Generalized anxiety disorder (GAD) can be treated with therapy, medications or a combination of both under the supervision of a doctor. Generalized anxiety disorder treatment can be highly effective in relieving symptoms.
Need For Generalized Anxiety Disorder Treatment (GAD)
Anxiety is a common feeling that most of us experience almost on a daily basis. In fact, it is a necessary and normal emotion which ensures our survival. However, pathologically heightened anxiety can be related to a number of psychiatric conditions like anxiety disorders. A 2018 study states, “anxiety is considered a disease requiring treatment when it arises in the absence of any threat, or in disproportionate relation to a threat, and keeps the affected individual from leading a normal life.” People suffering from GAD tend to be persistently stressed, worried and anxious. This makes them prone to avoid activities and environments which may trigger their anxiety without any logical explanation. This mental health condition can adversely affect a person’s thoughts, behavior, decision making abilities, education or career, social life, intimate relationships and other important aspects of life. This is why it is crucial that you consult a doctor and seek generalized anxiety disorder treatment.
Evidence 1 suggests that effective long-term treatment involving therapy and medications can prove to be beneficial and improve the symptoms of the disorder. Researchers from a 2002 study 2 explain “Psychotherapy, particularly relaxation, cognitive therapy, and cognitive-behavioral therapy, has shown long-term benefit in GAD and may be a useful approach alone and as an adjunct to pharmacotherapeutic options.” Proper diagnosis and treatment will enable you to improve your mental and emotional health, enhance your performance, make you open to new opportunities and strengthen relationships.
Generalized Anxiety Disorder Treatment Options
GAD is typically treated with either psychotherapy, prescription drugs or both. The treatment process may take some time depending on the severity of the condition and the individual. Here are some of the most effective treatment options available for this condition:
Therapy, commonly known as psychological counseling and talk therapy, can help to relieve symptoms of GAD when supervised by a licensed mental health professional, like a psychiatrist, psychologist or a therapist. Here are a few psychotherapy techniques that can help to overcome the disorder:
A. Cognitive Behavioral Therapy (CBT)
CBT is a popular type of psychotherapy and one of the most widely recommended generalized anxiety disorder treatment strategies. Considered as the current gold standard of psychotherapy, CBT is a short-term treatment which mainly focuses on helping patients learn certain coping skills that will enable them to manage their thoughts and emotions, including stress, anxiety and worry, and help them overcome the tendency to avoid situations and activities they deem anxiety-inducing.
CBT involves psychoeducation, changing maladaptive behavior and thought patterns and cautious exposure to anxiety-inducing circumstances. Through gradual exposure, it helps the patient to manage their reactions to stressful situations and control their feelings of fear, worry and anxiety. Evidence 3 shows that after CBT, patients “displayed an attenuation of symptoms and activation in the left amygdala and subgenual ACC to threat-related emotional cues.” CBT can also help the sufferer develop helpful coping mechanisms and learn new strategies to overcome their anxiety. Cognitive Behavioral Therapy can be extremely beneficial in improving symptoms, when used along with medication.
Research 4 has found that cognitive behavioral therapy is “efficacious” for anxiety disorders in adults. One 2017 study 5 states “CBT is an effective treatment for GAD, typically leading to reductions in worry, and a study has shown that such therapy is equal to pharmaceutical treatment and more effective 6 months after study completion.” Another 2015 study 6 has found that CBT is both efficacious and effective in not just generalized anxiety disorder treatment, but also in improving social anxiety disorder, panic disorder and specific phobia symptoms as well.
