Symptoms of Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) is an anxiety disorder characterized by excessive anxiety and worry that occurs on most days for a period of at least six months.
Individuals with GAD find it difficult to control their worry and experience a variety of symptoms including restlessness, fatigue, difficulty concentrating, irritability, muscle tension and difficulty sleeping (American Psychiatric Association, 2013). In 2019, over 15% of United States adults reported symptoms of Generalized Anxiety Disorder (Terlizzi and Villarroel, 2020).
Can Generalized Anxiety Disorder be cured or treated?
While Generalized Anxiety Disorder cannot be cured, Generalized Anxiety Disorder has been shown to respond incredibly well to a variety of treatments.
Medications, including SSRIs and others such as Buspirone, have been proven effective at managing Generalized Anxiety Disorder, However, research has found that psychotherapy, specifically cognitive behavior therapy, can be just as, if not more, effective in managing anxiety symptoms (Mitte, 2005) . In some cases, psychotherapy in addition to medication is the recommended course of treatment (Hoge et al., 2012).
What is ACT?
ACT, which is said as one word, rather than an acronym, stands for Acceptance and Commitment Therapy. ACT is a type of behavioral therapy based on the idea of psychological flexibility. Psychological flexibility is the ability to be mindful of one’s present experiences while behaving in a way that is in alignment with one’s values.
ACT consists of six core processes designed to help client’s increase their psychological flexibility: acceptance, cognitive defusion, contact with the present moment, self as context, values and committed action. The acceptance aspect of ACT consists of techniques designed to reduce avoidance of thoughts and feelings.
Clients are taught to recognize and accept their thoughts and feelings in a non judgemental way, without trying to change them. Another aspect of ACT is cognitive defusion. The goal of cognitive defusion is to change the way in which individuals relate to their thoughts and feelings. Another core part of ACT is helping clients stay connected to the present moment.
When clients are able to connect with both their internal thoughts and feelings and external environment in a more direct way, they are then able to alter their behavior to be more in line with the values that are important to them. ACT also aims to help clients understand the self as context. This is the idea that each individual is a “self” that is detached from the thoughts, feelings and behaviors that one experiences.
Russ Harris, a leader in ACT, describes this as the “noticing self” (Harris, 2019). ACT also aims to help clients identify the values which are most important to them. Once a client is able to identify their values, their therapist will help them make committed action.
Therapists help clients set clear goals that align with their values, and make concrete steps to achieve these goals (Hayes, 2013). All six of these processes work together to help the client reach their goals, and therapists will utilize all six throughout the process of ACT (Harris, 2019).
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Is ACT one of the most effective treatments for Generalized Anxiety Disorder?
While many experts in the mental health field consider Cognitive Behavioral Therapy (CBT) to be the gold-standard treatment of Generalized Anxiety Disorder, many scientific studies have found that ACT is also incredibly effective at treating anxiety.
One randomized control trial in 2014 found that group ACT was just as effective as group Cognitive Behavioral Therapy (CBT) in improving symptoms of Generalized Anxiety Disorder (Avdagic et al., 2014). Another randomized control trial conducted in 2007 found that individual ACT treatment was just as effective as individual CBT treatment (Forman et al., 2007).
Another study in 2013 found acceptance-based behavior therapy to be just as effective as applied relaxation in treating Generalized Anxiety Disorder (Hayes-Skelton et al., 2013) ACT functions upon the belief that avoidance of negative thoughts, feelings and experiences is at the core of anxiety (Batten, 2011).
The goal of ACT treatment for Generalized Anxiety disorder is not to eliminate the presence of anxiety, but to help clients achieve a higher level of functioning and better manage their anxiety (Twohig and Levin, 2017). ACT treatment for anxiety also strives to help clients accept and tolerate negative thoughts and feelings, rather than avoid them (Batten, 2011).
How to find an ACT therapist in NYC?
One of the best ways to find a therapist in NYC is online. One of the most popular websites designed to connect clients with therapists is psychologytoday.com. After you enter your zipcode and are shown therapists in your area, you are able to filter by “Type of Therapy,” in this case, Acceptance and Commitment Therapy.
Your results will then show therapists who utilize ACT as part of their practice. Psychology Today also allows you to filter therapists by price and insurance company so that you are able to find an ACT therapist within your budget. Many primary care physicians in NYC also have relationships with mental healthcare providers in the area and may be able to provide referrals.
Finding a therapist can be a difficult process, and it may take a while to find a therapist who you feel is a good fit for you. Many therapists offer free phone consultations so you can discuss what you are looking for in therapy, what services they provide and determine whether or not you may be a good match.
How many sessions are necessary for ACT to be effective for Generalized Anxiety Disorder?
