Evidence-Based Intervention for Generalized Anxiety Disorder

Each year, 4 million Americans are diagnosed with generalized anxiety disorder (GAD) although 8 or 9 million may suffer the pain and disability of GAD annually. Nearly twice as many women as men are diagnosed, but women are also more likely to seek help. Yet the effectiveness of treatment is supported by sound evidence.

Terms

• "Evidence-based practice," in short, is a method for putting knowledge in to practice; one where "evidence," comes from different levels of scientific research methods. "Systematic reviews" and "meta-analysis," two methods for combining a number of existing studies on the same subject, provide the best evidence. For a single study, "randomized controlled trials," (e.g. studies using placebos) or "observational studies" of current treatment provide the best evidence.

  Generalized anxiety disorder: GAD involves excessive fear or worry with no specific focus. People with GAD may, for example, compulsively plan their day, then lay awake, analyzing "mistakes" and planning the next day. When these symptoms are difficult to control, interfere with our lives, or feel painful or unhealthy, then it is time to seek diagnosis. According to the Diagnostic and Statistical Manual, Fourth Edition, an adult may be diagnosed with GAD when a person experiences three or more (one or more for a child) of the following symptoms for most days, over a period of at least six months: feeling wound up, tense or restless; easily fatigued; concentration problems; irritability; significant tension in muscles; sleep difficulties.

Considerations

• GAD has a very high incidence of comorbidity (co-occurrence) with depression and other kinds of anxiety disorders that complicates treatment. Any treatment depends upon the individual patient and requires consultation with trained mental health professionals.

Psychotherapy

• Psychotherapy ("talk therapy") is effective and lacks the potential side effects of medication. The most common choice for therapy is "cognitive behavioral therapy" (CBT)--a formalized method of getting patients to identify negative thoughts and behaviors, and replace them with positive ones in a relatively short course of treatment. Yet, while CBT is effective for some symptoms, symptoms from fears rooted in early-life experiences are more difficult to treat and likely require different, long-term psychotherapies (e.g. psychodynamic or inter-personal therapy). Hence, an "eclectic" approach, one that uses a number of techniques, may be used.

Medications

• Technically "anti-depressants," SSRI's, especially Paxil, Zoloft, and Lexapro, and SNRI's like Effexor and Cymbalta are likely the first choice for GAD treatment because they are effective, non-addictive and have fewer, less severe side effects than other medications.

  Benzodiazepines like Valium, Ativan, and Klonopin may also be prescribed because they are proven effective and work quickly (perhaps within hours). They also, however, can become addictive with long-term use, so they often tapered off after a short period. BuSpar provides an alternative to anti-depressants and benzodiazepines, but only for some patients and take longer (three to four weeks) to work.

Other Interventions

• Strong evidence shows exercise will reduce symptoms. Mindfulness meditation also appears an effective treatment.

• Yes, something missing from that one sentence; I added the word "plan". I hope it's ok in the final section to simply state that mindfulness meditation helps. There is more than one study, and more than a few reviews report the same findings.