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A COMPREHENSIVE REVIEW OF THE GENERALIZED ANXIETY DISORDER
Komolddinova Ismigul Jamoldin qizi
Master’s student in Andijan State Medical Institute. Uzbekistan.
No'monov Axmadjon Shukurullox o‘g‘li
Bachelor’s student in Kokand University Andijan branch. Uzbekistan.
https://doi.org/10.5281/zenodo.17517088
Abstract.
Generalized Anxiety Disorder (GAD) is a prevalent and often chronic
psychiatric condition characterized by excessive, uncontrollable worry occurring across
multiple domains for at least six months [1]. Despite its high burden, GAD remains
underdiagnosed and undertreated [2]. This article provides a comprehensive overview of GAD:
its epidemiology and clinical features, underlying mechanisms (cognitive, biological, neural,
interpersonal), diagnostic issues, and current treatment paradigms (psychological,
pharmacological, digital) [3,4]. We review and compare findings from key studies, highlight
areas of agreement and divergence, and point to gaps for future research [5,6]. In conclusion,
while evidence supports the efficacy of cognitive-behavioural therapy (CBT) and first‐line
pharmacotherapy (SSRIs/SNRIs) [2,7], emerging modalities such as digital interventions and
novel biological targets warrant further investigation to improve outcomes and reduce the care
gap [6,8].
Keywords:
Generalized Anxiety Disorder, GAD, cognitive-behavioural therapy, CBT,
pharmacotherapy, SSRIs, SNRIs, digital interventions, epidemiology, clinical features, cognitive-
emotional mechanisms, neurobiology, treatment strategies, comorbidity, mental health, anxiety
disorders.
КОМПЛЕКСНЫЙ ОБЗОР ГТР
Аннотация.
Генерализованное
тревожное
расстройство
(ГТР)
—
распространённое и часто хроническое психическое заболевание, характеризующееся
чрезмерным, неконтролируемым беспокойством, возникающим в различных сферах в
течение как минимум шести месяцев [1]. Несмотря на свою высокую тяжесть, ГТР
остаётся недостаточно диагностированным и не получающим достаточного лечения
[2]. В данной статье представлен всесторонний обзор ГТР: его эпидемиология и
клинические характеристики, базовые механизмы (когнитивные, биологические,
нейронные, межличностные), диагностические проблемы и современные парадигмы
лечения (психологические, фармакологические, цифровые) [3,4]. Мы рассматриваем и
сравниваем результаты ключевых исследований, выделяем области совпадения и
расхождения мнений, а также указываем на пробелы в будущих исследованиях [5,6]. В
заключение следует отметить, что, хотя данные подтверждают эффективность
когнитивно-поведенческой терапии (КПТ) и фармакотерапии первой линии
(СИОЗС/СИОЗСН) [2,7], новые методы, такие как цифровые вмешательства и новые
биологические мишени, требуют дальнейшего изучения для улучшения результатов и
сокращения пробелов в оказании помощи [6,8].
Ключевые слова:
генерализованное тревожное расстройство, ГТР, когнитивно-
поведенческая терапия, КПТ, фармакотерапия, СИОЗС, СИОЗСН, цифровые
вмешательства, эпидемиология, клинические особенности, когнитивно-эмоциональные
механизмы, нейробиология, стратегии лечения, коморбидность, психическое здоровье,
тревожные расстройства.
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ResearchBib IF - 11.01, ISSN: 3030-3753, Volume 2 Issue 11
Introduction
Generalized Anxiety Disorder (GAD) is marked by persistent and excessive worry about
a range of everyday issues—health, finances, family, work—over at least six months, and is
accompanied by symptoms such as restlessness, fatigue, difficulty concentrating, irritability,
muscle tension, and sleep disturbance [1].
Epidemiologically, anxiety disorders as a whole have a lifetime prevalence estimated
around 34% in the U.S., with GAD lifetime prevalence approximately 6.2% according to one
review [2,3]. The condition is associated with significant impairment in social, occupational, and
academic functioning, elevated comorbidity (especially mood disorders), and increased
healthcare utilization [4,5].
The purpose of this article is to synthesise current scientific knowledge on GAD—its
nature and mechanisms, diagnostic and treatment issues—and to discuss emerging research
directions and clinical challenges [3,4]. Through comparing relevant articles and systematic
reviews, we aim to delineate what is well-established, what remains uncertain, and how practice
might evolve [5,6].
Main Body
1. Clinical Features, Diagnosis, and Course
GAD is distinct from other anxiety disorders in that the anxiety tends to be diffuse,
sustained, and non‐episodic, rather than centred on discrete panic attacks or specific phobias
[1,4]. Diagnostic criteria (e.g., in DSM-5) require excessive anxiety and worry more days than
not for ≥6 months, difficulty controlling the worry, and at least three of the six associated
symptoms (for adults) [9,18].
Although some patients may present primarily with somatic symptoms (e.g., muscle
tension, sleep disturbance) rather than overt worry, comprehensive assessment is crucial [1,20].
The naturalistic course of GAD tends to be chronic or relapsing rather than self-limiting;
Newman and colleagues (2013) emphasise that GAD is “the least successfully treated” of the
common anxiety disorders [5].
2. Etiology & Mechanisms
Cognitive and emotional processes
One influential theoretical synthesis by Newman et al. (2013) proposed the Contrast
Avoidance model: individuals with GAD maintain chronic worry to avoid sharp spikes of
negative emotion, effectively using worry as a dysfunctional coping strategy [3,20]. Evidence
supports emotional hyper-reactivity, intolerance of uncertainty, and repetitive negative thinking
as core features in GAD [3].