The appropriate length of treatment for Generalized Anxiety Disorder varies by individual case. ACT has been proven to be effective at reducing symptoms of GAD in as few as six sessions (Avdagic, Morrissey, & Boschen, 2014).
However, many other studies have tested ACT’s effectiveness in twelve sessions. It is also important to acknowledge that individuals with Generalized Anxiety Disorder are likely to meet the criteria for another psychological disorder, which could require a course of treatment (American Psychiatric Association, 2013).
However, research has shown that clients continue to improve even after their ACT treatment has ended (Eifert et al., 2009). Your therapist will determine what length of treatment is appropriate for you after conducting an assessment.
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What techniques from ACT are used at New York Behavioral Health?
One of the reasons why individuals treated with ACT continue to improve post treatment is because ACT provides clients struggling with Generalized Anxiety Disorder with coping strategies and tools that can be used well beyond the end of treatment. Many therapists at NYBH utilize ACT techniques when working with clients struggling with anxiety.
These techniques include values clarification, mindfulness exercises and cognitive defusion techniques. One acceptance technique that your therapist at NYBH may utilize in your treatment is called creative hopelessness. The purpose of creative hopelessness is for the therapist and client to explore the ways in which the client has coped with their problems in the past, and evaluate how well they have worked.
The goal of creative helplessness is for the client to let go of the coping skills (such as avoidance, self-medicating) which have not been helpful in order to be open to creating new ways to manage their anxiety moving forward . Another technique from ACT that many therapists at NYBH utilize is value clarification.
Many individuals with Generalized Anxiety Disorder may find much of their life revolves around their anxiety and worry. A goal of ACT is to help clients instead focus their life around the values that are important to them (Eifert and Forsyth, 2009).
Your therapist may help you identify your values by asking you to describe a person’s life which you admire or asking you to write your own obituary. You and your therapist can then use your responses as a means to identify what exactly your values are, so you are able to live in a way that aligns with these values (Zettle, 2007).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) https://doi-org.ezproxy.cul.columbia.edu/10.1176/appi.books.9780890425596.dsm01
Avdagic, E., Morrissey, S. A., & Boschen, M. J. (2014). A randomised controlled trial of acceptance and commitment therapy and cognitive-behaviour therapy for generalised anxiety disorder: [1]. Behaviour Change, 31(2), 110-130. Retrieved from
Batten, S. V. (2011). Act for anxiety. In Essentials of acceptance and commitment therapy (pp. 75-84). SAGE Publications Ltd, https://dx.doi.org/10.4135/9781446251843.n9
Covin, R., Ouimet, A.J., Seeds, P.M., & Dozois, D.J.A. (2008). A meta-analysis of CBT for pathological worry among clients with GAD. Journal of Anxiety Disorders, 22(1), 108-116. doi:10.1016/j.janxdis.2007.01.002
Eifert, Georg & Forsyth, John & Arch, Joanna & Espejo, Emmanuel & Keller, Melody & Langer, David. (2009). Acceptance and Commitment Therapy for Anxiety Disorders: Three Case Studies Exemplifying a Unified Treatment Protocol. Cognitive and Behavioral Practice. 16. 368-385. 10.1016/j.cbpra.2009.06.001.
Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A Randomized Controlled Effectiveness Trial of Acceptance and Commitment Therapy and Cognitive Therapy for Anxiety and Depression. Behavior Modification, 31(6), 772–799. https://doi.org/10.1177/0145445507302202
Harris, R. (2019). Act Made Simple: An easy-to-read primer on acceptance and commitment therapy . New Harbinger Publications, Inc.
Hayes-Skelton, S. A., Roemer, L., & Orsillo, S. M. (2013). A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder. Journal of consulting and clinical psychology, 81(5), 761–773. https://doi.org/10.1037/a0032871
Hoge, E. A., Ivkovic, A., & Fricchione, G. L. (2012). Generalized anxiety disorder: diagnosis and treatment. BMJ, 345(7500).
Mitte, K. (2005). Meta-Analysis of Cognitive-Behavioral Treatments for Generalized Anxiety Disorder: A Comparison With Pharmacotherapy. Psychological Bulletin, 131(5), 785–795. https://doi-org.ezproxy.cul.columbia.edu/10.1037/0033-2909.131.5.785
Terlizzi, E.P. and Villarroel, M.A. (2020). Symptoms of generalized anxiety disorder among adults: United States, 2019. NCHS Data Brief (378). National Center for Health Statistics.
Twohig, M. P., & Levin, M. E. (2017). Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression: A Review. The Psychiatric clinics of North America, 40(4), 751–770. https://doi.org/10.1016/j.psc.2017.08.009Zettle, R. D. (2007). Act for depression: A clinician’s guide to using acceptance and commitment therapy in treating depression. New Harbinger Publication.
