Generalised anxiety disorder (GAD) is one of a range of anxiety disorders that includes panic disorder (with and without agoraphobia), post-traumatic stress disorder, obsessive-compulsive disorder, social phobia, specific phobias (for example, of spiders) and acute stress disorder. Anxiety disorders can exist in isolation but more commonly occur with other anxiety and depressive disorders.
GAD is a common disorder, of which the central feature is excessive worry about a number of different events associated with heightened tension
The anxiety and worry are associated with at least three of the following six symptoms (with at least some symptoms present for more days than not, for the past 6 months):
Symptoms should be present for at least 6 months and should cause clinically significant distress or impairment in social, occupational or other important areas of functioning
NICE suggest a stepped care model for GAD (2):
Focus of the Intervention | Nature of the Intervention |
STEP 4: Complex treatment-refractory GAD and very marked functional impairment, such as self-neglect or a high risk of self-harm | Highly specialist treatment, such as complex drug and/or psychological treatment regimens; input from multi-agency teams, crisis services, day hospitals or inpatient care |
STEP 3: GAD with an inadequate response to step 2 interventions or marked functional impairment | Choice of a high-intensity psychological intervention (CBT/applied relaxation) or a drug treatment |
STEP 2: Diagnosed GAD that has not improved after education and active monitoring in primary care | Low-intensity psychological interventions: individual non-facilitated self-help*, individual guided self-help and psychoeducational groups |
STEP 1: All known and suspected presentations of GAD | Identification and assessment; education about GAD and treatment options; active monitoring |
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