Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Christina Cavinder


Generalized anxiety disorder (GAD) is highly prevalent in the United States with at least 12% of the population affected (Edmund & Sheppard, 2018). GAD can pose significant distress and debilitation throughout the lifespan (Bystritsky, Khalsa, Cameron, & Schiffman, 2013; Edmund & Sheppard, 2018). Barriers to treatment include adverse effects, inaccessibility, and expense. The purpose of this project was to implement an evidence-based protocol involving combination therapy with self-administered cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication in order to improve patient outcomes through more accessible, affordable, and standardized treatment of GAD. The Neuman Systems Model and Stetler Model were utilized to guide this project among a sample population of 20 adults with GAD at a nurse practitioner-owned family practice clinic in Northwest Indiana. In fulfillment of the protocol, each participant was prescribed an SSRI in combination with independent completion of a CBT workbook for anxiety over 12 weeks. Anxiety symptoms via the Generalized Anxiety Disorder 7-item (GAD-7) Scale and depression symptoms via the Patient Health Questionnaire (PHQ-9) were measured at baseline, week 4, week 8, and week 12. A one-way repeated-measures analysis of variance (ANOVA) indicated that while mean GAD-7 scores decreased from baseline (M = 4.20, SD = 4.32) to week 12 (M = 1.60, SD = 2.12), there was no statistically significant decrease found (F(3,27) = 1.94, p > 0.05). Mean PHQ-9 scores decreased from baseline (M = 4.80, SD = 3.58) to week 12 (M = 1.90, SD = 2.81), and there was a statistically significant decrease found (F(3,27) = 4.34, p < 0.05). Participants were satisfied (44.4%), very satisfied (33.3%), and extremely satisfied (22.2%) with self-administered CBT. Providers are recommended to implement combined self-administered CBT and SSRI medication as a cost-effective, accessible, and effective method to decrease anxiety and depression symptoms among patients with GAD.