GAD-7 Screening — Quantifying Anxiety Severity
A brief seven-item self-report tool scores anxiety severity from 0 to 21.
- 7: Items (each scored 0–3)
- 0–21: Score range (higher = more severe)
- ~2 min: Completion time (self-administered)
- 89%: Sensitivity (at cutoff ≥10)
What the GAD-7 measures
Frequency of worry, restlessness, and tension over two weeks.
Why screening comes first
Severity band sets the starting point for treatment choice.
Score anchors every downstream recommendation in this model.
Mild GAD-7 (5–9) — CBT as First-Line Care
At mild severity, structured therapy alone usually resolves symptoms.
- 5–9: GAD-7 range (mild anxiety band)
- CBT: First-line option (skills-based, no meds)
- 8–12 wks: Typical course (weekly sessions)
- ~75%: Response rate (illustrative estimate)
Why therapy alone is favored
Lower symptom burden responds well to skills without medication.
When medication still enters
Strong patient preference can shift the recommended option.
Preference toggle nudges mild cases toward SSRI/SNRI if desired.
Moderate GAD-7 (10–14) — Shared Decision-Making
Both CBT and medication are reasonable; preference tips the balance.
- 10–14: GAD-7 range (moderate anxiety band)
- CBT / SSRI / Both: Options (preference-sensitive)
- SSRI, SNRI: Common agents (first-line pharmacotherapy)
- ~72%: Combined response (illustrative estimate)
Balancing two viable paths
Neither option dominates; patient values guide the choice.
Role of shared decision-making
Clinician and patient weigh access, side effects, and time.
No-preference default favors combined CBT plus medication.
Severe GAD-7 (15–21) — Medication-Led, CBT-Supported
High symptom burden favors starting medication, often paired with CBT.
- 15–21: GAD-7 range (severe anxiety band)
- SSRI/SNRI: First-line option (often plus CBT)
- 4–6 wks: Time to relief (pharmacologic onset)
- ~76%: Combined response (illustrative estimate)
Why medication leads here
Faster symptom control matters when severity is high.
CBT still adds value
Combined care improves durability beyond medication alone.
Even strong therapy preference still flags medication as an option.
Matched Treatment Outperforms One-Size-Fits-All
Severity-matched pathways generally beat a single default treatment.
- CBT-first: Minimal/mild fit (illustrative pathway)
- CBT or SSRI: Moderate fit (preference-sensitive)
- Combined: Severe fit (medication + CBT)
- +10–15%: Combined vs. single (illustrative uplift)
Stepped-care logic recap
Treatment intensity should scale with measured severity.
Combined care at higher severity
CBT plus medication often outperforms either alone.
Re-screen periodically — GAD-7 score can guide step-up or step-down.