GAD-7
Generalized Anxiety Disorder 7-item scale
Seven-item screen and severity measure for generalized anxiety symptoms; also reasonable for panic, social anxiety, and PTSD as a non-specific anxiety indicator.
The GAD-7 is a free, seven-item self-report scale developed by Spitzer, Kroenke, Williams and Löwe (2006) to screen for and measure the severity of generalized anxiety disorder. It takes most clients under two minutes and is the most widely used anxiety screen in primary care and outpatient mental-health settings worldwide.
When to use the GAD-7
Use the GAD-7 whenever worry, restlessness, or physical tension is part of the picture — at intake and then every 2–4 weeks. It takes under two minutes and gives you a defensible severity band plus a change score you can track.
What the GAD-7 measures
Frequency over the past two weeks of seven core anxiety symptoms: nervousness, uncontrollable worry, excessive worry, trouble relaxing, restlessness, irritability, and fear of awful things happening.
Use the GAD-7 when
- Intake screening alongside the PHQ-9
- The client describes uncontrollable worry, difficulty relaxing, or irritability
- Deciding whether anxiety or depression is the primary treatment target
- Tracking response to CBT for worry, exposure work, or an SSRI trial
Why use the GAD-7 instead of another measure
The GAD-7 shares the PHQ-9's 0–3 two-week frequency anchors, so the two sit on one intake form and clients only learn one response format. Its ≥10 cutoff also functions as a reasonable screen for panic, social anxiety, and PTSD, which makes it a strong first-pass anxiety measure.
When not to use the GAD-7
- You need to identify which anxiety disorder is present — follow a positive screen with a disorder-specific measure
- The primary problem is trauma-related; use the PCL-5
- Anxiety is situational and content-specific (e.g. a single phobia) — a SUDS hierarchy tracks change better
Scoring and bands
Cutoffs
A cutoff of ≥10 yields 89% sensitivity and 82% specificity for GAD. The same cutoff has reasonable sensitivity for panic, social anxiety, and PTSD, though specificity drops.
What GAD-7 results mean — and what to do next
Minimal anxiety.
Next stepNo anxiety-specific intervention needed; re-screen if symptoms emerge.
Mild anxiety.
Next stepPsychoeducation, worry-time scheduling, and skills work; repeat in 2–4 weeks.
Moderate anxiety — threshold for probable GAD.
Next stepStart structured CBT for worry; assess for panic, social anxiety, and trauma.
Severe anxiety.
Next stepIntensive CBT plus a medication consult; check avoidance, sleep, and substance use as maintainers.
How often to re-administer
Every 2–4 weeks. A ≥4-point reduction is the accepted marker of clinically meaningful improvement.
What to pair it with
PHQ-9 (comorbid depression), PCL-5 (if trauma is present), and K10 (general distress at intake).
How to talk about the score
Pair the score with what the client is describing. A high GAD-7 with predominantly worry content suggests GAD; high score with predominantly trauma content needs a PCL-5 or trauma-specific follow-up.
Limitations
- Designed for GAD; over-detects when used as a general anxiety screen
- Two-week window
- Doesn't distinguish among anxiety disorders
- Misses panic-specific or trauma-specific features
Best used for
- Anxiety screening at intake
- Tracking response in CBT for GAD
- Quick re-administration each session
The GAD-7 items
Over the last two weeks, how often have you been bothered by the following problems?
- 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 is hard to sit still
- Becoming easily annoyed or irritable
- Feeling afraid, as if something awful might happen
GAD-7 scoring — how to add up the score
Each of the seven items is rated 0 (not at all) to 3 (nearly every day) over the past two weeks. Total scores range from 0 to 21. A score of 5–9 indicates mild anxiety, 10–14 moderate, and 15–21 severe. A cutoff of ≥10 has 89% sensitivity and 82% specificity for generalized anxiety disorder. A reduction of ≥4 points is generally considered clinically meaningful change.
What does a GAD-7 score of 10, 15, or 20 mean?
A score of 10 puts a client in the moderate-anxiety band and is the standard threshold for further assessment or treatment. A score of 15 indicates severe anxiety, often warranting a structured anxiety treatment (CBT, medication, or both). A score of 20 is at the top of the severe band — pair with a panic, social-anxiety, or trauma-specific measure to rule out a more specific disorder.
GAD-7 vs PHQ-9 — using them together
Clinicians routinely administer the PHQ-9 (depression) and GAD-7 (anxiety) side-by-side because anxiety and depression frequently co-occur. The PHQ-9 is nine items, the GAD-7 is seven, and both use the same 0–3 frequency anchors over a two-week window, so they pair cleanly on a single intake form.
Free GAD-7 PDF and printable versions
The GAD-7 is in the public domain (no permission required for clinical, educational, or research use) and is freely available from Pfizer Inc. We do not redistribute the official PDF here; instead, send the assessment interactively from your TherapistAssist account so the score and trend are captured automatically.
Frequently asked questions about the GAD-7
Can I use the GAD-7 for panic disorder?
It will catch general arousal but will underestimate panic-specific severity. Use a panic-specific measure (PDSS) alongside if panic is the primary target.
What change is clinically meaningful?
A 4-point reduction is generally considered clinically meaningful, though the field uses a few different thresholds.
Is the GAD-7 free to use?
Yes. The GAD-7 is in the public domain and is free for clinical, educational, and research use. No license or permission from the developers is required.
How long does the GAD-7 take to complete?
Most clients finish the seven items in 90 seconds to two minutes. Scoring takes about 15 seconds by hand.
Is the GAD-7 valid for teens?
Yes — research supports use of the GAD-7 with adolescents from age 11. For children under 11, use a developmentally-appropriate measure such as the SCARED.