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generalized anxiety disorder treatment study

Psychological Techniques.Psychological treatment of anxiety disorders has involved broadly similar techniques, where only the specific content differs. The main techniques used include relaxation, cognitive restructuring, and exposure. For GAD, most successful treatments used a combination of relaxation and cognitive restructuring because the seeming lack of response to external cues has made in vivo exposure seem inappropriate. However, it is certainly possible to use exposure to subtle cues (such as being late or making mistakes) with GADs, and more comprehensive programs have included this technique. Additional strategies were also included in some packages including time management, assertiveness training, and problem solving.
In general, cognitive behavioral treatment packages for GAD produce moderate to large improvements in anxiety symptoms and related problems such as depression. In a quantitative analysis of twenty-two controlled trials of cognitive behavior therapy for GAD, Gould et al. found that the best cognitive behavioral treatments resulted in a reduction in anxiety that was 0.9 standard deviations greater than that produced by control conditions. Furthermore, several studies showed that cognitive behavior therapy is more effective than other supposedly active treatments. For example, cognitive behavior therapy is more effective in reducing GAD than analytic psychotherapy, nondirective counseling, and treatment with diazepam. Perhaps even more important is the demonstration that the effects of treatments last for up to one year and that this maintenance is greater than that achieved with medication. Despite these impressive results, treatment effects for GAD are not quite as large as for some of the other anxiety disorders, and the area will benefit from further development. One potential innovation involves exposure to the actual behavior of worrying. In this program, the uncontrollable process of worry itself is the principal source of chronic anxiety, rather than the rapidly changing content. Treatment involves regaining a sense of control of this out-of-control, anxiety-driven process. Evaluation of this strategy is continuing (Barlow, in press). Pharmacological Treatment.Medication has also proven generally effective in treating GAD, although the effects have not been quite as strong as for cognitive behavior therapy. The most widely used drugs have been benzodiazepines, and the average effect size improvement is around 0.7.
However, despite the fact that the benzodiazepines produce good short-term changes, they tend to result in relatively rapid tolerance, and the effects decrease within a few weeks. Other medications such as buspirone and the tricyclics produce a slower response that tends to last for a longer period. In one study that compared the tricyclic drug imipramine with the benzodiazepine diazepam, diazepam produced a significantly greater reduction in anxiety during the first two weeks but was no better than placebo from three weeks on. In contrast, imipramine showed significantly greater effects than placebo from week 4 until the end of the trial (week 8). Despite these promising results with medication, the major limitation of this form of treatment is the tendency for subjects to relapse after administration of the drug stops. As Schweizer and Rickels point out, the fact that GAD is a chronic disorder that begins at an early age, provides major problems for drug therapy.

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