On This Page:ToggleMedicationPsychotherapySelf-Help TechniquesConclusion
On This Page:Toggle
On This Page:
Individuals with GAD often struggle with restlessness, fatigue, irritability, muscle tension, and sleep difficulties, alongside their tendency to catastrophize and ruminate. Going through daily life feels emotionally draining or overwhelming.
Fortunately, research supports using both psychotherapy and medication interventions to effectively improve GAD symptoms like chronic apprehension, somatic distress, and functional disability for many patients.
This article outlines recommended first-line treatments for managing generalized anxiety disorder across psychotherapy, pharmacotherapy, and self-help approaches.
Medication
Several types of medications are commonly used to treat generalized anxiety disorder (GAD). These include antidepressants, anti-anxiety medications, and anticonvulsants.
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) like escitalopram, paroxetine, and sertraline area first-line treatment for GAD.
Randomized placebo-controlled trialsshow that SSRIs like escitalopram, paroxetine, and sertraline have overall response rates around 60-75% in treating generalized anxiety disorder, compared to 40-60% response rates for placebo.
SSRIs may cause side effects such as headache, nausea, sleep issues, sexual problems, and activation symptoms.
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine and venlafaxine also inhibit the reuptake of serotonin and norepinephrine.
Several studies demonstratethe efficacy of duloxetine and venlafaxine XR for acute and long-term treatment of GAD.
They can potentially lead to side effects such as nausea, sweating, constipation, increased blood pressure, and sexual dysfunction.
Pregabalin (an anticonvulsant)
The anticonvulsant pregabalin binds to calcium channels and reducesneurotransmitterrelease.
Randomized controlled trialsandmeta-analysesindicate pregabalin is efficacious and well-tolerated for acute and maintenance treatment of GAD.
Pregabalin is often well-tolerated but may elicit side effects like blurred vision, weight gain, swelling, and sleepiness.
Benzodiazepines
Benzodiazepines like alprazolam, clonazepam, and lorazepam activate GABA receptors, inhibitingneuron activity.
Benzodiazepines can provide rapid relief from anxiety but are only recommended for short-term treatment of GAD due to risks like dependence and abuse.
They can confer risks of dependence and abuse. Sedation, memory issues, and coordination problems are also possible side effects.
Medications summary:
First-line recommendations for GAD treatment emphasize SSRIs, SNRIs, and pregabalin, with optimal treatment duration of at least 6-18 months to prevent relapse. Benzodiazepines may be used short-term or as-needed.
Overall, medications can effectively reduce anxiety symptoms and improve functioning in many patients with GAD.
Psychotherapy
Cognitive-behavioral therapy
The core CBT components include:
Clients track internal cues (thoughts, physical sensations), external triggers, and reactions to understand personal worry patterns and catch early signals of anxiety spirals.
Methods like slowed breathing, progressive muscle relaxation, guided imagery, and meditation strengthenparasympathetic nervous systemtone to induce calmness. These are deployed promptly when detecting worry cues.
Visualizing pleasant scenes promotes relaxation as an alternative to verbal-linguistic worry.
Identifying and challenging irrational assumptions, logical errors, and the tendency to catastrophize counteracts worrying. Behavioral experiments test anxious predictions.
Visualizing coping with worry triggers facilitates fear tolerance through corrective learning rather than avoiding feared imagery.
Other elements likemindfulness,intolerance of uncertaintyapproaches, and emotion regulation skills may supplement traditional CBT.
Benefits include reduced threat appraisals, attentional/interpretive biases, autonomic hyperarousal, and somatic tension. Potential challenges involve compliance with self-monitoring, practicing new skills, and accepting the necessity of distress tolerance.
Overall,50-60% of GAD patientsattain remission after CBT, with gains maintained long-term. Future research can clarify optimal treatment matching and subcomponents for diverse clinical profiles.
Acceptance and Commitment Therapy
Acceptance and commitment therapy (ACT) is a type ofpsychotherapythat aims to help people live better with uncomfortable feelings and experiences related to their anxiety rather than trying to get rid of them.
ACT for anxietyfocuses on:
Research showsACT can lower symptoms of anxiety and depression and increase quality of life in conditions like chronic pain and multiple anxiety disorders.
Although more research is still needed, early trials also suggest ACT may help older adults specifically.Studies foundit reduced worry, anxiety, and depression and improved treatment completion rates compared to traditional cognitive behavior therapy (CBT).
By focusing less on controlling anxiety and more on valued living, ACT offers an alternative approach to treating persistent GAD that warrants further research in this population.
Emotion-Focused Therapy
HowEFT can help with GAD:
Through empathic exploration of personal narratives, EFT helps individuals symbolize suppressed experiences causing distress and understand negative self-treatment patterns learnedwhen emotions were dismissed or silenced.
Therapists facilitate “two-chair dialogues” to resolve anxiety splits between a worrying part and an overwhelmed experiencer. Further chairwork accesses core painful feelings, undoes self-invalidation, and develops self-soothing capacities.
Subsequent researchconfirms techniques like focusing, validating emotional experience, and transforming maladaptive feelings relieve anxiety symptoms and improve life functioning.
With adequate sessions over 6-24 months, EFT fosters confidence, resilience, and skills for regulating distress independently. Further controlled studies would strengthen the evidence base.
Self-Help Techniques
Alongside professional treatment, there are manyself-help techniquespeople with GAD can try to better cope with their anxiety. These involve making positive lifestyle changes, learning stress management skills, using relaxation techniques, and practicing mindfulness.