Biological and neural factors
Neuroimaging and EEG studies point to altered amygdala-prefrontal circuitry,
dysregulated inhibitory neurotransmission (especially GABA), and abnormal cortical functional
activity [6]. For instance, Wang et al. (2016) found cortical functional differences in GAD
patients through EEG nonlinear analysis [6]. Genetic research suggests multi-gene involvement,
though specific risk loci remain elusive [7,10,15].
Comorbidity and medical illness
GAD commonly co-occurs with depression, other anxiety disorders, and physical
illnesses (e.g., cardiovascular disease, chronic pain, gastrointestinal disorders) [8,10]. A 2022
systematic review detailed GAD’s presence in a wide range of medical illnesses [8].
3. Treatment: Psychological, Pharmacological, and Digital
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Psychological interventions
Cognitive-behavioural therapy (CBT) remains the gold standard psychological treatment
for GAD, with large effect sizes (e.g., Hedges g ≈ 1.01) reported in meta-analysis [2,14]. Other
therapies include acceptance-based behavioural therapy (ABBT), mindfulness, and interpersonal
approaches [7,17]. For example, a 2021 Indonesian literature review described humanistic,
psychoanalytic and cognitive-based approaches in GAD treatment [9,17].
Pharmacotherapy
First‐line medications include selective serotonin reuptake inhibitors (SSRIs) and
serotonin-norepinephrine reuptake inhibitors (SNRIs) [10,2]. The 2013 review “Diagnosis and
treatment of GAD” lists SSRIs, SNRIs and pregabalin as first choice, with benzodiazepines as
short-term adjuncts only [10]. Meta‐analyses report small to medium effect sizes for
pharmacotherapy in GAD [2].
Digital and remote interventions
As access to therapy remains limited, digital interventions (web-based CBT, apps) have
been investigated [6,11]. Saramago et al. (2021) conducted a network meta-analysis of digital
interventions for GAD; results were inconclusive regarding their advantage over no treatment or
standard therapy [11].
4. Comparative Discussion of Key Articles
Newman et al. (2013) offer a theoretical synthesis emphasizing cognitive/emotional
mechanisms (Contrast Avoidance model) [3].
Mishra & Varma (2023) provide a comprehensive recent review of GAD including
biology, epidemiology, and management [7].
Saramago et al. (2021) highlight the promise but limited evidence base of digital
interventions [11].
The review by Szuhany & Simon (2021) covers anxiety disorders more broadly but
provides specific data relevant to GAD (e.g., prevalence, effect sizes) [2].
Points of convergence:
All reviews agree GAD is prevalent, disabling, and relatively under-treated; CBT and
SSRIs/SNRIs are first-line treatments [2,7].
Points of divergence or uncertainty:
The efficacy and role of digital interventions remain uncertain [11]; biological
mechanisms are increasingly better defined but causal pathways are still under investigation
[6,7]; treatment response in “real-world” settings (versus trials) appears suboptimal (e.g., low
rates of treatment helpfulness in large surveys) [12].
Discussion
The literature supports a multi‐dimensional understanding of GAD: psychological
(worry, intolerance of uncertainty), biological (neurotransmitter dysregulation, neural circuitry),
and socio-environmental (stress, comorbid illness) factors all contribute [3,6,8]. The consistency
of CBT and pharmacotherapy efficacy across many studies is reassuring, yet the real-world
outcomes remain sub-optimal [2,12].
Digital interventions promise to expand access, but current evidence is inconclusive:
Saramago et al. caution that confidence intervals are wide and methodological heterogeneity is
large [11]. This suggests that digital treatments might serve as adjuncts rather than replacements
at present [11].
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Another pressing issue is the stratification of treatment: which patients will respond to
CBT vs medication vs combined vs digital? The cognitive-emotional models (e.g., Contrast
Avoidance) point to potential biomarkers or psychological moderators (e.g., emotional
reactivity) which might guide personalised care—but such applications are still mostly
theoretical [3,20].
Furthermore, the journey from diagnosis to care is fraught: given under-recognition of
GAD in primary care, comorbidity with other disorders, and variations in healthcare systems, the
“helpfulness” of care from a patient perspective remains modest [12].
Implications for practice include: ensuring screening (e.g., using GAD-7), adopting
stepped-care models (starting with CBT if available, otherwise medication, monitoring
outcome), considering digital options in low-resource settings, and focusing on long-term
follow-up (given the chronic nature of GAD) [2,11]. Research imperatives include long-term
outcome studies (especially digital interventions), elucidation of biomarkers/predictors of
response, and implementation science to close the gap between trial efficacy and real-world
effectiveness [3,6,7].
Conclusion
GAD is a common, impairing disorder characterised by pervasive worry and related
symptoms [1,2]. Robust evidence supports CBT and SSRIs/SNRIs as first-line treatments, yet
many patients remain under-treated or partially treated [2,7]. Advances in understanding
cognitive-emotional mechanisms, brain and neurotransmitter systems, and digital treatment
delivery offer promise—but translation into better outcomes remains a challenge [3,6,11].
Future research must emphasise personalised treatment, long-term outcomes, integration
of digital tools, and bridging the gap between controlled trials and everyday practice [2,11].
Clinicians should remain vigilant in screening for GAD, applying evidence-based
treatments, monitoring response, and adjusting care over time [18].
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