GAD-7 and diagnosing Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) is one of the most common diagnoses that therapists see in their practices. According to the National Institute of Mental Health, an estimated 5.7% of U.S. adults will experience symptoms associated with Generalized Anxiety Disorder at some point in their lives. Because of this high prevalence of GAD, clinical practitioners need to have a reliable and valid screening tool to help screen for anxiety symptoms, severity of symptoms, and progress in treatment.
Using the GAD-7 also guides clinicians through developing a treatment plan, communicating with the client regarding progress in treatment, and evaluating treatment interventions. The GAD-7 serves as an excellent and readily accessible screening tool for therapists to use in practice.
What is the GAD-7?
The GAD-7 is a brief self report scale that helps therapists screen for probable cases of Generalized Anxiety Disorder as well as measure and continue to monitor for symptom severity for clients ages 18 and older. The screening tool consists of 7 questions which clients can answer independently either through a paper-and-pencil format or an electronic version. The therapist can also conduct an interview type question and answer session of the GAD-7. The questions consist of various symptoms of GAD-7 identified in the DSM V. The respondent answers each question on a four-point Likert scale as to the frequency of experiencing the various symptoms over the past two weeks (Not at all sure; Several Days; Over Half the Days; Nearly Every Day). Each answer has a point value. It should take approximately two to five minutes to complete the screening tool.
Therapists can also use the GAD-7 to assist them in screening for symptoms of Panic Disorder, Social Anxiety, and PTSD. Providers can freely access the GAD-7 by going to the website https://www.phqscreeners.com. Pfizer does own the copyright for the tool but has made it freely accessible to providers. Additionally, various electronic practice management systems and online telehealth therapy platforms make the GAD-7 readily available for clinicians to use.
Why use the GAD-7?
When the therapist administers the GAD-7 at intake, the outcome gives the clinician and client a clinical picture of the severity of the anxiety symptoms. The clinician can then use this information to assist with developing a more clear diagnosis for the client and in designing a more individualized treatment plan for the client. The therapist can then administer the GAD-7 during the course of treatment.
Just as physicians routinely monitor and measure for changes in their patients (ex: blood pressure checks for a patient with high blood) therapists should routinely monitor and measure for changes regarding symptom severity with clients involved in therapy. When the therapist administers the GAD-7 at intake and then during the course of treatment, the answers and total score of the tool can provide the therapist and client with an assessment of progress in treatment.
Discussions on the overall scores and answers to the questions can help the clinician and the client gain a better understanding of how the client is responding to treatment by measuring for any changes in symptom severity. This process can also increase the individualization of treatment interventions by providing the clinician and client with an opportunity to discuss the treatment plan and any need for changes in interventions or a change in the frequency of sessions. For example, if the GAD-7 administered during the course of treatment indicates an improvement of symptoms, it may be appropriate for the therapist and client to discuss stepping down in the frequency of sessions or continuing with the current treatment model for a period of time. If the score indicates an increase in severity of symptoms, then it might warrant a discussion of what to do differently in treatment. These types of clinical discussions can improve the communication between the clinician and the client and increase their collaboration together on working towards treatment goals.
How to administer the GAD-7?
On the GAD-7, clients answer seven questions on a Likert scale regarding the severity of seven Generalized Anxiety Disorder symptoms from the DSM experienced within the past two weeks. Treatment providers can offer clients the opportunity to independently answer the questions prior to the session, during the session, or upon completion of the treatment session.
Some clinicians may prefer to administer the scale as part of the treatment session in an interview format. If the therapist administers the GAD-7 in an interview format, it is important that the clinician adhere to the question-and-answer format and not allow for discussion of the questions or responses during the administration time.
Following the completion of the GAD-7, the treatment session can allow for further discussion of responses, symptoms, and treatment planning based on the answers and overall score. Treatment providers may want to consider administering the tool upon intake, at regular intervals throughout treatment, and again at discharge.
GAD-7 scoring and interpretation
The GAD-7 may be completed on paper or by an electronic version. Clients rate the severity of the listed symptoms over the past 2 weeks according to the answers:
- 0=not at all;
- 1= several days;
- 2=more than half the days;
- 3=nearly every day.
The respondent is asked “Over the last 2 weeks, have you felt bothered by any of these things?” The assessment then lists the following questions with corresponding space to answer according to the Likert scale ratings:
- Feeling nervous, anxious, or on edge?
- Not being able to stop or control worrying?
- Worrying too much about different things?
- Trouble relaxing?
- Being so restless that it is hard to sit still?
- Becoming easily annoyed or irritable?
- Feeling afraid as if something awful might happen?
Respondents then answer a final question of “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? The respondent answers according to:
- Not difficult at all;
- Somewhat difficult;
- Very difficult; or
- Extremely difficult.
The clinician then scores the tool by adding up the answers of the Likert Scale. The totals indicate severity of anxiety symptoms.
- A score of 1 to 4 indicates minimal symptoms.
- A range of 5 to 9 indicates mild symptoms.
- Scores in the range of 10 to 14 suggest moderate symptoms.
- Scores of 15 to 21 correlate with severe symptoms.
The clinician can then use these severity ratings and answers to specific symptoms towards assigning a diagnosis and developing an appropriate treatment plan.
As a brief assessment tool with easy administration, scoring, and interpretation, the GAD-7 offers an opportunity to screen for symptoms of anxiety and measure for severity of symptoms.
Clients can complete it with ease. The short question and answer format of the tool is not overly invasive or difficult for a client to complete. The score and answers can generate a diagnostic picture of the severity of anxiety to assist with clinical discussion of the anxiety; assist in initial treatment planning; and guide the therapeutic process throughout the treatment process. The GAD-7 can serve as a reliable and valid tool to assist and guide clinicians in diagnosing and treating Generalized Anxiety Disorder in their practices.
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Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder - The GAD-7. Archives of Internal Medicine. 2006;166:1092-1097.
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