Symptoms of GAD include:

The symptoms of Generalised Anxiety Disorder (GAD) to consider for TCM treatments | Common TCM

Excessive worry: Feeling anxious or worried most days, even when there is little or no reason to worry.

Difficulty controlling worry: Finding it hard to control the worry, even when recognising that the anxiety is excessive.
Physical symptoms: Symptoms such as muscle tension, headaches, fatigue, irritability, trembling, sweating, or difficulty sleeping.
Restlessness or feeling on edge: Being unable to relax or feeling constantly on edge is akin to ingesting too much caffeine, usually to the point of affecting sleep or rest.
Difficulty concentrating: Finding it hard to concentrate due to worry or anxiety.
Pessimism: Always expecting the worst outcome in any situation.

Available Treatments and Self-Help Tips

With therapy, medication, lifestyle changes, relaxation techniques and support groups, GAD is highly treatable. Below are some treatments and self-help tips that can help:

Psychotherapy: Cognitive behavioural therapy (CBT) may help one to identify unhelpful thought patterns or behaviours, thereby allowing one to unlearn them to break the cycle of anxiety arising from these actions. Exposure therapy can be helpful to desensitise individuals by gradually exposing them to anxiety-provoking situations. Mindfulness-based therapies can help individuals focus on being present in the moment and accepting thoughts and feelings without judgment.
Medications: Antidepressants like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can help relieve symptoms of anxiety but often produce side effects like brain fog and dampened emotional response. Additionally, it often results in dependence as it becomes hard to stop taking these medicines.
Lifestyle changes: Physical activity is helpful in increasing levels of serotonin in the brain[3], leading to reduced anxiety and symptoms of stress. Healthy eating habits reduce our digestive burden and provide the body with essential building blocks to synthesise neurotransmitters that benefit our mental health. Getting enough quality sleep can decrease symptoms of depression and anxiety[4]. Cutting out caffeinated beverages can be helpful in managing symptoms of anxiety.
Relaxation techniques: Meditation and breathing techniques that utilise deep diaphragmatic breathing can help calm the body and mind aiding in relaxation. Bodywork practices like Yoga and Taichi can connect the mind and body into one unit, promoting mindfulness and relaxation.
Support groups: Connecting with others who have similar experiences can provide valuable support and coping strategies. A group setting provides you with an opportunity to be with people who have a common purpose and are likely to understand and help one another.

Evidence-Based TCM Approaches for Managing Generalised Anxiety Disorder (GAD)

In Traditional Chinese Medicine (TCM), although there isn’t a disease that translates to GAD, its associated symptoms can be likened to 脏燥(Zang Zao), 心悸(Xin Ji), 不寐(Bu Mei), 郁证(Yu Zheng) etc. Commonly seen patterns of disharmony that present in those afflicted with the above-mentioned TCM diseases are: “Heart-Spleen deficiency, Liver stagnation Spleen deficiency, Liver-Kidney Yin deficiency, Phlegm-Heat, Blood-stasis, Heart-Gall bladder deficiency” etc. Although anxiety is present in all the patterns of disharmony listed above, the way it is presented helps TCM practitioners identify the specific Organ System at play. For example, someone with a Heart-Spleen deficiency pattern would display anxiety in the form of excessive worry and even heart palpitations or lethargy whereas someone with a Heart-Gall bladder deficiency pattern would display anxiety in the form of being easily frightened and the inability to sit still for long. A comprehensive consultation is necessary to elucidate the pattern of disharmony for effective management of GAD using TCM.

Herbal Medicine

Since antiquity, TCM has been using herbs to treat emotional disturbances. One of the most commonly used formulas for the treatment of anxiety is 加味逍遥散(Jia Wei Xiao Yao Powder). Due to its mood-altering properties, its name can be translated as free and easy wanderer plus. Research into this formula has discovered that it exerts its anti-anxiety effects by normalising the levels of corticosterone in the plasm, thereby having an effect on the central nervous system(CNS) and hypothalamic-pituitary-adrenal axis (HPA)[5].

