Updated: October 4, 2024

Generalized Anxiety Disorder (GAD) affects millions of people worldwide, including many folks in Ontario and Canada. According to the Anxiety and Depression Association of America (ADAA), GAD affects about 6.8 million adults in the United States alone.

We all struggle with anxiety and worry at times. But, those who develop GAD worry to the point where it impacts their quality of life. It can impact their school or work, relationships, hobbies, sense of self, etc. Thankfully, GAD is treatable with cognitive behavioural therapy or CBT. CBT is a type of treatment or psychotherapy that has been heavily researched.

Symptoms of Generalized Anxiety Disorder

The DSM-IV criteria for Generalized Anxiety Disorder (GAD) include the following symptoms:

1. Excessive anxiety and worry happen more days than not

2. Difficulty controlling the worry

3. Restlessness or feeling keyed up or on edge

4. Feeling of fatigued

5. Difficulty concentrating or mind going blank

6. Irritability

7. Muscle tension (e.g. back pain or neck strain, headaches)

8. Difficulty sleeping

People with Generalized Anxiety Disorder (GAD) often fear uncertainty. This means they get very anxious when they face new situations, like starting a new job or having a baby, or when they don't know what will happen.

Common Avoidances in GAD

Avoidance is a common coping strategy when it comes to anxiety. It helps you feel good in the short term but may contribute to your anxiety in the long term. Learn more about safety behaviours, which impact all anxiety disorders. Here are some common avoidant behaviours that we see in people who have GAD (American Psychiatric Association, 2013).

1. Avoiding conflict: They may avoid conflict or assertiveness to avoid feelings of anxiety or discomfort.

   Preferring familiar Situations: They may prefer familiar environments and routines to reduce uncertainty.

2. Limiting Social Interactions: People with GAD may avoid social situations.

3. Withdrawal from Work or School Obligations: The pressure to perform in school or work settings can worsen anxiety for those with GAD. This often leads to avoidance of tasks or responsibilities to reduce stress.

4. Health-related Interactions: Fear of health issues may trigger anxiety. Because of this, it’s common to shy away from medical appointments. They may also avoid discussions about their well-being. Often they avoid medical interactions for fear of bad outcomes.

5. Travel or Change: The idea of unfamiliar places or changes to routine can provoke anxiety in people with GAD. They will often resist travel or changes to their surroundings so that they can have a sense of control.

6. Negative Emotional Triggers: They may avoid exposure to situations that lead to negative emotions, such as sadness or anger.

7. Risk-taking: Fear of failure or negative outcomes may stop people with GAD from pursuing opportunities for personal or professional growth.

8. Relaxation Activities: Some people with GAD may find it challenging to do relaxation techniques like mindfulness. They will often feel restless or guilty when spending time on self-care.

9. Media: Sensitivity to negative news or media coverage may trigger them to avoid or limit their consumption of such content. Opting to avoid sources that could worsen feelings of anxiety or distress.

Treatment and Tips for Anxiety

There are effective treatments available for people with GAD.

1. Cognitive Behavioural Therapy (CBT): CBT is a type of psychotherapy or counselling. It focuses on identifying and changing negative thoughts and behaviours. By learning to recognize and change thoughts, people with GAD can have healthier tools and reduce their levels of anxiety. Learn more about CBT for Anxiety.

2. Therapy: Other forms of therapy may also be helpful for people with GAD. Other types of therapy that may be helpful are acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), and interpersonal therapy (IPT) (Hofmann et al., 2012).

3. Mindfulness-Based Therapies: Mindfulness-based therapies, such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), have shown promise in reducing anxiety (Hofmann et al., 2010). These therapies emphasize present-moment awareness and nonjudgmental acceptance of thoughts and feelings.

4. Exercise: Regular exercise helps reduce symptoms of anxiety and improve well-being (Ströhle, 2009). Engaging in activities such as walking, jogging, swimming, or yoga can help ease stress and anxiety.

