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Treatment for Generalized Anxiety Disorder (GAD)

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.

We previously described this disorder and reviewed its diagnostic criteria.

Generalized Anxiety Disorder (GAD) is associated with many physical symptoms of stress and tension. Since anxiety is a combination of physical sensations, behaviors, emotions, and thoughts, it is important to target each of these components. Psycho-education teaches therapy participants about the physical sensations of anxiety. This helps the participant learn to recognize and manage those symptoms.

stressed and relaxed street signsProgressive muscle relaxation and imaginal techniques are very helpful to manage and reduce these physical sensations. Progressive muscle relaxation teaches people how to recognize the difference between physical tension, and relaxation. Consequently, they learn how to consciously relax their muscles. Progressive muscle relaxation consists of the therapist systematically guiding a person to tense, and then relax major-muscle groups. Regular practice is the best way to master the technique. Therapists often provide therapy participants with a tape recording of the exercise for homework practice. Imaginal techniques consist of guiding people to imagine themselves in a safe and relaxing situation, or to recall a pleasant memory, such as lying on a beach listening to the ocean. Therapy participants learn to use these techniques throughout the day to return to a state of relaxation and calm.

Cognitive therapy for GAD focuses on challenging the core beliefs. One such belief is the world is a dangerous place. This often includes cognitive distortions such as catastrophic predictions. Furthermore, people with GAD are encouraged to test out their predictions regarding future catastrophes. Exposure and response prevention therapy can be applied during imaginal exercises. This consists of the therapist guiding the therapy participant to imagine a feared future catastrophe. Repeated exposure, via imagination, helps the therapy participant to become desensitized to worries about negative outcomes by imagining them occurring. They may also be asked to imagine that they are successfully and competently handling the worrisome event.

Acceptance and Commitment Therapy (ACT) is also helpful. ACT teaches participants to recognize the catastrophic thoughts they have are not facts. Instead, they are merely thoughts with no more importance than the importance we assign them.