What evidence-based therapies are most effective for generalized anxiety disorder?

Short answer
- Cognitive behavioral therapy (CBT) is the strongest evidence-based psychological treatment for generalized anxiety disorder (GAD).
- Other therapies with good or growing evidence include metacognitive therapy (MCT), mindfulness-based treatments (MBSR, MBCT), acceptance and commitment therapy (ACT), and applied relaxation.
- Combining evidence-based psychotherapy with medication (SSRIs/SNRIs or buspirone) is often recommended for more severe or persistent GAD.

What the evidence says (summary)
- CBT: Multiple randomized controlled trials and meta-analyses show CBT produces clinically meaningful reductions in GAD symptoms and worry, and effects are durable. CBT targets worry-related thoughts and avoidance/behavioral patterns and is the best-supported first-line psychotherapy. Internet-delivered CBT also has robust evidence when guided.
- Metacognitive therapy (MCT): RCTs show MCT (which targets beliefs about worry rather than the content of worry) yields large effects and in some trials performs as well as or better than standard CBT for GAD. Evidence is growing.
- Mindfulness-based programs (MBSR, MBCT): Moderately strong evidence for symptom reduction, especially for reducing worry and comorbid depression and for relapse prevention; effects are generally smaller than CBT but helpful for patients who prefer a mindfulness approach.
- Acceptance and Commitment Therapy (ACT): Moderate evidence from trials and meta-analyses that ACT reduces anxiety and improves functioning; often useful when avoidance and experiential avoidance are prominent.
- Applied relaxation: A behavioral approach teaching progressive relaxation and cue-controlled relaxation has consistent evidence of efficacy (especially in older trials) and can be used when worry is dominated by somatic tension.
- Psychodynamic psychotherapy and interpersonal psychotherapy: Less consistent evidence specifically for GAD; can help some patients, especially when GAD is linked with interpersonal or developmental issues, but they are not first-line based on current trials.

Key CBT components that drive benefit
- Psychoeducation about worry and anxiety
- Cognitive restructuring (identifying and challenging unhelpful worry thoughts)
- Worry exposure and behavioral experiments (testing worry predictions)
- Problem-solving training (for realistic, solvable worries)
- Relaxation and breathing skills (for physiological symptoms)
- Relapse-prevention and activity scheduling

Practical points for choosing treatment
- Severity/comorbidity: For mild-to-moderate GAD, CBT (or guided internet CBT) alone is often sufficient. For moderate-to-severe GAD, combined CBT + medication tends to produce larger/earlier improvements.
- Access: If face-to-face CBT isn’t available, guided internet CBT and group CBT have good evidence.
- Patient preference and tolerability: Match therapy style (e.g., mindfulness/ACT vs CBT) to the person’s preferences—engagement predicts outcome.
- Treatment length: Typical CBT protocols are 12–20 weekly sessions; some MBIs and MCT protocols are shorter (8–12 sessions).
- Maintenance: Booster sessions or ongoing practice of skills improve long-term maintenance.

Medications (brief)
- If you want a complete evidence-based plan, note that SSRIs and SNRIs have strong evidence for GAD; buspirone and pregabalin are alternatives in some guidelines. Medication decisions are individualized and should involve a prescriber.

If you want next steps
- I can: (a) outline a brief CBT plan or 6–12 session agenda for GAD, (b) give practice worksheets (worry diary, cognitive restructuring), or (c) help you find online CBT programs or ways to discuss treatment options with a clinician. Which would you like?