Another commonly used formula for the treatment of anxiety is 甘麦大枣汤 (Gan Mai Da Zao decoction). The Gan Mai Da Zao decoction is one of the most famous herbal prescriptions in the Chinese medical book 金匮要略 Jin Gui Yao Lue (Medical Treasures of the Golden Chamber), which was written by medical sage Zhang Zhongjing. Gan Mai Da Zao decoction was used by Zhang Zongjing to treat 脏躁 (Zang Zao syndrome), which is a kind of emotional condition that presents with symptoms such as a racing heart, irritability, feeling spaced-out and insomnia. Zang Zao syndrome greatly resembles anxiety which we see in the modern day. Research into Gan Mai Da Zao decoction found that it exerts its anti-anxiolytic properties via the GABAergic and serotonergic systems[6].

Acupuncture, Cupping and Auricular Therapy

Acupuncture, the act of inserting fine needles into specific acupoints on the body, has long been practised and proven to be a safe and convenient way to manage emotional trauma with few side effects[7]. A meta-analysis reviewing the efficacy of TCM and acupuncture for generalised anxiety disorder found that acupuncture has clear superiority in relieving anxiety symptoms compared with Western medications or psychotherapy[8]. A commonly used acupuncture point to alleviate anxiety is 印堂 (Yin Tang) which is located at the midpoint between the eyebrows. Another acupoint that is commonly used for anxiety is conveniently located near Yin Tang on the top of the head. This point is called 百会 (Bai Hui), also called “a hundred convergences” in English, and so named because multiple meridians meet at this point. Acupuncture done on Bai Hui has a calming and sedative effect on the mind and body thus helping one to relax and let go of stress and anxiety.

In addition to acupuncture, cupping can also be used to help reduce the symptoms of anxiety from people who are afraid of needles. Utilising the suction of the cups, major muscle groups that tense up and hold tension can be made to release and relax, thereby helping the individual feel less bound up. Areas which tense up easily and hold tension are located in the neck, shoulders and middle back region. If bound up too tightly, breathing may become more shallow and thus cause all our energy to flow upwards. hence the saying, “all up in your head” to describe someone who overthinks.

A subset of acupressure includes auricular acupressure, where tiny beads are pasted on the ears to stimulate pressure points that correspond to different organs in the body. These beads can be self-stimulated and provide lasting acupressure stimulation long after a visit to the physician’s clinic.

How Many Sessions Do I Need?

Treatment for GAD adopts a multi-prong approach and requires consistency. There can be short-term goals such as alleviating accompanying physical symptoms and balancing overall cortisol spikes in the long run. The duration is individualised and depends largely on the patient’s responsiveness and willingness. Most of the time, there can be excellent therapeutic effects from attending acupuncture sessions regularly.

At Common TCM, your physician will review your medical history and determine the optimal frequency of visits based on the duration and severity of symptoms as well as any other underlying conditions (e.g. thyroid dysfunction) that may affect the prognosis. A course of treatment usually entails weekly sessions for a 3-month duration. Upon completion, depending on how the symptoms have abated, a follow-up treatment plan taking into account other factors (e.g. any upcoming major stressors/travel) will be suggested.

Who is This Suitable For?

Treatment is suitable for anyone, however, do inform the physician of any pre-existing medication that you are on. A personalised consultation with the physician will be necessary to determine the treatments chosen. GAD management requires a physician who adequately understands the ins and outs of your emotional and mental landscape to be able to help you to the greatest ability. Thus, a physical consultation is the best way to review your well-being status and stress levels and help personalise your healthcare journey.

Finally, do your research and seek advice from reputable professionals and from a good TCM in Singapore for an elevated healing experience. For more information, visit our website to learn more about our TCM wellness treatments and physicians or to book an appointment. Your well-being is our priority, and we are here to support you on your journey towards better health.

Managing Generalised Anxiety Disorder (GAD) with TCM