5. Lifestyle Changes: Making lifestyle changes like making a regular sleep schedule, setting realistic goals, and prioritizing self-care activities can also be helpful (Kroenke & Spitzer, 2002). Finding healthy ways to cope with stress and engaging in activities that bring joy and fulfillment can contribute to well-being.

6. Medication: Antidepressants can be prescribed to help manage symptoms of GAD (American Psychiatric Association, 2013). Book an appointment with your family doctor to talk about medication options for your mental health.

Is CBT Effective for Generalized Anxiety Disorder (GAD)?

Yes, Cognitive Behavioural Therapy (CBT) is effective for treating Generalized Anxiety Disorder (GAD). It helps you understand the connection between your thoughts, feelings, and behaviours. For people with GAD, worries can feel overwhelming and constant. CBT works by teaching you to identify and challenge these unhelpful thought patterns. Over time, you can learn new ways to respond to anxiety, which helps reduce both the frequency and intensity of worries.

What Is the Gold Standard Treatment for GAD?

The gold standard treatment for GAD is Cognitive Behavioural Therapy (CBT). In some cases, people will need a combination of CBT and medication. While medication can help reduce anxiety symptoms, CBT addresses the root of the anxiety by teaching long-term coping skills. Many therapists consider CBT to be the primary treatment for GAD due to its lasting effects even after therapy ends.

How Many CBT Sessions for GAD?

The number of CBT sessions for GAD can vary, but most people need between 8 to 12 therapy sessions. Some may need fewer, while others may need more, depending on the severity of their anxiety and how they respond to therapy. The idea is to work through your anxious thought patterns, build coping skills, and practice these skills in everyday life. The progress you make during therapy often determines the number of sessions needed.

What Are Some Examples of CBT Exercises for GAD?

CBT includes practical exercises that help reduce anxiety. Here are a few common examples:

1. Thought Records. This exercise helps you track your anxious thoughts and evaluate how realistic they are. You write down the thought, and the anxiety level it causes, and then challenge it with evidence or alternative perspectives.

2. Behavioural Experiments. This exercise involves testing your fears in a controlled way to see if the outcome is as negative as you think. For example, if you're worried about speaking up in a meeting, you might try it once and observe the actual consequences. Most people discover that it wasn't as bad as anticipated.

3. Progressive Muscle Relaxation. This technique helps you focus on relaxing your body. It can help reduce the mental tension that comes with anxiety. It involves tensing and then relaxing different muscle groups to promote a state of calm.

4. Exposure Therapy. Exposure therapy encourages you to face your fears in a safe, controlled manner. Over time, this reduces the power that anxiety has over you.

CBT for GAD Books

We like this book because it is CBT-based and supported by research!

The Generalized Anxiety Disorder Workbook: A Comprehensive CBT Guide for Coping with Uncertainty, Worry, and Fear by Melisa Robichaud, Ph.D., Michel J. Dugas, Ph.D., and Martin M. Antony, Ph.D.

This workbook gives practical tools and exercises. It will teach you about the nature of GAD and how it impacts your feelings, thoughts and behaviours.

Connect with a CBT Therapist for GAD Treatment

GAD is a common and debilitating condition that can have a significant impact on daily life. But, effective treatments such as CBT offer hope for those struggling with anxiety.

Book a free consultation by clicking the button and we will match you with a CBT specialist. We can answer any questions you have about CBT for GAD and discuss if it would be a good fit for you. We have a variety of therapists to choose from. Learn more about our team:

Registered Psychotherapists (RP)

Clinical Psychologists

Registered Social Workers RSW

* Must be an Ontario resident to receive services from our clinic.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). https://doi.org/10.1176/appi.books.9780890423349

Baldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J. A., ... & Wittchen, H. U. (2014). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology, 28(5), 403-439.

Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169-183.

Manzoni, G. M., Pagnini, F., Castelnuovo, G., & Molinari, E. (2008). Relaxation training for anxiety: A ten-year systematic review with meta-analysis. BMC Psychiatry, 8(1), 41.

Ströhle, A. (2009). Physical activity, exercise, depression and anxiety disorders. Journal of Neural Transmission, 116(6), 777-784.

Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.

Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509-515.