B. Acceptance and Commitment Therapy (ACT)
ACT is another form of psychotherapy that is focused on the present and the current problem, instead of past issues. This is another effective generalized anxiety disorder treatment that aims to alleviate the sufferer’s struggle to manage stress, anxiety and sensations which cause distress & discomfort. The primary goals of this psychological intervention are –
- Training acceptance of unhelpful, difficult thoughts and emotions which cannot be controlled and may be eliminated
- Committing and acting towards building a life filled with chosen values
It also focuses on improving patient’s involvement in activities that have meaning and value to the sufferer’s life. Research 7 has found evidence that acceptance and commitment therapy can be highly effective in the treatment of anxiety. One 2015 study 8 explains that ACT for GAD is “an innovative acceptance-based behavior therapy that focuses on decreasing the behavior regulatory function of anxiety and related cognitions, and has a strong focus on behavior change,” of the patient. Researchers 9 have also observed that ACT can be especially helpful in improving symptoms in older adults 10 with geriatric generalized anxiety disorder (GAD).
The objective of ACT is to reduce the patient’s struggle to regulate or remove certain aversive internal experiences, like thoughts, memories, emotions, urges and sensations. ACT also helps in increasing engagement in meaningful life activities.
C. Psychodynamic therapy
Also known as psychoanalytic psychotherapy or insight-oriented therapy, psychodynamic psychotherapy is a type of depth psychology. The main objective of this treatment is to identify the unconscious thoughts of a patient’s psyche to relieve their mental tension. The therapy relies on the principle that our thoughts and feelings are often regulated by factors outside our awareness and consciousness. This can lead to internal conflict and cause anxiety. Research 11 reveals that short-term psychodynamic therapy is effective in treating certain anxiety disorders.
However, studies 12 have observed that in comparison with cognitive behavioral therapy, psychodynamic therapy has been found to be weaker for generalized anxiety disorder treatment.
D. Interpersonal psychotherapy (IPT)
Interpersonal psychotherapy (IPT) is a time restricted treatment strategy focused on the present instead of the past. The therapy is based on the belief that symptoms of most mental disorders are based on the patient’s social and interpersonal relationships. It is assumed that improving social functioning and relationships can help to relieve symptoms. This evidence-based approach has been found to be effective in the treatment of anxiety disorders, according to research 13 . A 2014 study 14 found that “IPT shows some promise for anxiety disorders but has thus far shown no advantages in controlled trials relative to other therapies.” The researchers found that “IPT lowered anxiety symptoms, was well tolerated, and had low attrition,” but may not be more effective than CBT.
Apart from the therapy strategies mentioned above, a mental health expert may also recommend psychoeducation as a helpful option for generalized anxiety disorder treatment. A 2017 study 15 explains “Psychoeducation includes information about the physiology of the bodily symptoms of anxiety reactions and the rationale of available treatment possibilities.” Another 2009 study 16 found that brief passive psycho-educational interventions for depression, anxiety and psychological distress can effectively help to relieve symptoms. Another 2010 study 17 recommends psychoeducation for effective generalized anxiety disorder treatment, including providing information related to the causes and treatment of their disorder. Further research 18 suggests that family members and relatives of the patients must also be included in such sessions as teaching family members about the nature of the illness is as important as teaching patients.
Various types of medications are prescribed by doctors and mental health professionals for generalized anxiety disorder treatment. Typically, medications for GAD interact with certain chemicals in the brain known as neurotransmitters. These medications can enhance the activities or block the absorption of such brain chemicals. According to a 2013 study 19 , “patients with anxiety disorders benefit from decades of psychopharmacological research that has yielded safer, more tolerable side-effect profiles than before.”
However, it should be noted that the medications for GAD treatment may cause certain side effects like sleeping problems, nausea and headaches. It is recommended that the patient consults their doctor regarding any side effects they may experience. Moreover, medications have been known to be powerfully effective in reducing anxiety in a short period of time. However, this may lead to tolerance and dependence when used continuously. Hence, it is important to follow the instruction of the doctor and take the medications only for the prescribed brief periods of time.
