Generalized anxiety disorder psychotherapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A psychological method of treatment for GAD is cognitive behavioral therapy (CBT), which involves a therapist working with the patient to understand how thoughts and feelings influence behavior. The goal of the therapy is to change negative thought patterns that lead to the patient's anxiety, replacing them with positive, more realistic ones. Elements of the therapy include exposure strategies to allow the patient to gradually confront their anxieties and feel more comfortable in anxiety-provoking situations, as well as to practice the skills they have learned. CBT can be used alone or in conjunction with medication.

Cognitive Behavioral Therapy

• A basic concept in CBT treatment of anxiety disorders is in vivo exposure—a gradual exposure to the actual, feared stimulus.
  • This treatment is based on the theory that the fear response has been classically conditioned and that avoidance positively reinforces and maintains that fear. This "two-factor" model is often credited to O. Hobart Mowrer.
• Through exposure to the stimulus, this conditioning can be unlearned; this is referred to as extinction and habituation.
• A specific phobia, such as fear of spiders, can often be treated with in vivo exposure and therapist modeling in one session. Obsessive compulsive disorder is typically treated with exposure with response prevention.

• Social phobia has often been treated with exposure coupled with cognitive restructuring, such as in Heimberg's group therapy protocol.
• Evidence suggests that cognitive interventions improve the result of social phobia treatment.

• CBT has been shown to be effective in the treatment of generalized anxiety disorder, and possibly more effective than pharmacological treatments in the long term.
  • In fact, one study of patients undergoing benzodiazepine withdrawal who had a diagnosis of generalised anxiety disorder showed that those who received CBT had a very high success rate of discontinuing benzodiazepines compared to those who did not receive CBT.
    • This success rate was maintained at 12 months follow up.
  • Furthermore in patients who had discontinued benzodiazepines it was found that they no longer met the diagnosis of general anxiety disorder and that patients no longer meeting the diagnosis of generalized anxiety disorder was higher in the group who received CBT.
• Thus CBT can be an effective tool to add to a gradual benzodiazepine dosage reduction program leading to improved and sustained mental health benefits.