How to Use the GAD-7

Anxiety is a normal feeling that everyone experiences to some extent. It can be useful for survival and protecting us from threats. However, like many aspects we’ve evolved, it doesn’t always function the way it should. Sometimes, anxiety becomes persistent and unhealthy, interfering with everyday life.

The GAD-7 or Generalized Anxiety Disorder-7 is a self-reported assessment that identifies if someone’s symptoms could qualify as Generalized Anxiety Disorder (GAD). It’s a 7 item questionnaire that measures the presence and severity of anxiety symptoms. 

Background information

The GAD-7 was first established in 2006 by Spitzer et al.  Though it has high validity for Generalized Anxiety Disorder,  it also aids with the identification of other anxiety disorders, such as PTSD, panic disorder, and social anxiety.  

Now widely used, the GAD-7 originally asked 13 questions to determine if someone had GAD per the Diagnostic and Statistical Manual of Mental Disorders.  It was eventually refined to just 7 items that mostly correlated with the total 13 point score. Statistically, these 7 items were shown to be just as effective as the original 13 questions—internal validity at development was .92!

Part of the validity also includes effective correlation between self-report and scoring. As the clients’ scoring increased, clients showed a decrease in functioning.  

Scoring

The GAD-7 asks people to think about how they’ve been feeling the past 2 weeks. They then rate how frequently they’ve been impacted by these problems on a scale from 0 to 3: 

• 0 — Not at all
• 1 — Several days
• 2 — More than half the days
• 3 — Nearly every day

The questions are:

Over the last 2 weeks, how often have you been bothered by the following problems?

1. Feeling nervous, anxious, or on edge
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it is hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid as if something awful might happen

Additionally, a final question asks about how these symptoms interfere with daily life. Though, this isn’t added in the final score: 

“If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?”

• Not difficult at all
• Somewhat difficult
• Very difficult
• Extremely difficult

The scoring process is straightforward. Each of the 7 questions can be scored from 0 to 3. 0 for “Not at all”, 3 for “Nearly every day”.  The therapist can then add up the scoring for a maximum score of 21. The score can be interpreted as follows:

• 0 to 4 — Minimal anxiety
• 5 to 9 — Mild anxiety
• 10 to 14 — Moderate anxiety
• 15 to 21 — Severe anxiety

Source

Treatment and next steps

Score of 0 to 4 — No anxiety to minimal anxiety indicated

No interventions required.

Score of 5 to 9 — Mild anxiety

Treatment should include monitoring and follow-up. Some changes, such as education on exercise, sleep, and breathing exercises, may be helpful. 

Higher scores of 8 or 9 may suggest a disorder and require regular follow-up. 

Score of 10 to 14 — Moderate anxiety

Treatment should include education about symptoms. Therapy services are highly suggested and medication could also be suggested.

Score of 15 to 21 — Severe anxiety

Therapy and medication are highly recommended. The client should be monitored for worsening symptoms. 

Using the GAD-7 in treatment

Of course, the questionnaire is just one piece of the therapeutic puzzle. However, the information can be incredibly useful in treatment. One way quantitative data can be helpful is during information gathering and intake. The questionnaire can reinforce or identify anxiety. Often, clients struggle to verbalize their difficulties and impact of symptoms. The GAD-7 is a helpful assessment for both the client and for you as a provider.  

Another way in which data is helpful is treatment itself.  Using valid questionnaires increases treatment efficacy, engagement, and more. You could engage the client in discussion of their effort-decreased scores can be positive reinforcement of a client’s hard work! As a provider, GAD-7 scores can also identify the need for adjustment with your current therapeutic approach, or even explore deeper concerns. 

There are also a few considerations when using the GAD-7. While the questionnaire is a great measuring tool, you can never discount the therapist’s observations and instincts. Additionally, the questionnaire measures symptoms in the 2 weeks prior to when the client takes the assessment, so it shouldn’t be administered too frequently.  

Because the GAD-7 tries to capture as much as possible, its questions can be vague. Combining it with other inventories may be beneficial. The Beck Anxiety Inventory, for instance, asks the client to rate the presence of specific anxiety symptoms the month before. There are 21 symptoms in total that are rated on a scale of 0-3; severity correlates with scoring. The questionnaire may be longer, but does provide useful data that could increase efficacy of treatment.

The therapeutic process is one that requires the counselor to consider many factors and data through various ways. Questionnaires aren’t definitive but do provide valuable insight that could inform treatment. Qualitative data, along with professional observations, are equally important. Effective treatment requires good use of all information gathered throughout the therapeutic process.