Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Christine Paquin


Generalized anxiety disorder (GAD) is a debilitating psychological condition that affects 3.1% of the American population and is one of the leading causes of disability (Anxiety and Depression Association of America, 2022; Baxter, 2014). The purpose of this evidence-based practice project was to implement a multimodal intervention to decrease GAD symptoms in adults in the primary care setting. The PICOT question that guided this project was: In adults, over the age of 18, who have been diagnosed with generalized anxiety disorder (GAD), does the combination of digital cognitive behavioral therapy (CBT) through a smartphone application, lifestyle modification education, and pharmacotherapy improve patient’s GAD-7 scores over an 8-week period in the primary care setting? A comprehensive literature search of six databases and citation chasing were conducted to determine the best treatment practices for GAD in primary care. Fourteen pieces of high-level evidence graded using evidence-based appraisal tools supported the implementation of CBT, lifestyle modifications, and pharmacotherapy. A sample of 13 adult participants were recruited in a primary care clinic and screened for GAD using the GAD-7 scale. Participants underwent an eight-week intervention consisting of digital CBT, lifestyle modification including an exercise regimen, and pharmacotherapy. Participants were contacted every two weeks to obtain GAD-7 scores and assess adherence to interventions. A paired t test was used to compare the mean baseline GAD-7 scores to the mean eight-week GAD-7 scores. A significant decrease from baseline to eight weeks was found (t (13) = -3.975, p <0.05). A repeated measures ANOVA was calculated comparing scores of participants at four different times: baseline, two-weeks, four-weeks, and eight-weeks. A significant effect was found (F (1,12) = 42.783, p < 0.01). Follow up protect t tests revealed that scores did not begin to significantly decrease until four weeks after the intervention (M = -2.38, sd = 3.38). These findings suggest that a combination of digital CBT, lifestyle modifications, and pharmacotherapy decreases anxiety symptoms in adults with GAD. Future research should compare digital CBT to face-to-face CBT. Research should be conducted to identify barriers to implementing 10 psychological interventions in primary care and evaluate their effectiveness in comparison to pharmacological interventions.

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Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

M. Cullings DNP brochure.pdf (164 kB)

M. Cullings DNP poster.pdf (393 kB)