What is the recommended treatment approach for patients with generalized anxiety disorder (GAD)?

Healthcare Team Referrals for Generalized Anxiety Disorder

For optimal management of generalized anxiety disorder (GAD), a stepped care model is recommended with referrals to appropriate healthcare professionals based on symptom severity, including primary care providers for mild cases, psychologists for evidence-based psychotherapy, and psychiatrists for medication management in moderate to severe cases. 1

Assessment and Severity-Based Referral Pathway

Initial Assessment

• Use the GAD-7 scale as the recommended screening tool for GAD 1
• Categorize severity based on GAD-7 scores:
  • Mild: 0-9
  • Moderate: 10-14
  • Severe: 15-21

Referral Algorithm Based on Severity

For Mild Anxiety (GAD-7 score 0-9):

• Primary care team can manage through supportive care 1
• Referral to educational and support services
• Consider referral for structured physical activity/exercise programs

For Moderate Anxiety (GAD-7 score 10-14):

• Referral to licensed mental health professionals for psychological interventions 1
• Options include:
  • Clinical psychologist for cognitive behavioral therapy (CBT)
  • Licensed therapist for behavioral activation
  • Mental health professional for acceptance and commitment therapy

For Severe Anxiety (GAD-7 score 15-21):

• Urgent referral to psychiatrist for comprehensive evaluation and medication management 1
• Concurrent referral to psychologist for high-intensity psychological interventions
• Consider multidisciplinary team approach

Specific Professional Referrals

Psychiatrist Referrals

• Essential for patients with:
  • Severe symptoms (GAD-7 score ≥15)
  • Risk of self-harm or harm to others
  • Complex comorbidities (especially depression)
  • Need for medication management
  • Previous treatment failures

Psychologist/Therapist Referrals

• For evidence-based psychological interventions:
  • Cognitive behavioral therapy (strongest evidence base)
  • Behavioral activation
  • Acceptance and commitment therapy
  • Structured relaxation techniques

Primary Care Provider

• Ongoing monitoring and coordination of care
• Management of mild anxiety symptoms
• Medication management in uncomplicated cases

Additional Specialized Referrals

• Social worker: For assistance with social determinants and resource connection
• Occupational therapist: For functional impairment affecting daily activities
• Support groups: For peer support and shared experiences

Follow-Up and Monitoring

• Monthly follow-up is recommended until symptoms have subsided 1
• Assess compliance with referrals and treatment satisfaction
• Evaluate medication adherence and side effects
• Consider treatment modifications after 8 weeks if inadequate response

Important Considerations

• Treatment adherence: Anxiety disorders are characterized by avoidance behaviors, making follow-through on referrals challenging; active follow-up is essential 1
• Medication selection: SSRIs and SNRIs (like venlafaxine) are first-line pharmacotherapy options with demonstrated efficacy for GAD 2
• Benzodiazepine caution: Use should be time-limited due to risks of dependence and cognitive impairment 1
• Comorbidities: Depression frequently co-occurs with GAD and should be addressed in treatment planning 2

By implementing this structured referral approach based on symptom severity and specific patient needs, healthcare providers can optimize outcomes for patients with generalized anxiety disorder, reducing morbidity and improving quality of life.