Some of these techniques can be used as and when anxiety strikes when you need toreduce anxiety quickly, or they may be implemented into your lifestyle as long-term strategies.
Lifestyle Changes
Improving overall physical health and well-being can help create a strong foundation for managing anxiety. This includes:
Stress Management Skills
Learning to mitigatesources of stresscan prevent anxiety from intensifying. Useful skills include:
Relaxation Techniques
Techniques that elicit the body’s relaxation response counter “fight-or-flight” sensations. These include:
Practicing regularly elicits calmness faster. These can be used whenever anxiety ramps up.
Mindfulness
Mindfulness means focusing awareness on the present moment rather than brooding over the uncertain future. Useful skills include:
Using mindfulness, people can learn to step back and dis-identify from anxiety and worry rather than being entangled in attempts to fight it. Apps like Headspace provide guided mindfulness sessions.
Trying various anxiety self-help strategies allows people to determine what works best for them personally in managing symptoms, preventing escalation into panic, and staying grounded in the present.
Conclusion
GAD involves ongoing, unremitting anxiety, tension, and worry, which substantially impacts one’s quality of life and ability to function.
Research supports using both psychotherapy approaches to address maladaptive thoughts and behaviors as well as medications to improve biological anxiety symptoms. Self-help techniques also assist with lifestyle factors, skill building, and coping ahead of escalation.
While GAD remains challenging to treat given high rates of chronicity and comorbidity, the interventions outlined targeting cognitive, emotional, physiological, and behavioral aspects of GAD can increase individuals’ self-efficacy in managing symptoms.
Combining professional modalities like CBT or medication with consistent self-help techniques, including relaxation, organization skills, and mindfulness practices, is recommended for optimal treatment response.
References
Allgulander, C., & Baldwin, D. S. (2013). Pharmacotherapy of generalized anxiety disorder.Modern Trends in Pharmacopsychiatry, 29, 119–127.https://doi.org/10.1159/000351955
A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems.Psychotherapy and Psychosomatics, 84(1), 30–36.https://doi.org/10.1159/000365764
Baldwin, D. S., Ajel, K., Masdrakis, V. G., Nowak, M., & Rafiq, R. (2013). Pregabalin for the treatment of generalized anxiety disorder: an update.Neuropsychiatric disease and treatment, 883-892.10.2147/NDT.S36453
Baldwin, D. S., Waldman, S., & Allgulander, C. (2011). Evidence-based pharmacological treatment of generalized anxiety disorder.The International Journal of Neuropsychopharmacology, 14(5), 697–710.https://doi.org/10.1017/S1461145710001434
Cuijpers, P., Sijbrandij, M., Koole, S. L., Huibers, M. J., Berking, M., & Andersson, G. (2014). Psychological treatment of generalized anxiety disorder: a meta-analysis.Clinical Psychology Review, 34(2), 130-140.https://doi.org/10.1016/j.cpr.2014.01.002
Davidson, J. R., Wittchen, H. U., Llorca, P. M., Erickson, J., Detke, M., Ball, S. G., & Russell, J. M. (2008). Duloxetine treatment for relapse prevention in adults with generalized anxiety disorder: a double-blind placebo-controlled trial.European Neuropsychopharmacology,18(9), 673-681.https://doi.org/10.1016/j.euroneuro.2008.05.002
Elliott, R. (2013). Person-centered/experiential psychotherapy for anxiety difficulties: Theory, research and practice.Person-Centered & Experiential Psychotherapies, 12(1), 16-32.https://doi.org/10.1080/14779757.2013.767750
Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: current and emerging treatment options.Frontiers in psychiatry, 1412.https://doi.org/10.3389/fpsyt.2020.595584
Generoso, M. B., Trevizol, A. P., Kasper, S., Cho, H. J., Cordeiro, Q., & Shiozawa, P. (2017). Pregabalin for generalized anxiety disorder: an updated systematic review and meta-analysis.International clinical psychopharmacology,32(1), 49-55.https://doi.org/10.1097/YIC.0000000000000147
Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., … Walker, J. R. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders.BMC Psychiatry, 14 Suppl 1(Suppl 1), S1.https://doi.org/10.1186/1471-244X-14-S1-S1
Levy Berg, A., Sandell, R., & Sandahl, C. (2009). Affect-focused body psychotherapy in patients with generalized anxiety disorder: Evaluation of an integrative method.Journal of Psychotherapy Integration, 19(1), 67–85.https://doi.org/10.1037/a0015324
Watson, J. C., & Greenberg, L. S. (2017).Emotion-focused therapy for generalized anxiety.American Psychological Association.https://doi.org/10.1037/0000018-000
Wetherell, J. L., Afari, N., Ayers, C. R., Stoddard, J. A., Ruberg, J., Sorrell, J. T., Liu, L., Patterson, T. L., Thorp, S. R., Golshan, S., Nord, K., & Petkus, A. J. (2011). Acceptance and commitment therapy for generalized anxiety disorder in older adults: a preliminary report.Behavior therapy, 42(1), 127–134.https://doi.org/10.1016/j.beth.2010.07.002
Wilson, A. J., & Stein, D. J. (2019). Pharmacological treatment of anxiety disorders. In S. M. Evans & K. M. Carpenter (Eds.),APA handbook of psychopharmacology(pp. 195–215). American Psychological Association.https://doi.org/10.1037/0000133-009
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
