Psychological interventions in the treatment of generalized anxiety disorder: a structured review

Interventi psicologici nel trattamento del disturbo ansioso generalizzato: una revisione strutturata

F. Bolognesi, D.S. Baldwin, C. Ruini

1 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; 2 Department of Psychology, University of Bologna, Italy



Generalized anxiety disorder (GAD) is a common and distressing condition, which typically has a persistent course and is often resistant to treatment. Cognitive behavioural therapy (CBT) has long been considered the first-line psychotherapeutic option for GAD, but many patients, and especially the elderly, do not experience long-lasting benefits. The aim of this review is to summarize the strengths and weaknesses of CBT and other psychological interventions to guide the development of new approaches and encourage new controlled studies to improve clinical outcomes.


We conducted a computerized literature search through PubMed and Google Scholar using the term generalized anxiety disorder/ GAD, both alone and in combinations with the terms psychological treatment, cognitive behavioural therapy/CBT, CBT Packages, new CBT approaches, third wave CBT, internet computer-based CBT, psychodynamic therapy, brief psychodynamic therapy, applied relaxation, AR and mindfulness. The identified articles were further reviewed to scan for additional suitable articles. The search took place between October 2011 and September 2012.


Cognitive behavioural therapy has been the most studied psychological treatment and is recommended as a first choice intervention for GAD. Applied relaxation has demonstrated similar effectiveness as CBT. Novel approaches and adaptations of GAD, such as well-being therapy, have been developed to provide a wider range of therapeutic choices: although preliminary results are encouraging, further studies are needed to establish their efficacy and relative value when compared to more conventional CBT.


CBT, applied relaxation, psychodynamic approaches, internetcomputer- based CBT, mindfulness techniques, interpersonal emotional processing therapy metacognitive model and wellbeing therapy have all shown beneficial effects in treating GAD. The current “gold standard” in treating GAD remains CBT, but given the nature of the disorder, clinicians should be aware of the other therapeutic options when making treatment decisions in accordance with patients’ needs.


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