Types of therapy for generalized anxiety disorder

Deborah C. Escalante

Everyone experiences anxiety. But people with generalized anxiety disorder (GAD) are frequently distracted by their worries, avoidant of activities that might stir up the anxiety, and “on edge” without explanation. In most cases of GAD, the anxiety negatively impacts the individual’s relationships and/or performance at school or work.

Treatment for GAD aims to help people feel better mentally and physically and to increase engagement with the people, places, and situations that previously elicited worry.

Given the far-reaching effect that anxiety can have on day-to-day functioning, even low-grade anxiety that does not meet the threshold for a firm diagnosis can be worth working on.

treatment options for generalized anxiety disorder

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Psychotherapy

Psychotherapy is a popular form of treatment for GAD. “Talk therapy” can be performed by a variety of mental health professionals, and though the approaches described below can overlap, they are guided by differing theories and emphases.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is the gold standard of psychotherapy and one of the most popular treatments for GAD. Proven to work for adults just as effectively as it does for younger patients, CBT focuses on present difficulties and current situations. CBT is typically a short-term, structured treatment that focuses on the interplay between the conscious thoughts, feelings, and behaviors that perpetuate anxiety.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) is another present- and problem-focused talk therapy used to treat GAD. Although similar to CBT, the goal of ACT is to reduce the struggle to control anxious thoughts or uncomfortable sensations and increase involvement in meaningful activities that align with chosen life values. ACT can produce symptom improvement in people with GAD, and may be a particularly good fit for older adults.

Other Talk Therapies

Two other types of “talk therapy”—psychodynamic therapy and interpersonal psychotherapy—can also be used in the treatment of GAD.

Psychodynamic psychotherapy, also known as insight-oriented therapy, is based on the idea that thoughts and emotions that are outside of our consciousness (i.e., outside of our awareness) can lead to internal conflict and manifest as anxiety.

Interpersonal psychotherapy (IPT) is a time-limited, present-focused treatment based on the assumption that symptoms may be caused or maintained by problems in relationships, and that resolving these problems can help reduce symptoms.

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Medication

Medications for anxiety work by interacting with brain chemicals called neurotransmitters. Particular medications may block the absorption or enhance the action of one or more of these chemicals.

The different types of medications used in the treatment of anxiety include:

  • selective serotonin reuptake inhibitors (SSRIs)
  • serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • anxiolytics
  • tri-cyclic antidepressants

Also, another “older” category of antidepressants—monoamine oxidase inhibitors (MAOIs)—are sometimes used.

Antidepressants have a well-documented ability to help with GAD symptoms, but they can take several weeks to take effect. SSRIs, such as sertraline (Zoloft) or fluoxetine (Prozac), are typically considered a good, first-line choice for the treatment of GAD because they are relatively safe medications that tend to be well tolerated by individuals.

Anxiolytics, such as benzodiazepines, do not treat the underlying cause of anxiety, but they are effective in the treatment of symptoms. However, this class of medication has some notable drawbacks, including potential side effects like sedation and a tendency to be habit-forming. Buspirone (Buspar) is one medication in this class that is approved for the treatment of GAD and is not known to be habit-forming. There is some evidence that buspirone may also help augment antidepressants.

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Tricyclic antidepressants are an older type of antidepressants that are used less commonly because they may carry some potentially significant side effects.

Self-Help

Self-help refers to less formal approaches that address anxiety symptoms with limited (or no) guidance. For example, there are several self-help books that provide help in a step-by-step format and closely mirror evidence-based psychotherapies for GAD, such as CBT or ACT.

With the advent of smartphone technology and the rising popularity of interactive applications, there are now also electronic self-help options that deliver programs informed by evidence-based GAD treatment. There are also applications available with circumscribed, do-it-yourself anxiety-busting tools, like relaxation techniques and mindfulness meditation exercises.

The Best Option for You

Speaking with a clinician—a physician or mental health provider—is the best way to figure out next step(s). Depending on the nature and extent of the anxiety symptoms, one or a combination of the approaches described above may be useful.

In general, mild or intermittent anxiety may improve with the use self-help resources. Self-help resources are also a good option for those wishing to pursue an evidence-based psychotherapy who lack access to specialized care. Self-help options can also be used in conjunction with ongoing treatment, or to prevent relapse and promote continued progress after the conclusion of a course of psychotherapy.

If your symptoms are persistent, are impacting your day-to-day functioning and/or the important relationships in your life, or are clearly noticeable to others, then more formal treatment is worth considering.

For anxiety of a moderate to a severe degree, a course of psychotherapy may be indicated. Medications can help with persistent anxiety of any degree.

When considering psychotherapy versus medication, it is important to note that psychotherapy may take longer to bring symptom relief than medication, but its effects can also be longer lasting (i.e., the insight and skills learned in psychotherapy are retained after treatment ends). And for some individuals with GAD, maximizing treatment—taking medication and participating in psychotherapy—maximizes results.

Making the decision that’s right for you is really a process of ongoing assessment. If you select a self-help approach, be aware that persistent or worsening symptoms are indicators that you would benefit from an in-person evaluation by a clinician.

With medication or psychotherapy treatment, find a provider you trust and ask questions to fully understand what type of treatment you will be receiving as well as its risks and benefits (You can read more on deciding if medication is right for you here).

When pursuing treatment of any kind, it is important to be patient and to participate in regular monitoring of symptoms (and, in the case of medication treatment, side effects) with your clinician.

