Clinical Experiences in Conducting Empirically Supported Treatments for Generalized Anxiety Disorder Lauren E. Szkodny The Pennsylvania State University Michelle G. Newman The Pennsylvania State University Marvin R. Goldfried Stony Brook University Knowledge of the efficacy of cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) predomi- nantly derives from randomized controlled trials (RCTs). However, there may be unique or complex issues encoun- tered in practice, but not necessarily in the context of a controlled clinical trial. Therefore, launching a systematic dialogue between researcher and practicing clinician can be instrumental in augmenting evidence-based therapies through identification of variables that promote and interfere with clinical effectiveness. Through an initiative sponsored by the American Psychological Association’s Divisions 12 (Society for Clinical Psychology) and 29 (Psychotherapy), this study aimed to examine clinical experiences conducting CBT for GAD. The participants were 260 psychotherapists who completed an online survey on assessment and therapeutic intervention utilization and their experience of factors that limit successful GAD treatment and symptom reduction. The majority of respon- dents reported 20 years or less experience using ESTs for GAD, typically treating clients in outpatient clinics, treat- ment centers, and private practice. Some of the most commonly used interventions address clients’ maladaptive cognitions and elevated anxiety and muscle tension typical of GAD. Approximately one half of respondents reported incorporating integrative techniques into treatment. Factors perceived as limiting effective GAD treatment included severity and chronicity of GAD, presence of comorbid conditions, stressful home and work environments, client motivation and resistance to treatment, and issues encoun- tered when executing therapy techniques. This study provides researchers with clinically derived directions for future empirical investigation into enhancing efficacy of GAD treatment. Keywords: empirically supported treatment (EST); evidence-based treatment; generalized anxiety disorder (GAD); cognitive-behavioral therapy (CBT) GENERALIZED ANXIETY DISORDER (GAD) is a chronic problem marked by pathological worry, and typical- ly associated with a variety of physical, emotional, and cognitive symptoms, including restlessness, fatigue, irritability, muscle tension, concentration dif- ficulty, and sleep disturbance (American Psychiatric Association, 2000). It is a highly prevalent anxiety disorder (Kessler et al., 2005), and likely to be encountered in both clinical and primary care settings. GAD is characterized by later onset than other anxiety disorders (Kessler et al.) and comprises fluctuations in symptom severity and impairment that may not be indicative of recovery (Wittchen, Lieb, Pfister, & Schuster, 2000; Yonkers, Warshaw, Massion, & Keller, 1996). GAD is also associated with a high degree of comorbidity that can interfere with its natural remission (e.g., Bruce et al., 2005). Finally, the disability and impairment associated with Available online at www.sciencedirect.com ScienceDirect Behavior Therapy 45 (2014) 7 – 20 www.elsevier.com/locate/bt Address correspondence to Lauren E. Szkodny, M.S., Department of Psychology, 378 Bruce V. Moore Building, The Pennsylvania State University, University Park, PA 16802-3103; e-mail: les233@psu.edu 0005-7894/45/7–20/$1.00/0 © 2013 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.