GAD‑7: Generalized Anxiety Disorder 7‑Item Scale

The Generalized Anxiety Disorder 7‑item (GAD‑7) scale is a brief, self‑administered questionnaire used to assess the presence and severity of generalized anxiety symptoms over the past two weeks. Developed in 2006 by Robert L. Spitzer and colleagues, the GAD‑7 condenses core DSM criteria into seven questions. Despite its brevity, research shows that it has strong psychometric properties and can also screen for other anxiety disorders such as panic disorder, social anxiety and post‑traumatic stress. The tool has been validated for adults and adolescents aged 14 and older.

Evidence & validation: The original validation study found that a cut‑off score of 10 yields high sensitivity (about 89%) and specificity (about 82%) for detecting generalized anxiety disorder. A score of 8 or greater may optimize sensitivity without substantially reducing specificity. As with depression screening tools, the GAD‑7 offers a reliable and quick assessment for routine use in primary care and mental health settings.

Why use it? Anxiety disorders are among the most common mental health conditions and often go undetected. The GAD‑7 empowers you to quantify worrying, restlessness, irritability and other symptoms, making it easier to track changes and facilitate conversations with your therapist. Evidence suggests that repeated use (every 2–4 weeks) helps monitor treatment progress and guide interventions.

Alternatives: Shorter versions like the GAD‑2 (two questions) can be used for initial screening, with a positive result prompting the full GAD‑7. Other instruments include the Hamilton Anxiety Rating Scale (HAM‑A), Hospital Anxiety and Depression Scale (HADS), State‑Trait Anxiety Inventory (STAI) and the Generalized Anxiety Disorder Questionnaire‑IV.

Important disclaimer: The GAD‑7 is a screening and monitoring tool. It cannot diagnose anxiety disorders. If your score falls in the moderate or severe range or you feel overwhelmed by anxiety, seek professional help. In the U.S., you can call the 988 Suicide & Crisis Lifeline.

Reference: View the original GAD‑7 questionnaire (PDF) from the American Psychiatric Association.

You'll answer seven questions about how often you've been bothered by specific anxiety symptoms during the past two weeks. Each response is scored from 0 (Not at all) to 3 (Nearly every day), producing a total score between 0 and 21.

Common GAD-7 Symptoms Include:

• Feeling nervous, anxious or on edge
• Not being able to stop or control worrying
• Worrying too much about different things
• Trouble relaxing
• Being so restless that it's hard to sit still
• Becoming easily annoyed or irritable
• Feeling afraid that something awful might happen

Most people complete the questionnaire in just a couple of minutes.

0–4 (Minimal/None): Anxiety symptoms are minimal and may not require treatment. Continue to monitor your mental health and retake the GAD‑7 periodically.

5–9 (Mild): Mild anxiety that might be situational. Self‑help strategies (e.g., relaxation techniques) or brief counseling may help. Reassess in two weeks.

10–14 (Moderate): Symptoms are likely interfering with daily life. A comprehensive assessment by a healthcare provider is recommended to discuss psychotherapy or medication options.

15–21 (Severe): Significant anxiety requiring active treatment. This often involves cognitive‑behavioral therapy, medication or a combination. Prompt evaluation and close follow‑up with a mental health professional are essential.

When to Seek Professional Help:

• Score of 10 or above on a single administration
• Score of 8 or above on two consecutive administrations (2-4 weeks apart)
• Any score combined with significant functional impairment (missing work, avoiding social situations, difficulty sleeping)
• Worsening scores despite self-help efforts
• Co-occurring depression symptoms (consider also taking the PHQ-9)

What Each Item Tells You:

• Items 1-2 (nervous/worry): Core cognitive symptoms of generalized anxiety. These two items alone form the GAD-2 ultra-brief screener.
• Items 3-4 (excessive worry/trouble relaxing): Somatic and cognitive tension. High scores here often respond well to relaxation-based interventions.
• Items 5-6 (restlessness/irritability): Behavioral manifestations. High scores may indicate the anxiety is affecting relationships and daily functioning.
• Item 7 (feeling afraid): Catastrophic thinking. Elevated scores here may suggest panic features worth exploring further.

Tracking Progress Over Time: A decrease of 4 or more points between administrations represents a clinically meaningful improvement. Many therapists administer the GAD-7 at intake and every 2-4 weeks to monitor treatment response. If scores plateau after 6-8 weeks of treatment, discuss adjusting the approach with your provider.

Using your results: You can download or print your score to share with your therapist. Keep a record if you're monitoring treatment progress. Remember, the GAD-7 guides discussions but does not provide a diagnosis.

Crisis support: If you experience severe anxiety, panic attacks or thoughts of self-harm, seek immediate help. Call the 988 Suicide & Crisis Lifeline for support.