Usually, the following types of medications are used in the treatment of GAD:
Antidepressants like selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SNRIs) are considered as the most effective drugs for generalized anxiety disorder treatment. “Many national guidelines for the management of anxiety disorders recommend the use of SSRIs as first-line treatment,” explains a 2007 study 20 . However, these medications can take many weeks to show any positive effect. SSRIs, like fluoxetine 21 (Prozac) and sertraline 22 (Zoloft) are widely prescribed as these drugs are well tolerated by most patients. Moreover, vilazodone, paroxetine, fluvoxamine, escitalopram and citalopram are also SSRIs prescribed by doctors. These drugs inhibit the serotonin transporter and result in the desensitization of postsynaptic serotonin receptors. This helps to balance the activities of serotonergic pathways.
On the other hand, SNRIs inhibit serotonin and norepinephrine transporters. The drugs in this category include duloxetine, desvenlafaxine and venlafaxine. SNRIs are primarily used when SSRIs fail to be effective or patients don’t respond. One 2014 study 23 has found that “duloxetine has the most FDA-approved indications of any SNRI,” and has been found to be effective in the treatment of generalized anxiety disorder and depression. Another study 24 revealed that in placebo-controlled trials, “venlafaxine has demonstrated efficacy significantly greater than placebo in the treatment of GAD patients without accompanying depression.”
Anxiolytics like benzodiazepines focus more on effectively treating the GAD symptoms rather than treating the underlying causes leading to anxiety. But such types of medications can cause certain potential side effects like habit-forming and sedation. Benzodiazepines, like clonazepam and diazepam, are long-acting agents that can help in relieving symptoms immediately or when short-term treatment is recommended. Research 25 has found that although effective in treating anxiety disorders, benzodiazepines can “cause significant problems in terms of side effects, dependence or an exacerbation of symptoms.” Hence, patients with alcohol or drug misuse tendencies are typically not prescribed for such medications. A 2013 study 26 explains that benzodiazepines “are very effective in reducing acute anxiety but are associated with problematic adverse effects when used for a long time in high doses.”
Buspirone (Buspar) is another medication in this category that has been found to be effective in GAD without leading to habit formation. Research 27 shows that it is “a non-benzodiazepine which does not cause dependency.” Buspirone has also been found to be “less sedating than benzodiazepines.” According to a scientific review 28 , buspirone is mainly used for treating GAD and is regarded as a second-line agent for treatment after selective serotonin reuptake inhibitors (SSRIs). It is usually prescribed when patients do not respond to SSRIs or are unable to cope with the side effects. The review states “Buspirone is FDA approved for the short and long-term treatment of GAD, as well as short-term symptomatic relief of anxiety. It is as effective as benzodiazepine treatment for GAD.”
Research 29 shows that Pregabalin, a calcium modulator, is another anxiolytic agent that is effective in generalized anxiety disorder treatment in adults. Along with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), pregabalin is also considered as one of the first-line pharmacotherapies, according to a 2013 study.
C. Other antidepressants
Apart from SSRIs and SNRIs, other types of antidepressants, such as tricyclic antidepressants (TCAs) & monoamine oxidase inhibitors (MAOIs) may also be recommended. Although these are less commonly prescribed due to certain severe side effects, research 30 has shown that tricyclic antidepressants can be effective for generalized anxiety states. The researchers state “The onset of efficacy appears to begin at about 2 weeks or later and is probably superior to at least one well-known benzodiazepine, chlordiazepoxide, well beyond that time.” According to another 2000 study 31 , TCAs have been found to be effective in generalized anxiety disorder treatment. However, SSRIs are prescribed more “due to their greater safety and tolerability, should be the preferred choices in treating anxiety disorders.”
Monoamine oxidase inhibitors (MAOIs) have been found to be greatly superior to placebo in the treatment of anxiety disorders. In fact, researchers 32 have found that MAOIs tend to be more effective than TCAs in treating GAD.
