Generalized anxiety disorder treatment

Which generalized anxiety disorder treatment options are there?

Generalized anxiety disorder treatment infographic

Generalized anxiety disorder facts


Generalized anxiety disorder can be treated in roughly three different ways: with psychotherapy, medication or a combination of both. With each of these generalized anxiety disorder treatment options you can choose different ways of being treated. Unfortunately, not every treatment option is as effective as others. Some are really effective on the short run, but not so effective on the long run. Whereas other generalized anxiety disorder treatment options are less effective than placebos.
These treatment options have been mentioned because they are considered to be effective and further explanations will be given on how they work. In case you’re missing a treatment option listed below, please contact me so I can give you an explanation as to why that option is missing.
 
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At Barends Psychology Practice we offer (online) therapy for generalized anxiety disorder. Contact us to schedule a first, free of charge, online session. (Depending on your health insurance, treatment may be reimbursed).

 
 

Generalized anxiety disorder treatment options- therapy

Generalized anxiety disorder (GAD) therapy focuses on reducing GAD symptoms, such as (excessive) worrying, fear of making the wrong decision, and the inability to relax. Therapists use a variety of techniques, such as psycho-education, emotional skills training, problems solving techniques, relaxation techniques, and experiential exposure, to reduce your symptoms and to teach you new and effective coping mechanisms. Be aware of the fact that treatment effectiveness for a large part is dependent on your ‘click’ with the therapist. If you don’t feel comfortable with your therapist, then please look for a new one that you may feel you connect with. For more information about the way the mentioned therapies below work, I recommend you read: how do these therapies work?

There are different therapy types available. Here are the most effective types of therapy:
 

Cognitive behavioural therapy

Effectiveness: Cognitive Behavioural Therapy (CBT) is more effective than placebo pills or no therapy at all. This means that CBT is effective in treating generalized anxiety disorder (GAD) [1],[3]. However, in severe cases CBT is significantly less effective than attention placebo. This means that in severe cases of GAD CBT treatment is less effective than a social support group or a GAD discussion group [1].
In combination with exposure therapy CBT is also effective in treating GAD.
CBT treatment for GAD is effective on the short run (immediately), on the long run (it has a lasting effect), and prevents people from relapsing after a few months or longer [4].

Internet based Cognitive Behavioural Therapy can be an effective way of treating generalized anxiety disorder when guided by a therapist. The effects of the treatment are still present 1 and 3 years after treatment [2].
 

Exposure therapy

Effectiveness: Exposure therapy is more effective than placebo pills or no therapy at all. This means that exposure therapy is effective in treating generalized anxiety disorder [3].
 

Acceptance and commitment therapy (ACT)

Acceptance and Commitment therapy (ACT) is more effective in treating GAD than no treatment or placebo. ACT, exposure therapy and CBT are approximately equally effective in treating GAD [5].
 
 

Generalized anxiety disorder treatment options – Prescription drugs / medication

Effectiveness: According to popular websites (Mayo Clinic, WebMD) prescription drugs / medication are as effective as cognitive behavioural therapy, ACT, and exposure therapy. However, the effects of CBT, ACT, and exposure therapy last longer and there is less chance of a relapse with CBT or exposure therapy.
According to a recent (2011) study to pharmacological treatment of generalized anxiety disorder found that pharmacological treatment, such as SSRIs, SNRIs, Pregabalin, and Quetiapine can be effective, but that the overall clinical outcome for patients can be quite poor [6]. Some medication works poor on the short term whereas others work poor on the long term. And some medication can have some adverse effects when taken for long periods.
NOTE: medication reduces anxiety and depression symptoms, but it doesn’t teach you how to cope with them on the long run.
Psychiatrists and General practitioners are allowed to prescribe drugs/medication for Generalized anxiety disorder. To treat GAD professionals usually prescribe Anti-depressants, Benzodiazepines, and Buspirone. Every prescription drug has its own risks, possible side effects, and benefits. Some medication takes several weeks to have effect, whereas others work immediately. Some medications can be addictive (meaning: if you take them for too long your body will get used to a certain amount, which means you need more of that medication to feel the same effect as before. It’s also very difficult to stop taking that medication once you are addicted to it).
Some medication works only for as long as you take it, whereas others work for a longer period of time.

Antidepressants: for information about the way they work, please read: how do antidepressants work?
 

Benzodiazepines (Benzos): Benzos have a sedative, hypnotic effect and reduce feelings of anxiety. Benzos can be addictive. Benzos enhance the effect of neurotransmitter receptor GABA-A. Recommendations for GAD treatment are to use benzos between 2-4 weeks, because they are not effective on the long-term [7]. Benzos are considered to be the second-line treatment option for GAD treatment.
Examples of anxiety reducing benzodiazepines:

  • Oxazepam
  • Diazepam
  • Lorazepam
  • Alprazolam
  • Prazepam
  • Chlordiazepoxide
  • The side effects of Benzos: sleepiness during the day (this could be dangerous when driving a vehicle), amnesia, concentration problems (problems with studying), increased appetite and weight gain, drowsiness, blurred vision, sometimes aggression and agitation.

    Buspirone: Buspirone enhances both serotonin and dopamine receptors, and has an anxiety and depression reducing effect. Buspirone is considered to be as effective as Benzos in treating GAD. It can take a few weeks before Buspirone is effective. There are no signs of withdrawal when you stop taking Buspirone (Never stop a prescription drugs without consulting your general practitioner or psychiatrist).

    The side effects of Buspirone: dizziness, lightheaded, headaches, sleepiness, premature ejaculation, sleeping problems, nervousness, depression, anger, chest pain, tremor, fatigue and nausea. For more side effects, please visit Buspirone side effects.
     
     

    Literature used for this page:

  • [1] Haby, M.M., Donnelly, M., Corry, J., & Vos, T., 2006. Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: a meta-regression of factors that may predict outcome. Aust N Z J Psychiatry, 40, 9-19.
  • [2] Paxling, B., Almlöv, J., Dahlin, M., Carlbring, P., Breitholtz, E., Eriksson, T., & Andersson, G., 2011. Guided internet-delivered cognitive behavior therapy for generalized anxiety disorder: a randomized controlled trial. Cognitive Behaviour Therapy, 40, 159-173.
  • [3]Norton, P. J. & Price, E. C., 2007. A meta-analytic review of adult cognitive-behavioral
    treatment outcome across the anxiety disorders. J Nerv Ment Dis, 195, 521-531.
  • [4]Baldwin, D. S., et al., 2005. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 19, 567-596.
  • [5] Powers M. B., Zum Vörde Sive Vörding, M. B., Emmelkamp, P. M. G., 2009. Acceptance and commitment therapy: a meta-analytic review. Psychotherapy and psychosomatics, 78, 73-80.
  • [6]Baldwin, D. S., Waldman, S., Allugander, C., 2011. Evidence-based pharmacological treatment of
    generalized anxiety disorder. International Journal of Neuropsychopharmacolog, ??, 1-14.
  • [7] Canadian Psychiatric Association (July 2006). “Clinical practice guidelines. Management of anxiety disorders”. Can J Psychiatry, 51, 51S–55S.