"At its basic level, anxiety serves as an adaptive function to alert an individual to

novel or threatening situations, and thus to allow the person to confront or flee
such situations.
(Mash & Barkley, 2003, p. 292)
For individuals with GAD, threat is felt often, yet the problem situations cannot
be solved (one cannot flee or confront it) due to the following:
1) it may be in their minds 2) the anxious cues refer to bad potential
events in the future
3) feared events are unlikely to happen (Borkovec, Alcaine & Behar, 2004)





Common GAD Scales Advantages
Hamilton Anxiety Scale
Most commonly used and assesses the severity of
anxiety symptoms.
GAD Inventory
Specific to GAD and assesses symptom profile and
severity.
Penn State Worry
Questionnaire
Good measure of pathological worry, specific to
general worry.
(Katzman, 2009)
GAD Interventions-Cognitive Behavioural Therapy (CBT)
-Most widely used and empirically supported method of treating GAD. In CBT,
an individual is taught self-monitoring techniques, cognitive distortions are
identified, as are frequent and negative patterns of thought. Resulting
Prevalence: Up to 3% of children may experience GAD.
Up to 10% of adolescents may experience GAD (Mash & Barkley, 2003).
Appears to run a chronic course into adulthood if untreated (Silverman, Pina &
Viswesvaran, 2008).
Generalized Anxiety Disorders (GAD)
Interventions
behaviours are recorded and then evaluated (Hoge & Ivkovic, 2012). CBT
proceeds in stages, leading up to the present (Roemer & Orsillo, 2005).

1-First step, evaluate personal worry triggers (can be a person, place, thing,
or event that causes immediate unpleasant thinking (like the sound of an
alarm going off that produces an image of your house fire). Identifying the
trigger(s) is an important first step for CBT interventions that follow.
2-Next, evaluate thoughts one has when worried (evaluate beliefs on worry,
does it help or harm?)
3-Then with guidance, evaluate the reality of perceived threats by keeping a
worry episode log. Identify thinking errors through collected evidence in log.
4-Worry exposure allows the fight or flight response (that is supressed in
individuals with GAD) to activate. Structured and guided confrontation of
aversive images during therapy activates distressing feelings. End goal of worry
exposure: an awareness that distress feelings subside naturally.
5-Lastly, positive imagery is a technique that gradually replaces aversive
mental images with positive images that facilitate relaxation.
(Rygh & Sanderson, 2004)

-Relaxation exercises are used to mediate physical symptoms of worry, such as
muscle tension and a sensitive startle response (Marten et al., 1993). Deep
relaxation, diaphragmatic breathing techniques are taught and rehearsed both
with and without the presentation of aversive (worry producing) imagery. Once
the relaxation technique is perfected, it is used as a tool against unnecessary
feelings of worry, immediately following the onset of anxious feelings that the
client has learned to identify.
(Rygh & Sanderson, 2004)


Modern fight : seek reassurance Modern flight/freeze: avoid, seek
over check, over protect. reassurance, and procrastinate.
CBT Interventions for Cognitive Symptoms of GAD (What You Think)
Interventions for Physical Symptoms in GAD (What You Feel)
Interventions for Behaviours in GAD (What You Do)- Modern Fight,
Flight or Freeze
Response Prevention utilizes invivo exposure (systematic confrontation of
anxiety provoking situations) and eventually reduces unnecessary fight or flight
responses. Evidence is collected to assess the necessity of the fight or flight
response after the fact.
The above mentioned techniques have been found to be helpful; however, not
every technique works for everyone (Rygh & Sanderson, 2004).
-helpful, current research on evidence based strategies and GAD in general in
Treating Generalized Anxiety Disorders: Evidence Based Strategies, Tools, and
Techniques by Jayne Rygh and William Sanderson
Works Cited
Borkovec, T. D., Alcaine, O., & Behar, E. (2004). Avoidance theory of worry and
generalized anxiety disorder. Generalized anxiety disorder: Advances in
research and practice, 2004.
Katzman, M. A. (2009). Current considerations in the treatment of generalized
anxiety disorder. CNS drugs, 23(2), 103-120.
Mash, E., Barkley, R. (2003). Child Psychopathology. Ney York: The Guilford
Press.
Roemer, L., & Orsillo, S. M. (2005). An acceptance-based behavior therapy for
generalized anxiety disorder. In Acceptance and mindfulness-based
approaches to anxiety (pp. 213-
240). Springer US.
Rygh, J. L., & Sanderson, W. C. (2004). Treating generalized anxiety disorder:
Evidence-based strategies, tools, and techniques. The Guilford Press
Silverman, W. K., Pina, A. A., & Viswesvaran, C. (2008). Evidence-based
psychosocial treatments for phobic and anxiety disorders in children and
adolescents. Journal of Clinical Child & Adolescent Psychology, 37(1), 105-
130.
Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski, S.
(2012). Establishing the neurobiologic basis of treatment in children and
adolescents with generalized anxiety disorder. Depression and Anxiety,
29(4), 328-339.