3. Relaxation techniques
Various types of relaxation techniques can also help to significantly lower chronic anxiety. Relaxation techniques refer to therapeutic exercises and strategies that can help a person to reduce physical and psychological tension & anxiety. Relaxation techniques help to reduce feelings of stress and increase feelings of calm. These strategies primarily aim to reduce certain symptoms, like muscle tension, shortness of breath, increased heart rate etc. Researchers from a 2020 study 33 explain “Strategies to assist patients with relaxation have long been a hallmark component of psychotherapy; however, they can be utilized throughout healthcare environments as complementary therapies,” for stress, anxiety and depression. These techniques can be learned and applied through self-help methods or under the guidance of professionals.
According to a 2012 study 34 , “Relaxation therapy can be effective in the improvement of depression, anxiety and stress.” Another 2008 study 35 found that relaxation training has shown significant and consistent efficacy in reducing anxiety. Relaxation techniques like deep breathing, progressive muscle relaxation 36 and autogenic training 37 , can enable the sufferer to cope with stress and anxiety better. Progressive muscle relaxation (PMR) helps in systematic desensitization and teaches the patient to consistently reduce muscle tension & experience a more relaxed state, found a 2013 research paper 38 .
Moreover, certain lifestyle habits can also help in generalized anxiety disorder treatment, such as:
- A nutritious, healthy diet
- A healthy sleeping routine
- Avoiding smoking, caffeine, alcohol and drugs
These practices can not only help to elevate mood but also improve the patient’s overall mental, emotional and physical well being. In fact, one 2015 study found that Kundalini Yoga can greatly help in coping with GAD. Another 2013 study found that mindfulness meditation or Mindfulness-Based Stress Reduction (MBSR) techniques “have a beneficial effect on anxiety symptoms in GAD and may also improve stress reactivity.” Moreover, biofeedback intervention has proved to be “effective in significantly reducing the levels of stress, anxiety, and depression” over a 4-week period, as per a recent study 39 .
Recovery From GAD Is Possible
Generalized anxiety disorder is a common mental health condition which is highly treatable. If you think you or a loved one is suffering from GAD, then make sure to consult a doctor or a mental health professional immediately. Although generalized anxiety disorder treatment can be a time-taking and complicated process, the outlook for patients is mostly positive. Treatment will not only help you overcome GAD symptoms but also help to increase your ability for day-to-day functioning and strengthen personal relationships.
- Bandelow B, Boerner J R, Kasper S, Linden M, Wittchen HU, Möller HJ. The diagnosis and treatment of generalized anxiety disorder. Dtsch Arztebl Int. 2013 Apr;110(17):300-9; quiz 310. doi: 10.3238/arztebl.2013.0300. Epub 2013 Apr 26. PMID: 23671484; PMCID: PMC3651952.
- Gorman JM. Treatment of generalized anxiety disorder. J Clin Psychiatry. 2002;63 Suppl 8:17-23. PMID: 12044104.
- Fonzo, G. A., Ramsawh, H. J., Flagan, T. M., Sullivan, S. G., Simmons, A. N., Paulus, M. P., & Stein, M. B. (2014). Cognitive-behavioral therapy for generalized anxiety disorder is associated with attenuation of limbic activation to threat-related facial emotions. Journal of affective disorders, 169, 76–85. https://doi.org/10.1016/j.jad.2014.07.031
- Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. The Journal of clinical psychiatry, 69(4), 621–632. https://doi.org/10.4088/jcp.v69n0415
- Borza L. (2017). Cognitive-behavioral therapy for generalized anxiety. Dialogues in clinical neuroscience, 19(2), 203–208. https://doi.org/10.31887/DCNS.2017.19.2/lborza
- Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337–346. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin
- Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Acceptance and Commitment Therapy in the treatment of anxiety: a systematic review. 2013. Available from: https://www.ncbi.nlm.nih.gov/books/NBK159897/
- Hasheminasab, M., Babapour Kheiroddin, J., Mahmood Aliloo, M., & Fakhari, A. (2015). Acceptance and Commitment Therapy (ACT) For Generalized Anxiety Disorder. Iranian journal of public health, 44(5), 718–719.
