Essay on Practice Guidelines for Generalized Anxiety Disorder

Practice guidelines are essential among nurses and other clinicians in making evidence-based decisions regarding specific healthcare concerns. In addition, nurses utilize these guidelines to develop interventions that render providing high-quality care. Anxiety is expected as part of life among interindividual due to multiple situations such as making critical decisions or performing activities. However, when anxiety persists, it becomes a generalized anxiety disorder (GAD) characterized by symptoms observed among individuals with panic attacks and other anxiety-related disorders. This paper will describe the significance of GAD and the practice guidelines applied in its management.

Significance of Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is among the major psychiatric disorders that influence the quality of life among populations in the U.S. and across the globe. According to Brage et al. (2019), the disorder is underdiagnosed and undertreated in healthcare leading to increased prevalence among varied ages. Most patients with GAD make frequent visits to community pharmacies for medication help to improve their quality of life due to the associated impacts of the disease. Approximately 270 million individuals were diagnosed with GAD globally by 2017 (Braga et al., 2019). About 3.1% of the U.S. population of varied ages and gender suffer from GAD, with only 44% of them receiving informed management based on practice guidelines. According to Gautam et al. (2017), GAD is characterized by elements of apprehension such as on-edge feelings and worries about misfortunes, motor tension resulting in restlessness, trembling, and inability to relax and autonomic over an activity, characterized by light-headedness, tachypnea, and tachycardia. The symptoms can be severe based on missed management interventions leading to aggravated mental health issues.

The American Psychiatric Organization provides clinicians with evidence-based practice guidelines essential in managing GAD based on the diagnostic criteria that utilize the Diagnostic and statistical manual of mental disorders (DSM-5). Patients diagnosed with GAD display anxious symptoms that can be constant, ranging from standard to painful experiences that can predispose them to hypervigilance based on the 60-to-100 anxiety scale. The Anxiety Association of America (2017) recommends clinicians assessing the severity of the symptoms to evaluate patients’ risks and develop personalized suitable individualized interventions. The current treatment for GAD constitutes pharmacological and non-pharmacological interventions that target reducing the severity of the symptoms for improved patients’ quality of life. The most applied non-pharmacological intervention in cognitive-behavioral therapy is among the top practice guidelines for clinicians in managing GAD for varied populations. Among the therapeutical interventions, antidepressants such as scitalopram (Lexapro), venlafaxine, duloxetine, and paroxetine are primarily prescribed to reduce the severity of the symptoms. According to Munir and Takov (2021), medications have a 50% or lower response rate, leading to practice guidelines for cognitive-behavioral therapy being prioritized in managing GAD to pharmacotherapies.

Practice Guideline Development

Cognitive-behavioral therapy entails providing GAD patients with psychoeducation, counseling, and maladaptive thought pattern changes, coupled with anxiety controlling situations that reduce GAD symptoms, thus improving patients’ quality of life.

Cognitive-Behavioral Therapy

This guideline aims to provide informed care for patients with GAD, eliminating the main symptoms such as worries, thus improving their quality of life and experiences. The guideline is based on the best practices such as psychoeducation, counseling, and exposing patients to situations that evoke anxiety. It focuses on identifying the challenges among patients and developing interventions that distort the thoughts leading to anxiety (Widnall et al., 2019). Furthermore, the guideline exposes patients to conditions they have been avoiding due to anxiety, thus providing them with informed approaches to confront GAD. It can be offered to a group or individual patients, mainly as an assignment where patients are advised to complete in sessions.

Preparing Clients for Cognitive-Behavioral Therapy

The first approach recommended in preparing patients for cognitive-behavioral therapy is assessing the factors associated with GAD, such as stressors, gender, health literacy, and social factors (Munir & Takov 2021). Clinicians are recommended to evaluate these factors before initiating the therapy to develop informed, objective data regarding the type of intervention to initiate based on the guidelines’ elements. After the assessment, a clinician can initiate the approaches based on the procedural recommendations.

The Procedure for Cognitive Behavioral Therapy

Psychosocial Education

1. The clinician briefs the client about the condition (Munir & Takov, 2021). This approach creates awareness about GAD to ensure the patient understands the risk factors and symptoms associated with the disease.
2. The clinician then provides problem training based on the patient’s health literacy and the other aspects before informing the practice guidelines.
3. Establishing communication training to enhance the patient overcomes the worries associated with interacting with other people and sharing information. This is a critical challenge among individuals with GAD.
4. Self-assertiveness training. This intervention improves a client’s coping skills with anxiety and stressors (Widnall et al., 2019). In addition, it provides them with an opportunity to express themselves regarding their experiences with the condition, guiding the clinician on defining the problem based on subjective data.

