Treatment for Generalized Anxiety Disorder (GAD)

Research shows that cognitive behavioral therapy (CBT) is one of the most effective treatments for Generalized Anxiety Disorder (GAD). CBT is a blend of two types of therapies, cognitive therapy and behavioral therapy, and can be delivered in an individual or group format. Family members can also be involved in the treatment and can help reinforce treatment concepts.

CBT starts with a thorough assessment of symptoms. Using information from the assessment, the therapist will then provide education about GAD and tailor it to the person’s specific symptoms. The cognitive therapy component of CBT focuses on a person’s thoughts and beliefs and is often used to help people with GAD change their anxious thoughts or distorted thinking. People with GAD often believe that bad things, or catastrophes, are looming in the future, and a therapist can help with managing these thoughts.

How CBT for GAD Works

First, many people with GAD often treat their fears as a given and don’t look at realistic probabilities. For example, consider a good student who worries about failing every test she takes. With the help of the therapist, she could see that she has never actually failed a test, and she is greatly overestimating the probability it will happen.

Second, a therapist will help with decatastophizing and facing fears head-on; that is, helping the person figure out how they will cope if their dreaded worry occurs. In the example of the student with academic anxiety, the therapist will help her examine how she would cope if she did actually fail. Helping a person face their fears and see that it wouldn’t be the end of the world can help deflate the power of a worry.

The behavioral component of CBT for GAD is also helpful in reducing worry and related anxiety. Imaginal exposure is one technique that a therapist might use. The therapist will systematically help guide the person to imagine the things that they worry about, over and over again. With repeated practice, the worries will no longer hold so much power over the person, and their anxiety will decrease.

Another behavioral strategy involves reducing or eliminating behaviors that reinforce fears. For example, a person who is excessively worried about finances and goes online to check their bank accounts multiple times a week will be directed to stop checking so much, as it only fuels the anxiety. Similarly, a person who frequently asks others for reassurance about their fears will be taught to eliminate that behavior.

Relaxation Training

Some therapists use relaxation training as a method of reducing anxiety. It can be used along with CBT and/or medication. Most professionals agree that relaxation training alone is probably not sufficient to fully get rid of anxiety symptoms for most people.

One type of relaxation strategy often used for generalized anxiety is progressive muscle relaxation, a type of relaxation which involves tensing and relaxing different muscles in the body and then applying this relaxation in moments of distress and worry. Another relaxation strategy is diaphragmatic breathing, or belly breathing. This type of breathing, which leads to deeper breaths and more oxygen in the lungs, can be very relaxing for many people.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

People with GAD commonly experience sleep problems. CBT can be an effective tool in helping to improve sleep. A therapist will first do a thorough assessment of the insomnia to get a better understanding of what might be causing it.

A common practice for CBT-I is to instill good sleep hygiene practices, which might include going to bed and waking up around the same time every day, taking time to wind down before bed, not drinking caffeine from the mid-afternoon on, not using alcohol before bedtime (can disrupt sleep rhythms), not using electronics in bed, and not doing work in bed.

Another important facet of CBT-I is making sure the bed is not associated with stress and anxiety, which means having the person with insomnia get out of bed and do something relaxing and calming if they haven’t fallen asleep after approximately 15 minutes. They can return to bed after they feel sleepy again.

A therapist will also use cognitive techniques, like decatastrophizing, to help a person address anxious thoughts associated with sleep. Often people who have insomnia have fearful thoughts about sleep (e.g., “I’ll never get a good night’s sleep again,” or “What if I don’t sleep tonight?”), which is counterproductive to sleep. It’s important that these thoughts are addressed because they increase anxiety, making it harder to fall asleep.

A therapist might assign “worry time” during the day or early evening. During this time, the person will allow themselves to worry and/or plan as much as they need to do, in order to get their worries out of their system before bed. Finally, a person might be instructed to do relaxation or mindfulness activities to help them wind down before going to sleep.