- Petkus, A. J., & Wetherell, J. L. (2013). Acceptance and commitment therapy with older adults: Rationale and considerations. Cognitive and Behavioral Practice, 20(1), 47-56. https://doi.org/10.1016/j.cbpra.2011.07.004
- Wetherell JL, Afari N, Ayers CR, Stoddard JA, Ruberg J, Sorrell JT, Liu L, Petkus AJ, Thorp SR, Kraft A, Patterson TL. Acceptance and Commitment Therapy for generalized anxiety disorder in older adults: a preliminary report. Behav Ther. 2011 Mar;42(1):127-34. doi: 10.1016/j.beth.2010.07.002. Epub 2010 Nov 5. PMID: 21292059; PMCID: PMC3496779.
- Fonagy P. (2015). The effectiveness of psychodynamic psychotherapies: An update. World psychiatry : official journal of the World Psychiatric Association (WPA), 14(2), 137–150. https://doi.org/10.1002/wps.20235
- Bandelow B, Lichte T, Rudolf S, Wiltink J, Beutel ME. The diagnosis of and treatment recommendations for anxiety disorders. Dtsch Arztebl Int. 2014 Jul 7;111(27-28):473-80. doi: 10.3238/arztebl.2014.0473. PMID: 25138725; PMCID: PMC4187407.
- Cuijpers P, Donker T, Weissman MM, Ravitz P, Cristea IA. Interpersonal Psychotherapy for Mental Health Problems: A Comprehensive Meta-Analysis. Am J Psychiatry. 2016 Jul 1;173(7):680-7. doi: 10.1176/appi.ajp.2015.15091141. Epub 2016 Apr 1. PMID: 27032627.
- Markowitz, J. C., Lipsitz, J., & Milrod, B. L. (2014). Critical review of outcome research on interpersonal psychotherapy for anxiety disorders. Depression and anxiety, 31(4), 316–325. https://doi.org/10.1002/da.22238
- Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
- Donker T, Griffiths KM, Cuijpers P, et al. Psychoeducation for depression, anxiety and psychological distress: a meta-analysis. 2009. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK76945/
- Davidson, J. R., Feltner, D. E., & Dugar, A. (2010). Management of generalized anxiety disorder in primary care: identifying the challenges and unmet needs. Primary care companion to the Journal of clinical psychiatry, 12(2), PCC.09r00772. https://doi.org/10.4088/PCC.09r00772blu
- Sarkhel, S., Singh, O. P., & Arora, M. (2020). Clinical Practice Guidelines for Psychoeducation in Psychiatric Disorders General Principles of Psychoeducation. Indian journal of psychiatry, 62(Suppl 2), S319–S323. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_780_19
- Farach, F. J., Pruitt, L. D., Jun, J. J., Jerud, A. B., Zoellner, L. A., & Roy-Byrne, P. P. (2012). Pharmacological treatment of anxiety disorders: current treatments and future directions. Journal of anxiety disorders, 26(8), 833–843. https://doi.org/10.1016/j.janxdis.2012.07.009
- Pinder R. M. (2007). Treatment of generalized anxiety disorder. Neuropsychiatric disease and treatment, 3(2), 183–184. https://doi.org/10.2147/nedt.2007.3.2.183
- Zou, C., Ding, X., Flaherty, J. H., & Dong, B. (2013). Clinical efficacy and safety of fluoxetine in generalized anxiety disorder in Chinese patients. Neuropsychiatric disease and treatment, 9, 1661–1670. https://doi.org/10.2147/NDT.S38899
- Brawman-Mintzer O, Knapp RG, Rynn M, Carter RE, Rickels K. Sertraline treatment for generalized anxiety disorder: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2006 Jun;67(6):874-81. doi: 10.4088/jcp.v67n0603. PMID: 16848646.