According to Sarkhel et al. (2020), psychoeducation ensures patients are knowledgeable about the condition, thus improving their competence in the management. It also provides patients with insight regarding psychiatric illness, relapse prevention, suicide prevention, and crisis management. Psychosocial education is significant in promoting patient’s or families’ adherence to the recommendations for anxiety control.

Exposing Individuals to Anxiety Revoking Situations

1. Clinicians provide threatening and non-threatening situations to the clients. They then assess the client’s response to the situation and repeatedly apply the same approach to improve their attention. According to Hirsch et al. (2019), persons with GAD attend to specific information in different approaches based on the benign stimuli, leading to different perceptions that influence their concentration and attention. Exposure to such information is significant in improving clients’ attention and eliminate biasness thus, reducing their anxiety.

 Counseling

1. Clinicians establish a conducive environment that supports interaction with a GAD client. They then evaluate individual’s causes of anxiety, evaluate their perceptions based on the worries and advise them correctly based on the assessments (Perrin et al., 2019). Qualified professionals provide clients with scenarios that may induce anxiety and uncertainties to help improve coping skills, thus guiding them on overcoming anxiety.

Summary

Generalized anxiety disorder offers a significant burden to the public due to its impact on mental wellbeing. The condition’s prevalence is influenced by undertreatment and reduced diagnosis among populations due to reduced attention among care providers. However, the literature has defined multiple approaches that are effective in managing GAD. Pharmacotherapies have a lower response rate in managing GAD, hence the need to combine them with psychotherapies. Multiple researchers have evaluated cognitive behavioral therapy as an essential practice guideline for psychotherapy for informed management of GAD. Counseling patients, providing psychoeducation, and exposing them to situations leading to anxiety coupled with control measures are fundamental principles guiding cognitive-behavioral therapy. Therefore, clinicians need to consider a combined intervention of cognitive-behavioral therapy and pharmacotherapy as the most effective approach to managing patients with GAD for informed patients’ and families’ experiences and clinical outcomes.

References

Anxiety and Depression Association of America. (2017). Clinical Practice Review for GAD | Anxiety and Depression Association of America, ADAA. Adaa.org. Retrieved 28 June 2021, from https://adaa.org/resources-professionals/practice-guidelines-gad.

Braga, S., Clark, K., & Shirer, A. (2019). An overview of generalized anxiety disorder for the community pharmacist. U.S. Pharmacist, 44(11), 23-28. https://www.uspharmacist.com/article/an-overview-of-generalized-anxiety-disorder-for-the-community-pharmacist

Gautam, S., Jain, A., Gautam, M., Vahia, V., & Gautam, A. (2017). Clinical practice guidelines for managing generalized anxiety disorder (GAD) and panic disorder (PD). Indian Journal of Psychiatry, 59(5), 67. https://doi.org/10.4103/0019-5545.196975

Hirsch, C., Beale, S., Grey, N., & Liness, S. (2019). Approaching cognitive behavior therapy for generalized anxiety disorder from a cognitive process perspective. Frontiers In Psychiatry, 10(1). https://doi.org/10.3389/fpsyt.2019.00796

Munir, S. & Takov, V. (2021). Generalized Anxiety Disorder. Treasure Island (FL): StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK441870/

Perrin, S., Bevan, D., Payne, S., & Bolton, D. (2019). GAD-specific cognitive-behavioral treatment for children and adolescents: A pilot randomized controlled trial. Cognitive Therapy and Research, 43(6), 1051-1064. https://doi.org/10.1007/s10608-019-10020-3

Sarkhel, S., Singh, O., & Arora, M. (2020). Clinical practice guidelines for psychoeducation in psychiatric disorders general principles of psychoeducation. Indian Journal of Psychiatry, 62(8), 319. https://doi.org/10.4103/psychiatry.indianjpsychiatry_780_19

Widnall, E., Price, A., Trompetter, H., & Dunn, B. (2019). Routine cognitive behavioral therapy for anxiety and depression is more effective at repairing symptoms of psychopathology than enhancing wellbeing. Cognitive Therapy and Research, 44(1), 28-39. https://doi.org/10.1007/s10608-019-10041-y