Psychological Treatment for GAD
Cognitive-Behavioral therapy
There is ample scientific evidence that cognitive-behavioral therapy (CBT) is very effective in treating all anxiety disorders, including generalized anxiety disorder (GAD). That is why the doctors of Anxiety.org developed myAnxietyApp, a CBT-based self-help module that you can use for free on this site. myAnxietyApp uses information you provide to create a custom treatment program focused on your specific symptoms.
Cognitive-behavioral therapy teaches individuals with GAD new ways to think and react to situations, which ultimately reduces their anxiety and worry both in the short-term and long-term. This form of GAD treatment may also reduce symptoms of a co-occurring psychiatric disorder like depression or another anxiety disorder. This is particularly helpful, given the fact that individuals with GAD often suffer from other psychiatric disorders as well.
CBT is structured yet uses a collaborative approach to treatment, where the client and therapist work together on aspects of the therapy. CBT as a generalized anxiety disorder treatment may include some or all of the following components:
- Psychoeducation: Clients learn the purpose of the treatment and how it works. They are taught about the nature and causes of anxiety and worry, and the interaction among thoughts, behavioral responses, and physical sensations that are involved in GAD.
- Self-monitoring: Clients are encouraged to notice what brings on their anxiety and worry, and what happens when they worry. They are guided to look for cues that can be in the form of thoughts, behaviors, feelings, situations, or physical changes. The purpose of this component is for clients to notice the antecedents and consequences of worrying in their efforts to learn to eliminate their worry and anxiety.
- Relaxation: Clients are taught different forms of relaxation and they are encouraged to practice them daily, often more than once a day. Common relaxation techniques include diaphragmatic breathing, progressive muscle relaxation, and positive imagery. The goal is for them to be able to apply these relaxation techniques when they feel anxious.
- Cognitive Restructuring: The client and therapist work together on thoughts and beliefs that are unique to the individual and GAD. (Some maladaptive ways of thinking are discussed on the generalized anxiety disorder description page.) Clients are encouraged to identify thoughts associated with anxiety and worry, to figure out whether they are accurate or likely, and to replace them with helpful thoughts that don’t lead to worry.
- Exposure: This component is helpful in providing evidence to the client that their thoughts are not accurate or likely. In-session exposure for GAD is typically imaginal, where the client is asked to imagine the subject of their worry (for example, the catastrophic event) and to think about it for an extended period of time (e.g., 20 minutes). In-vivo exposures might involve practicing not planning or preparing for events. Cognitive restructuring and relaxation are used as coping mechanisms during the exposures. Exposure is an important step in treating GAD, because individuals with this disorder tend to avoid thinking about the catastrophic event itself by worrying about it and planning for it, which may perpetuate the worry.
Most of these components are taught and reviewed in session, however the client is expected to practice them outside of session as well, usually on a daily basis. CBT for GAD can have long-lasting effects and works best when clients practice self-monitoring, relaxation, cognitive restructuring, and exposures in session as well as on their own, in multiple settings and under different circumstances. This way, they can generalize their skills and use them in as many situations as possible.
CBT is also an effective treatment for GAD in children and some experts may involve the parents in the process to help in modeling and reinforcing skills and to learn to manage their own anxiety1.
The treatment of choice for GAD in older adults is often CBT, because it is time-limited and can accommodate age-related memory changes2, and CBT can be used in primary care settings or even at home3. Some experts suggest a more individualized treatment plan may be more appropriate for older adults, given that symptoms may vary greatly and that clients may respond better when treatment is designed to target their specific needs4.
Cognitive-behavioral therapy is effective in treating generalized anxiety disorder, however many continue to experience some symptoms after treatment completion. Therapist sometimes choose to individualize their treatment plans to integrate components of other treatment methods, such as emotion-focused or interpersonal therapy5, acceptance and commitment therapy6, or to apply treatment in primary care settings7,8. Many individuals receive psychological treatment in combination with medication.
Medications Used to Treat GAD
Studies show that many individuals with GAD who are treated with medication benefit from short-term reduction in symptoms. The most commonly prescribed medications are benzodiazepines, antidepressants (SSRI, SNRI, and tricyclic), and azapirones9, each with its own set of positive and negative side effects. There are many factors involved in determining which medication would work best, including the patient’s medical and psychiatric history, and other medications being used. Individuals taking medications for GAD should be monitored regularly by a physician. Some medications may need an adjustment in dosage once an individual has begun treatment, whereas others require a gradual tapering in preparation for treatment termination to avoid potentially dangerous withdrawal reactions.
Here are the different classes and names of medications used to treat GAD10. Each of these is discussed in detail on the Anxiety Medications page.
Selective Serotonin Reuptake Inhibitor (SSRI): Paroxetine, Sertraline, Fluvoxamine, Escitalopram
Serotonin and Noradrenaline Reuptake Inhibitor (SNRI): Venlafaxine, Duloxetine
Benzodiazepine: Alprazolam, Diazepam, Lorazepam
Azapirone: Buspirone
Tricyclic Antidepressant: Imipramine
Antihistamine: Hydroxyzine
Anticonvulsant: Pregabalin (PGP)
Complementary and Alternative Medicine (CAM): Kava-kava and other homeopathic preparations
1. Hirshfeld-Becker, D. R., Masek, B., Henin, A., Blakely, L. R., Pollock-Wurman, R. A., McQuade, J., DePetrillo, L., Briesch, J., Ollendick, T. H., Rosenbaum, J. F., & Biederman, J. (2010). Cognitive behavioral therapy for 4- to 7-year-old children with anxiety disorders: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 78, 498-510.
2. Beck, J. G. (2008). Treating generalized anxiety in a community setting. In D. Gallagher-Thompson, A. M. Steffen, & L. W. Thompsom (Eds.). Handbook of Behavioral and Cognitive Therapies with Older Adults. Springer Science + Business Media: New York.
3. Brenes, G., Wagener, Stanley, M. (2008). Treatment of late-life generalized anxiety disorder in primary care settings. In D. Gallagher-Thompson, A. M. Steffen, & L. W. Thompsom (Eds.). Handbook of Behavioral and Cognitive Therapies with Older Adults. Springer Science + Business Media: New York.
4. Wetherell, J. L., Sorrell, J. T., Thorp, S. R., & Patterson, T. L. (2005). Psychological interventions for late-life anxiety: A review and early lessons from the CALM Study. Journal of Geriatric Psychiatry and Neurology, 18, 72-82.
5. Newman, M. G., Castonguay, L. G., Borkovec, T. D., Fisher, A. J., Boswell, J. F., Szkodny, L. E., & Nordberg, S. S. (2011). A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interpersonal therapies. Journal of Consulting and Clinical Psychology, 79, 171-181.
6. Roemer, L., Orsillo, S. M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 76, 1083-1089.
7. Craske, M. G., Rose, R. D., Lang, A., Welch, S. S., Campbell-Sills, L., Sullivan, G., Sherbourne, C., Bystritsky, A., Stein, M. B., & Roy-Byrne, P. P. (2009). Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings. Depression and Anxiety, 26, 235-242.
8. Stanley, M. A., Wilson, N. L., Novy, D. M., Rhoades, H. M., Wagener, P. D., Greisinger, A. J., Cully, J. A., & Kunik, M. E. (2009). Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care. Journal of the American Medical Association, 301, 1460-1467.
9. Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.
10. Hidalgo, R. B., Tupler, L. A., Davidson, J. R. T. (2007). An effect-size analysis of pharmacologic treatments for generalized anxiety disorder. Journal of Psychopharmacology, 21, 864-872.
