Question 1

My patient has a lot of worry but is still functioning - does this need treatment?

Accepted Answer

Symptom severity only modestly predicts functional impairment (mean correlation r = 0.34 across 497 analyses). Two patients with identical GAD-7 scores can have entirely divergent functional trajectories. Presenteeism (impairment while working) reaches 26.3% for severe GAD — far exceeding absenteeism at 11.4%. Residual sub-threshold symptoms persist in nearly half of remitted patients even after symptom remission. The Sheehan Disability Scale (3 items, <1 minute) captures functional impact that symptom measures miss.

Question 2

What instruments measure functional impairment in anxiety beyond symptom counts?

Accepted Answer

Symptom severity only modestly predicts functional impairment (mean correlation r = 0.34 across 497 analyses). Two patients with identical GAD-7 scores can have entirely divergent functional trajectories. Presenteeism (impairment while working) reaches 26.3% for severe GAD — far exceeding absenteeism at 11.4%. Residual sub-threshold symptoms persist in nearly half of remitted patients even after symptom remission. The Sheehan Disability Scale (3 items, <1 minute) captures functional impact that symptom measures miss.

Question 3

When does sub-threshold anxiety warrant treatment vs watchful waiting?

Accepted Answer

Symptom severity only modestly predicts functional impairment (mean correlation r = 0.34 across 497 analyses). Two patients with identical GAD-7 scores can have entirely divergent functional trajectories. Presenteeism (impairment while working) reaches 26.3% for severe GAD — far exceeding absenteeism at 11.4%. Residual sub-threshold symptoms persist in nearly half of remitted patients even after symptom remission. The Sheehan Disability Scale (3 items, <1 minute) captures functional impact that symptom measures miss.

Question 4

How common is residual functional impairment even after successful treatment?

Accepted Answer

Symptom severity only modestly predicts functional impairment (mean correlation r = 0.34 across 497 analyses). Two patients with identical GAD-7 scores can have entirely divergent functional trajectories. Presenteeism (impairment while working) reaches 26.3% for severe GAD — far exceeding absenteeism at 11.4%. Residual sub-threshold symptoms persist in nearly half of remitted patients even after symptom remission. The Sheehan Disability Scale (3 items, <1 minute) captures functional impact that symptom measures miss.

Question 5

Should I treat symptoms or functional impairment - what's the primary outcome?

Accepted Answer

Symptom severity only modestly predicts functional impairment (mean correlation r = 0.34 across 497 analyses). Two patients with identical GAD-7 scores can have entirely divergent functional trajectories. Presenteeism (impairment while working) reaches 26.3% for severe GAD — far exceeding absenteeism at 11.4%. Residual sub-threshold symptoms persist in nearly half of remitted patients even after symptom remission. The Sheehan Disability Scale (3 items, <1 minute) captures functional impact that symptom measures miss.

PsychHQ

Functioning Well Despite Worry: When Sub-Threshold Anxiety Needs Treatment