GAD-7 (Generalized Anxiety Disorder Screener)

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The GAD-7 is a 7-item self-report questionnaire used to screen for and assess the severity of generalized anxiety disorder (GAD). It is one of the most commonly used tools in mental health, primary care, and integrated care settings for monitoring anxiety symptoms over time.

Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues, the GAD-7 is brief, validated, and freely available. It can also detect other anxiety-related conditions, including panic disorder, PTSD, and social anxiety, making it a valuable part of routine mental health assessment.

Recommended Frequency: Every 2–4 weeks during treatment; at intake or when anxiety symptoms emerge

About the GAD-7

The GAD-7 focuses on core symptoms of generalized anxiety, including:

  • Excessive worry
  • Feeling nervous or on edge
  • Trouble relaxing
  • Restlessness
  • Irritability
  • Fear of something awful happening
  • Difficulty controlling worry

Clients are asked how often they’ve experienced each symptom over the last two weeks, using a 4-point Likert scale:

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

Who is the GAD-7 For?

This tool is recommended for adults 18+ who:

  • Report persistent worry, tension, or unease
  • Experience physical symptoms of anxiety, such as restlessness, fatigue, or muscle tension
  • Are in treatment for mood, trauma, or stress-related disorders where anxiety may co-occur
  • Are being monitored for treatment response in medication or psychotherapy

Use this checklist to evaluate fit:

  • Has the client reported excessive worry or irritability?
  • Are they having trouble sleeping, relaxing, or concentrating?
  • Is there no known medical explanation for the symptoms?

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Note: While the GAD-7 is best suited to generalized anxiety, it also picks up symptoms related to other anxiety disorders. Use follow-up questions or differential assessments (e.g., PHQ-9, PCL-5, panic-specific tools) when needed.

The Scale

Clients respond to 7 items, based on how often each symptom has occurred in the past 2 weeks. The total score ranges from 0 to 21.

Sample item:

“Feeling nervous, anxious, or on edge?”

Each response contributes to the total score. HiBoop also tracks response patterns to flag item-level spikes (e.g., sudden increase in restlessness or catastrophic worry).

Scoring the GAD-7

Each item is scored from 0 to 3, summed for a total score out of 21.

  • 0–4 Minimal anxiety: Reassure, monitor if needed
  • 5–9 Mild anxiety: Educate, consider watchful waiting or light intervention
  • 10–14 Moderate anxiety: Recommend structured intervention or therapy
  • 15–21 Severe anxiety: Consider formal diagnosis, medication, or referral

A score of 10 or higher is considered the threshold for clinically significant anxiety. HiBoop flags moderate to severe scores and highlights change over time to support treatment planning.

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TIP FOR PRACTICE

Explore how anxiety shows up functionally—ask clients how it affects relationships, work, or sleep. Even mild scores can reflect debilitating worry, especially in clients who underreport or normalize their symptoms.

The GAD-7 in Practice

Used widely across settings for:

  • Initial screening in primary care or intake
  • Monitoring treatment response in CBT, ACT, or pharmacotherapy
  • Tracking flare-ups during life stressors or trauma recovery
  • Identifying co-occurring anxiety in clients with depression, ADHD, or medical illness

In HiBoop, GAD-7 data integrates with other symptom scales (e.g., PHQ-9) to show comorbidity trends, and supports dynamic care planning when anxiety impacts treatment engagement.

Copyright

Developed by Drs. Spitzer, Williams, and Kroenke. The GAD-7 is part of the PHQ family and is free to use for clinical and research purposes.

References

  • Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092

Disclaimer

The GAD-7 is a screening and monitoring tool, not a diagnostic test. Diagnosis should be confirmed through clinical interview and alignment with DSM-5 criteria for anxiety disorders.

Permissions

The GAD-7, also developed and released by Pfizer, is free for use in clinical and commercial applications. HiBoop may integrate the full tool with digital scoring and interpretation as long as authorship and copyright attribution are included.

Frequently Asked Questions

  • Can it be administered remotely?

    Yes. HiBoop supports secure remote delivery, automated scoring, and integrated charting.

  • What should I do after a high GAD-7 score?

    Explore context, duration, triggers, and impairment. Offer therapeutic support or a referral depending on severity and client preference.

  • How often should I administer it?

    Every 2–4 weeks is ideal during active treatment to monitor progress or emerging issues.

  • Can it detect panic attacks or social anxiety?

    Partially—it flags shared symptoms but doesn’t assess specific features. Use disorder-specific tools if needed.

  • What if my client scores low but reports significant worry?

    Explore further. Some clients underreport or have high-functioning anxiety that’s still distressing.

  • Can the GAD-7 diagnose generalized anxiety disorder?

    No. It is a screening tool. A diagnosis requires clinical judgment and assessment of symptom duration, severity, and functional impact.