Patients with generalized anxiety disorder may respond to psychologic or pharmacologic therapies or a combination of both approaches. A combination of drug therapy and psychotherapy may help a patient with generalized anxiety disorder. Benzodiazepines, such as clonazepam and alprazolam, may relieve mild anxiety and improve the patient's ability to cope.
Psychologic Treatment for GAD
Psychotherapy for generalized anxiety disorder has two goals: helping the patient identify and deal with the cause of the anxiety, and eliminating environmental factors that precipitate an anxious reaction.
Nonpharmacologic modalities should be the initial treatment for patients with mild anxiety 4 to address the three categories of symptoms of GAD. Relaxation techniques and biofeedback are used to decrease arousal.
Cognitive therapy helps patients to limit cognitive distortions by viewing their worries more realistically, enabling them to make better plans to manage their anxiety.
In cognitive therapy, patients may be taught to record their worries, listing evidence that justifies or contradicts the extent of their concerns. Patients also learn that "worrying about worry" maintains anxiety and that avoidance and procrastination are not effective ways to solve problems.
Family members should participate in the treatment plan of patients with GAD. Initially they can provide additional historical information and contribute to the formulation of the treatment plan. Because patients with this disorder tend to be vigilant for signs of danger and may misinterpret information, family members can provide another perspective on the patient's problems.
In addition, family members should be included in efforts to help the patient develop problem-solving skills and can also help decrease the social isolation of patients with GAD by providing structured activities to promote interaction with others and lessen rumination about problems.
Psychologic methods for GAD include the following:
- Controlled exposure to anxiety-causing situations
- Planning relaxed events and relaxation training
Relaxation techniques such as deep breathing, meditation, biofeedback, or yoga help bring a sense of peace and calm. Group counseling with others who have a similar condition is sometimes helpful.
Pharmacologic Treatment for GAD
Antidepressants, such as venlafaxine or higher doses of short-acting benzodiazepines, may relieve the patient of severe anxiety and panic attacks. Antihistamines and sedatives medication may also be prescribed. which may pose less risk of physical and psychological dependence than benzodiazepines.
Pharmacologic therapy should be considered for patients whose anxiety results in significant impairment in daily functioning. Study results have not revealed an optimal duration of pharmacologic treatment for patients with GAD.
While 25 percent of patients relapse within one month of discontinuing drug therapy and 60 to 80 percent relapse within one year, patients treated for at least six months have a lower relapse rate than those treated for shorter time periods.
If anxiety is very high, an anti-anxiety medication may be helpful to temporarily create calmness, until the person learns self-soothing behaviors. It is generally better for any such medication to be prescribed and closely monitored by a psychiatrist who is aware of the differences in anti-anxiety medications and their possible side effects.
Two herbal remedies that are often used for the treatment of anxiety - GAD are:
- Valeriana officinalis (valerian), a root extract, and
- a beverage made from the root of Piper methysticum (kava-kava).
Both have sedating properties, but kava has worrisome side effects that include synergy with alcohol and benzodiazepines, dyskinesias and dystonia, and dermopathy. Valerian root has been reported to cause delirium and cardiac failure if abruptly discontinued. Further studies are needed before these herbal products can be recommended as therapeutic agents for persons with GAD.