- Sansone, R. A., & Sansone, L. A. (2014). Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison. Innovations in clinical neuroscience, 11(3-4), 37–42.
- Cassano, G. B., Baldini Rossi, N., & Pini, S. (2002). Psychopharmacology of anxiety disorders. Dialogues in clinical neuroscience, 4(3), 271–285. https://doi.org/10.31887/DCNS.2002.4.3/gcassano
- Swedish Council on Health Technology Assessment. Treatment of Anxiety Disorders: A Systematic Review (Summary and conclusions) [Internet]. Stockholm: Swedish Council on Health Technology Assessment (SBU); 2005 Nov. SBU Yellow Report No. 171/1+2. Available from: https://www.ncbi.nlm.nih.gov/books/NBK447974/
- Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current diagnosis and treatment of anxiety disorders. P & T : a peer-reviewed journal for formulary management, 38(1), 30–57.
- Munir S, Takov V. Generalized Anxiety Disorder. [Updated 2020 Nov 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441870/
- Wilson TK, Tripp J. Buspirone. [Updated 2020 Sep 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531477/
- Frampton JE. Pregabalin: a review of its use in adults with generalized anxiety disorder. CNS Drugs. 2014 Sep;28(9):835-54. doi: 10.1007/s40263-014-0192-0. PMID: 25149863.
- Kahn RJ, McNair DM, Frankenthaler LM. Tricyclic treatment of generalized anxiety disorder. J Affect Disord. 1987 Sep-Oct;13(2):145-51. doi: 10.1016/0165-0327(87)90019-x. PMID: 2960709.
- Zohar J, Westenberg HG. Anxiety disorders: a review of tricyclic antidepressants and selective serotonin reuptake inhibitors. Acta Psychiatr Scand Suppl. 2000;403:39-49. doi: 10.1111/j.1600-0447.2000.tb10947.x. PMID: 11019934.
- Tyrer P, Shawcross C. Monoamine oxidase inhibitors in anxiety disorders. J Psychiatr Res. 1988;22 Suppl 1:87-98. doi: 10.1016/0022-3956(88)90070-2. PMID: 3050061.
- Norelli SK, Long A, Krepps JM. Relaxation Techniques. 2020 Sep 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30020610.
- Kashani, F., Babaee, S., Bahrami, M., & Valiani, M. (2012). The effects of relaxation on reducing depression, anxiety and stress in women who underwent mastectomy for breast cancer. Iranian journal of nursing and midwifery research, 17(1), 30–33.
- Manzoni, G. M., Pagnini, F., Castelnuovo, G., & Molinari, E. (2008). Relaxation training for anxiety: a ten-years systematic review with meta-analysis. BMC psychiatry, 8, 41. https://doi.org/10.1186/1471-244X-8-41
- Li, Y., Wang, R., Tang, J., Chen, C., Tan, L., Wu, Z., Yu, F., & Wang, X. (2015). Progressive muscle relaxation improves anxiety and depression of pulmonary arterial hypertension patients. Evidence-based complementary and alternative medicine : eCAM, 2015, 792895. https://doi.org/10.1155/2015/792895
- Kanji N, Ernst E. Autogenic training for stress and anxiety: a systematic review. 2000. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK68303/
- Hayes-Skelton, S. A., Roemer, L., Orsillo, S. M., & Borkovec, T. D. (2013). A contemporary view of applied relaxation for generalized anxiety disorder. Cognitive behaviour therapy, 42(4), 292–302. https://doi.org/10.1080/16506073.2013.777106
- Ratanasiripong, P., Kaewboonchoo, O., Ratanasiripong, N., Hanklang, S., & Chumchai, P. (2015). Biofeedback Intervention for Stress, Anxiety, and Depression among Graduate Students in Public Health Nursing. Nursing research and practice, 2015, 160746. https://doi.org/10.1155/2015/160746