Cognitive and Behavioral Therapies

for Generalized Anxiety Disorder

Status: Strong Research Support


Cognitive and behavioral therapies for generalized anxiety disorder (GAD) refer to a variety of techniques that can be provided individually or in combination. The basic premise underlying the therapy approaches is that thoughts, feelings and behaviors are inter-related, so altering one can help to alleviate problems in another (e.g., changing negative thinking will lead to less anxiety). The excessive, uncontrollable worry that is the hallmark of GAD is thought to be maintained through maladaptive thinking about the utility of worrying, a tendency to repeat worries instead of problem-solving, difficulties relaxing, and unhealthy behaviors, including attempted avoidance of negative thoughts and images, as well as situations that might provoke worry. The cognitive therapy techniques focus on modifying the catastrophic thinking patterns and beliefs that worrying is serving a useful function (termed cognitive restructuring). The behavioral techniques include relaxation training, scheduling specific ‘worry time’ as well as planning pleasurable activities, and controlled exposure to thoughts and situations that are being avoided. The purpose of these exposures is to help the person learn that their feared outcomes do not come true, and to experience a reduction in anxiety over time.

The research evidence suggests that both cognitive or behavior therapy on their own can be helpful for GAD (especially cognitive restructuring or applied relaxation). However, there may be some advantage to combining the approaches, with some studies finding that the treatment is more powerful when therapy involves cognitive work, exposures and relaxation. Cognitive Behavior Therapy (CBT) typically refers to a combination of the various cognitive and behavioral approaches, and ‘Anxiety Management Training’ usually refers to the particular combination of relaxation and cognitive restructuring. The therapies can be conducted individually or with a group, and CBT is helpful for older adults with GAD as well. Typically, CBT will be conducted in weekly sessions of 1–2 hours over the course of approximately 4 months, for a total of 16–20 hours of treatment.

Key References (in reverse chronological order)

Clinical Resources

Training Opportunities

Center for Cognitive Therapy
Cory Newman, PhD, Director
Mary Anne Layden, Ph.D., Director of Education
University of Pennsylvania Medical School
3535 Market Street, 2nd Floor
Philadelphia, PA 19104-3309
Phone: 215-898-4100
Beck Institute for Cognitive Therapy and Research
Judy S. Beck, PhD, Director
One Belmont Avenue, Suite 700
Bala Cynwyd, PA 19004-1610
Phone: 610-664-3020
San Francisco Bay Area Center for Cognitive Therapy
Oakland, CA (Rockridge)
Phone: 510.652.4455
Padesky’s Center for Cognitive Therapy
PO Box 5308
Huntington Beach CA 92615-5308 USA
Phone: 714 963 0528

Teaching Resources

CBT for Generalized Anxiety Disorder Slide Set