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Cognitive behavioral therapyThere is a strong cognitive component to GAD in that patients are often preoccupied with a variety of distorted thought processes. It is thought that using CBT to highlight these distortions will help patients challenge their maladaptive thoughts.29 The vast majority of studies have focused on the effects of CBT on anxiety in general, not within a specific disorder.13,30 Clinical studies have consistently shown that structured CBT programs produce significant reduction in anxiety symptoms and increase the quality of life for patients.13 This is especially true in adolescent populations where the effects of CBT are seen on a larger scale than for younger populations.31 There are different types of CBT programs, and among the most commonly used, the rates of effectiveness, and long-term outcomes are not significantly different.32 CBT is a long-term therapy with the best treatment effects seen when a patient completes nine or more sessions.31 When referrals to CBT are necessary, the provider should refer to programs that are pediatric-specific with on-staff providers properly trained in pediatric CBT. Providers with an interest in treating adolescents with GAD should receive training in CBT. (See Online cognitive behavioral training.) Although CBT has been shown to be an effective treatment for GAD, it is important for providers to closely monitor patients and educate patients and families to contact the provider or return to treatment with the recurrence of or increase in GAD symptoms
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