Generalized Anxiety Disorder
Finding The Right Treatment
Treatment for GAD
Generalized anxiety disorder has multiple proven means of treatment including therapy, medications, and small behavior changes that individuals can adopt. Research shows that the best outcomes come from a combination of therapy, medication, and lifestyle changes (i.e. sleeping adequately, eating a healthy and well balanced diet).
Finding a therapist
Talk therapy has been proven to yield major improvements in the lives of those with Generalized Anxiety. Whether it be recognition of one's symptoms, an understanding of how one's past might have impacted them, or a simple awareness of thoughts and their triggers, therapy can help people become more content versions of themselves. Most therapists have experience working with adults with GAD.
There are different kinds of professionals who can provide effective therapy:
- Clinical psychologists (PhD)
- Licensed clinical social workers (LCSW or LMSW)
- Licensed professional counselors (LPC)
- Licensed clinical professional counselors (LCPC)
- Licensed Marriage and Family Therapists (LMFT)
- National certified counselors (NCC)
There are several styles of therapy that can be helpful for GAD including psychodynamic, interpersonal, and supportive therapy. In recent years, more therapists employ cognitive behavioral therapy (CBT), which is a method that helps the individual identify unhelpful thought patterns and challenge self-destructive cognitions, replacing them with more constructive thinking.
For example, there are common logical errors that many people make with their thinking, and CBT therapists often refer to these errors as “cognitive distortions.”
Here are a few common cognitive distortions:
Catastrophizing: An individual making this error assumes everything is going to be terrible—the worst possible outcome that could happen. For example, the person with GAD may worry that their college student child who is driving home in a snowstorm will get into a terrible accident and die, and consequently, the person may worry themselves sick until their child shows up, unharmed.
Ignoring positive outcomes: An individual who makes this error assumes any positive outcome was an accident of fate and unlikely to happen again. For example, the individual studied hard on a test and received an “A.” The person without GAD would assume their studying led to the successful result of doing well on the test. However, an individual with GAD may assume the high marks just happened by some fluke of fate. The problem is that thinking this way impedes people from understanding that their strong efforts often have a positive impact on outcomes.
Fortune-telling/catastrophizing: A possible example of this combination error is to think, “I better not get a mammogram because then I’ll get diagnosed with breast cancer.” The reality is the mammogram is a tool that diagnoses breast cancer, and it doesn’t make anyone develop cancer. Without getting the mammogram, the person with breast cancer won’t know about a cancer they may have and will not receive needed life-saving treatment.
Therapists help their clients replace these common cognitive distortions with more positive and realistic thinking and also help them to manage their uncomfortable anxious feelings, and excessive worry.
A CBT therapist will help their clients learn essential skills to manage the uncomfortable anxious feelings, the excessive worry, and the additional tools one may need for their particular concerns and worries. Most people with GAD need multiple tools to manage their anxiety so they can have a tool for any situation that comes their way.
The decision to start therapy
Many people try to cope with their distress on their own, and then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.
For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.
Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.
Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.
Where to start
Asking one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.
To find a therapist who takes one's insurance, the National Institute of Mental Health offers a comprehensive list of resources.
Psychology Today also lists therapists by type, location and insurance.
Determining whether medications will play a role in treatment
Medications to treat anxiety are often helpful.
SSRIs
The most commonly used medications are antidepressants called Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). Even though these medications are called antidepressants and can be used for treating depression, they are also studied and approved for use in individuals who struggle with Generalized Anxiety Disorder. This class of medications takes 4-6 weeks before they start working.
While these medications are used to treat a number of mental health conditions, including depression, OCD, and some pain conditions, the dosing and the use of concomitant medications differs across conditions.
Benzodiazepines
Benzodiazepines are another category of drugs used to help people with anxiety. These are helpful medications that work quickly, but many doctors are cautious about using benzodiazepines, and this class of medications is most safely prescribed for occasional or short-term use.
Benzodiazepines have addictive potential, so individuals with a history of substance abuse should stay clear of these medications. However, taken as a doctor directs, these medications can provide rapid relief from acute anxiety. It is best not to take benzodiazepines for long periods of time because of the risk of psychological and physical dependency. Benzodiazepines should not be taken with any opioid medications or alcohol.
Buspirone
Buspirone is a non-addictive anti-anxiety medication. It does not work as quickly as benzodiazepines, nor does it have the same level of efficacy. Because of its perceived safety, most providers feel comfortable prescribing it. Unlike benzodiazepines, buspirone can be used for weeks and months for Generalized Anxiety Disorder. In general, SSRIs/SNRIs are deemed to be more effective for GAD than buspirone. Buspirone and the antidepressants have different side effect profiles, and prescribers might choose one or the other based on their patient’s ability to tolerate each class. Sometimes buspirone is added to anti-anxiety antidepressants to boost their effect.
FDA warning about suicide risk with antidepressants
Some research exists that, occasionally, newly initiated anti-depressants may increase the risk of suicide. If an individual begins to have these thoughts after starting an anti-depressant, please stop this medicine and contact a prescriber immediately. This risk is more evident in children, adolescents, and young adults.
Dietary supplements
There are an increasing number of supplements, such as an herb, vitamin, mineral, and other supplements claiming to improve sleep, depression, stress, restlessness, or anxiety. While it is possible for a supplement to improve one’s symptoms, their effects are often unproven.
Be aware that dietary supplements are not controlled by the FDA and, therefore, are not subject to the standards of quality, uniformity, and testing for efficacy and safety as regulated medications. It is important to share a list of all medications and supplements with one's treating provider because some of them may interact with the medications they prescribe.
Healthcare providers that can prescribe medications
Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN, or a new primary doctor.