GAD 7 – Assessing Your Anxiety

Over the last 2 weeks, how often have you More than
been bothered by the following problems? Not Several Nearly
half the
at all days every day
(Use “✔” to indicate your answer” days

1. Feeling nervous, anxious or on edge 0 1 2 3

2. Not being able to stop or control worrying 0 1 2 3

3. Worrying too much about different things 0 1 2 3

4. Trouble relaxing 0 1 2 3

5. Being so restless that it is hard to sit still 0 1 2 3

6. Becoming easily annoyed or irritable 0 1 2 3

7. Feeling afraid as if something awful 0 1 2 3

might happen

Column totals: ___ + ___ + ___ + ___

= Total 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 Somewhat Very Extremely

at all difficult difficult difficult

GAD-7 total score for the seven items ranges from 0 to 21. This is calculated by assigning scores of
0, 1, 2, and 3, to the response categories of “not at all,” “several days,” “more than half the days,” and
“nearly every day,” respectively.

Scores represent: 0-5 mild 6-10 moderate 11-15 moderately severe anxiety 15-21 severe anxiety

New Directions Behavioral Health 1

Understanding Worrying

Positive Beliefs About Worrying Rethinking Beliefs About Worrying

Worry shows that I am a caring person. • Do I know caring people who don’t worry as
much as I do?
• What else besides worry shows that I care?
Worrying helps me to be prepared. • Am I confusing worrying (in my head) with
actually doing something (for example, actually
solving problems rather than worrying about
them)?
• Do I know people who are organized and
prepared who don’t worry as much as I do?
Worry motivates me. • Am I really more motivated when I worry?
• Has worrying ever actually prevented me from
doing the things I want to do? (for example,
worrying so much about being healthy that you
actually avoid the gym?)
Worry prevents negative outcomes. • If something bad did happen, would I really not
be as upset?
• Has anything bad ever happened in my life?
Did I really feel more prepared to deal with it
because I worried about it?

TOOL: Paced Breathing

1. Take a slow breath in through the nose, breathing into your lower belly so you feel it inflate
like a balloon (for the count of 4)
2. Hold your breath for 1 or 2 seconds
3. Exhale slowly through the mouth so that you are pushing out the air in the “balloon” and you
feel your belly suck in (for the count of 5)
4. Make sure the exhale breath is one or two counts longer that the inhale breath as this
activates a greater relaxation response.
5. Wait a few seconds before taking another breath
About 6-8 breathing cycles per minute is often helpful to decrease anxiety, but find your
own comfortable breathing rhythm.

New Directions Behavioral Health 2

TOOL: Writing a worry script
Unlike worries about current problems, using problem-solving skills is usually not very effective
in dealing with worries about hypothetical situations. For example, no amount of problem solving
will help you to deal with worries about developing a serious illness later on in life.
For these types of worries, the best technique is to write a worry script every day for a week or
two.
What is a worry script?
A worry script is like a journal entry, where you write about your worry, and what you are
afraid will happen. For example, if you are afraid of developing a serious illness, you
might write in your worry script about how afraid you are of becoming sick, what you fear
might happen, such as being in a hospital, being forgotten or abandoned by family, and
missing out on all the great opportunities in life.

What will a worry script do?

Writing a worry script will help you to experience the negative emotions associated with
your fears and worries, rather than avoid them. Although this will feel uncomfortable at
first, research shows us that when you face your fears in this way, your anxiety and
worries will go down over time. A worry script also helps you to imagine what your
feared outcome would actually look like, rather than thinking about it in “fuzzy”, “blurry”,
or imprecise ways.

TOOL: Controlled worry time

Pick a worry period. This is a set time, place and length of time to do all your worrying. Try to
keep your worry period the same everyday (e.g. 6.00 p.m. dining room, 15 minutes). Preferably
this will not be the hour or two before bedtime.
When you notice yourself worrying about something during the day, list your worries briefly (in a
couple of words only).
Make the decision not to worry about it then and there, but save the worry for your set worry
period. Bring your attention back to the present and what it was you were doing, reassuring
yourself that you will deal with your worries later.
When the time arrives, allow yourself to worry for 15 minutes. Only spend the time worrying if
you still feel it is necessary to worry. If the problem doesn’t seem important anymore, you
needn’t spend time worrying about it.

New Directions Behavioral Health 3

Dealing with Unhelpful Thoughts
• Have I had any experiences that show me that this thought is not completely true all the time?
• If a friend had this thought, what would I tell them?
• If a friend was thinking this thought, what would they say to me? What evidence would they
point out to me that would suggest that my thoughts were not 100% true?
• When I am not feeling this way, do I think about this type of situation any differently? How?
• When I have felt this way in the past, what did I think about that helped me feel better?
• Have I been in this type of situation before? What happened? Is there anything different
between this situation and previous ones? What have I learned from prior experiences that
could help me now?
• Are there any small things that contradict my thoughts that I might be discounting as not
important?
• Five years from now, if I look back at this situation, will I look at it differently? Will I focus on
any different parts of my experience?
• Are there any strengths or positives in me or the situation that I am ignoring?
• Am I jumping to any conclusions in columns 2 and 4 of the thought record that are not
completely justified by the evidence?
• Am I blaming myself for something over which I do not have complete control?

New Directions Behavioral Health 4

Challenging Your Positive Beliefs About Worry

• Do I have any evidence for my belief? If so, is it possible that there might be an alternative
explanation?

• Do I have any evidence against my belief?

• Can I think of any times in my life when I did not worry and events turned out positively?

• Does worrying really prevent bad things from happening? Or make good things more likely?
Or will good and bad things just happen regardless of whether I worry?

• Does worry really help me cope, or does it interfere with my coping?

• Would I be able to handle a bad situation if I had not worried beforehand?

• When I am worrying, am I really problem-solving? Or am I just going over the same thoughts
over and over again without coming up with a solution?

• What are the real effects of worrying – how is it affecting my life?

• How often does my worry really reflect reality? How often do I over predict the likelihood of
something going wrong?

• How often is my worrying really “worth it”?

• If I stopped worrying, would it really mean I didn’t care?

New Directions Behavioral Health 5