Outcome measure reference · for clinicians
GAD-7 scoring, cut-offs and interpretation
GAD-7 — Generalised Anxiety Disorder-7. Severity of anxiety symptoms over the last two weeks.
- Items
- 7
- Each item
- 0–3
- Score range
- 0–21
- NHS TT caseness
- 8+
What it measures
The GAD-7 is a seven-item self-report outcome measure of anxiety symptom severity, rated for how often each symptom has been a problem over the last two weeks. It was developed as a brief measure for generalised anxiety disorder and is widely used as a general measure of anxiety.
Alongside the PHQ-9 it is one of the two core measures in NHS Talking Therapies, given at assessment and at every session. A total score describes severity; it is not a diagnosis, and where a specific anxiety disorder is the focus of treatment a problem-specific measure usually sits alongside it.
Scoring
Sum the seven item scores (each 0–3) for a total between 0 and 21.
Clinical cut-off: 10. Spitzer and colleagues recommend 10 as the cut-point for further evaluation. (Spitzer, Kroenke, Williams & Löwe (2006))
Formulate does not reproduce the GAD-7 items on this page and offers no public score calculator. Use the official copy (see licence below).
Severity bands
Scores, severity bands, and outcome classifications are computed by applying published clinical thresholds. They are informational aids, not diagnoses or clinical recommendations. Clinical interpretation remains the sole responsibility of the treating practitioner.
| Score | Anxiety severity |
|---|---|
| 0–4 | Minimal |
| 5–9 | Mild |
| 10–14 | Moderate |
| 15–21 | Severe |
Source: Spitzer, Kroenke, Williams & Löwe (2006).
NHS Talking Therapies use
- Caseness: 8 or more
- Reliable change: a change of 4 or more points
A score of 8 or more is caseness — lower than the cut-point of 10 in the original paper. A change of 4 or more points between two scores counts as reliable change.
Source: NHS Talking Therapies manual, v7.1 (2024).
Licence and the official copy
The official PHQ Screeners site states that no permission is required to reproduce, translate, display or distribute the PHQ and GAD-7 screeners.
phqscreeners.com (opens in a new tab)
This page describes the measure and cites its published scoring. It is not endorsed by the measure’s authors, its rights holder or the NHS.
How Formulate uses the GAD-7
- Assign it as homework: your client completes it on their own device through a secure link, without needing an account.
- Scored automatically when your client submits, and recorded against their outcomes.
- Reliable change and recovery tracked against the NHS Talking Therapies thresholds on the client’s outcomes dashboard.
- Outcome tracking is included on the Practice and Specialist plans; every account starts with a 14-day Practice trial.
References
- Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.
- NHS England (2024). NHS Talking Therapies for anxiety and depression manual, version 7.1.
Frequently asked questions
What is the GAD-7 cut-off?
Spitzer and colleagues (2006) recommend a score of 10 as the cut-point for further evaluation, with 5, 10 and 15 marking mild, moderate and severe anxiety symptoms. NHS Talking Therapies uses a lower caseness threshold of 8.
What counts as reliable change on the GAD-7?
The NHS Talking Therapies manual (v7.1, 2024) treats a change of 4 or more points between two GAD-7 scores as reliable change.
Where can I get the official GAD-7?
The official PHQ Screeners site hosts the GAD-7 and its translations, and states that no permission is required to reproduce, translate, display or distribute it.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- Samaritans: 116 123 — free, day or night, 365 days a year
- SANEline: 0800 689 5555 — 4:30pm–10:30pm, every day
Track the GAD-7 across your caseload
Assign it as homework, let Formulate score it, and see change over treatment alongside the rest of your client’s work.