A Word From Verywell

While the symptoms associated with GAD are undeniably uncomfortable, the good news is that they are treatable. The treatments described above will take work, but the work will pay off in the form of relief and respite from anxiety and worry.

Diagnosis

To help diagnose generalized anxiety disorder, your doctor or mental health professional may:

  • Do a physical exam to look for signs that your anxiety might be linked to medications or an underlying medical condition
  • Order blood or urine tests or other tests, if a medical condition is suspected
  • Ask detailed questions about your symptoms and medical history
  • Use psychological questionnaires to help determine a diagnosis
  • Use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Care at Mayo Clinic

Our caring team of Mayo Clinic experts can help you with your generalized anxiety disorder-related health concerns Start Here

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Treatment

Treatment decisions are based on how significantly generalized anxiety disorder is affecting your ability to function in your daily life. The two main treatments for generalized anxiety disorder are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.

Psychotherapy

Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. Cognitive behavioral therapy is the most effective form of psychotherapy for generalized anxiety disorder.

Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to directly manage your worries and help you gradually return to the activities you’ve avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.

Medications

Several types of medications are used to treat generalized anxiety disorder, including those below. Talk with your doctor about benefits, risks and possible side effects.

  • Antidepressants. Antidepressants, including medications in the selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) classes, are the first line medication treatments. Examples of antidepressants used to treat generalized anxiety disorder include escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva). Your doctor also may recommend other antidepressants.
  • Buspirone. An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective.
  • Benzodiazepines. In limited circumstances, your doctor may prescribe a benzodiazepine for relief of anxiety symptoms. These sedatives are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these medications aren’t a good choice if you have or had problems with alcohol or drug abuse.

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Lifestyle and home remedies

While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here’s what you can do:

  • Keep physically active. Develop a routine so that you’re physically active most days of the week. Exercise is a powerful stress reducer. It may improve your mood and help you stay healthy. Start out slowly and gradually increase the amount and intensity of your activities.
  • Make sleep a priority. Do what you can to make sure you’re getting enough sleep to feel rested. If you aren’t sleeping well, see your doctor.
  • Use relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety.
  • Eat healthy. Healthy eating — such as focusing on vegetables, fruits, whole grains and fish — may be linked to reduced anxiety, but more research is needed.
  • Avoid alcohol and recreational drugs. These substances can worsen anxiety.
  • Quit smoking and cut back or quit drinking coffee. Both nicotine and caffeine can worsen anxiety.
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Alternative medicine

Several herbal remedies have been studied as treatments for anxiety. Results tend to be mixed, and in several studies people report no benefits from their use. More research is needed to fully understand the risks and benefits.

Some herbal supplements, such as kava and valerian, increase the risk of serious liver damage. Other supplements, such as passionflower or theanine, may have a calming effect, but they’re often combined with other products so it’s hard to tell whether they help with symptoms of anxiety.

Before taking any herbal remedies or supplements, talk with your doctor to make sure they’re safe and won’t interact with any medications you take.

Coping and support

To cope with generalized anxiety disorder, here’s what you can do:

  • Stick to your treatment plan. Take medications as directed. Keep therapy appointments. Practice the skills you learn in psychotherapy. Consistency can make a big difference, especially when it comes to taking your medication.
  • Take action. Work with your mental health professional to figure out what’s making you anxious and address it.
  • Let it go. Don’t dwell on past concerns. Change what you can in the present moment and let the rest take its course.
  • Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus your mind away from your worries.
  • Socialize. Don’t let worries isolate you from loved ones or enjoyable activities. Social interaction and caring relationships can lessen your worries.
  • Join a support group for people with anxiety. Here, you can find compassion, understanding and shared experiences. You may find support groups in your community or on the internet, for example, the National Alliance on Mental Illness (NAMI).

Preparing for your appointment

You may see your primary care doctor, or your doctor may refer you to a mental health professional. Here’s some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

  • Any symptoms you’ve been experiencing, including when they occur, what seems to make them better or worse, and how much they affect your day-to-day activities, such as work, school or relationships
  • Key personal information, including major life changes or stressful events you’ve dealt with recently and any traumatic experiences you’ve had in the past
  • Medical information, including other physical or mental health conditions with which you’ve been diagnosed
  • Any medications, vitamins, herbs or other supplements you’re taking, including the dosages
  • Questions to ask your doctor or mental health professional

Some questions to ask your doctor may include:

  • What’s the most likely cause of my symptoms?
  • Are there other possible issues or physical health problems that could be causing or worsening my anxiety?
  • Do I need any tests?
  • What treatment do you recommend?
  • Should I see a psychiatrist, psychologist or other mental health professional?
  • Would medication help? If so, is there a generic alternative to the medicine you’re prescribing?
  • Are there any brochures or other printed material that I can have? What websites do you recommend?

Don’t hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor or mental health professional will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Questions may include:

  • What are your symptoms?
  • What things do you tend to worry about?
  • Do your symptoms interfere with your daily activities?
  • Do you avoid anything because of your anxiety?
  • Have your feelings of anxiety been occasional or continuous?
  • When did you first begin noticing your anxiety?
  • Does anything in particular seem to trigger your anxiety or make it worse?
  • What, if anything, seems to improve your feelings of anxiety?
  • What, if any, physical or mental health conditions do you have?
  • What traumatic experiences have you had recently or in the past?
  • Do you regularly drink alcohol or use recreational drugs?
  • Do you have any blood relatives with anxiety or other mental health conditions, such as depression?

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