Dallas Counseling & Psychotherapy

STEVE B. REED, LPC, LMSW, LMFT

Generalized Anxiety Disorder

7 Simple Questions Provide the Answer. 

Generalized Anxiety Disorder (GAD) is “one of the most common anxiety problems seen in general medical practices.”  Doctors will see between 2.8% and 8.5% of their patients suffering from generalized anxiety, according to a national survey¹. 

Fortunately, this is the exact problem that many of the advances in psychotherapy (such as Quick REMAP, the REMAP process, EFT and EMDR) are excellent at treating.  Yet too often, diagnosis and treatment of anxiety related issues never happens.  What has been missing, until now, is a simple and easily available way to spot the symptoms and intensity that warrants a referral for treatment.

A recent development that solves this problem is now available.  Robert L. Spitzer, MD (et. al) reports on their development of a new, quick and effective tool to measure anxiety in the May 22, 2006 edition of the Archives of Internal Medicine².  The name of this anxiety inventory is the GAD-7 (the Generalized Anxiety Disorder-7 questions).

The researchers conclude that the “GAD-7 is a valid and efficient tool” to screen for anxiety and to assess “its severity in clinical practice and research.”   What is more impressive is that you can do this by answering seven short questions.  All the patient needs to do is to read the seven questions and pick one of four possible answers.  Each question has a number value (0-3).  Add the numbers and you quickly arrive at a score between 0 and 21.

The researchers find that a score of 10 or higher means significant anxiety is present.  Scores over 15 are severe.  In the study, they find that people diagnosed with GAD have an average score of 14.4 while people without GAD average only 4.9.

Their study also points out the effect on people’s lives when they suffer from anxiety.

During a three-month period, 47% of the people scoring in the highest anxiety category suffered difficulties because of their symptoms.  They also had twice the number of doctor visits and took over four times the number of sick days from work.  The complete details from that portion of the study are below.

              Group averages during 3 months:

                anxiety score     disability days        physician visits     % of symptom related difficulty

0-4                          3.9                              1.2                                15.0

5-9                          7.9                              1.7                                  5.5

10-14                    10.7                              2.2                                13.7

15-21                    16.8                              2.4                                47.4      

Percent of symptom related difficulty refers to the response to one extra question-- "How difficult have these problems made it for you to do your work, take care of things at home or get along with other people?" (Not at all; Somewhat difficult; Very difficult or Extremely difficult) 

These numbers show that as anxiety scores increase, there is also a steady increase in the number of sick days and doctor visits.  Yet there is not the same steady increase in awareness about anxiety and its impact.  The awareness that anxiety is affecting their lives occurs only when it reaches a high intensity.  This means that patients do not recognize or report a gradual worsening of anxiety until it becomes acute.  The GAD-7 can help catch an increase in anxiety before it becomes disabling.

In this case, people are like the old story of putting a frog in boiling water.  The story says that if you drop a frog in boiling water that it will try to get out.  However, if you place the frog in water at room temperature and the heat is gradually turned-up, it will boil without even trying to escape.

Like the frog, people adjust to changes if they are in small increments.  They do not even notice there is a problem until it crosses an intense threshold.

This can explain why 96% of patients in the study with GAD-7 scores of 10 or greater have been experiencing symptoms of anxiety for a month or more.  In addition, 67% have been suffering from symptoms of anxiety for 6 months or longer.  Failure to recognize and accept the seriousness of anxiety symptoms prevents people from getting proper diagnosis and treatment.  Either patients need to be able to tell their healthcare providers there is an increasing problem or the providers need a way to discover it earlier.  The GAD-7 is a tool can help doctors to make appropriate referrals for mental health care and help psychotherapists to be alert to the need to focus treatment on this issue.

Some patients with symptoms of high anxiety (according to the GAD-7) score low on depression symptoms.  This suggests that we need to assess the dimensions of anxiety and depression separately because they do not always coexist.

The authors also point-out that as anxiety symptoms increase in severity, patients have greater “impairment in multiple domains of functioning”.  The authors believe the GAD-7 can help identify patients with “disabling anxiety” that will benefit from treatment. 

The GAD-7 provides a reliable brief scale to identify General Anxiety Disorder and to measure the severity of its symptoms.  It can help psychotherapists, doctors and even potential patients to know when further assessment and possible treatment is necessary.

By now you may be wondering, “What are these 7 revealing questions?”  Let’s take a look at them and see how you score.

GAD-7 developed by Dr. Robert L. Spitzer, Dr. K. Kroenke, et al.²

How often during the past 2 weeks have you felt bothered by:

1.  Feeling nervous, anxious, or on edge?
            0 = not at all
                1 = several days
                2 = more than half the days
                3 = nearly everyday

2.  Not being able to stop or control worrying?
            0 = not at all
                1 = several days
                2 = more than half the days
                3 = nearly everyday

3.  Worrying too much about different things?
            0 = not at all
                1 = several days
                2 = more than half the days
                3 = nearly everyday

4.  Trouble relaxing?
            0 = not at all
                1 = several days
                2 = more than half the days
                3 = nearly everyday

5.  Being so restless that it is hard to sit still?
            0 = not at all
                1 = several days
                2 = more than half the days
                3 = nearly everyday

6.  Becoming easily annoyed or irritable?
            0 = not at all
                1 = several days
                2 = more than half the days
                3 = nearly everyday

7.  Feeling afraid as if something awful might happen?
            0 = not at all
                1 = several days
                2 = more than half the days
                3 = nearly everyday

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?

__Not difficult at all __Somewhat difficult __Very difficult __Extremely difficult

Scoring:  Add the results for question number one through seven to get a total score.

If you score 10 or above you might want to consider one or more of the following: discuss your symptoms with your doctor, contact a local mental health care provider or contact my office for further assessment and possible treatment.  Although these questions serve as a useful guide, only an appropriate licensed health professional can make the diagnosis of Generalized Anxiety Disorder.

Steve B. Reed, LPC, LMSW, LMFT is a psychotherapist who specializes in treating people with an anxiety disorder.  Steve is the developer of the REMAP process, a method for treating PTSD, phobias, panic attacks and generalized anxiety disorder.

Click here to get in touch with Steve about new, effective treatments for your anxiety problem.

    www.psychotherapy-center.com

REFERENCES:

1.  Wittchen HU, Zhao S, Kessler RC, Eaton WW. DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:355-364.

2.  Spitzer RL, Kroenke K, Williams JB, Lowe B. A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7. [Journal Article] Arch Intern Med. 2006;166(10):1092-7.
 

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