Guidelines on Anxiety

National Institute for Clinical Excellence (NICE) Recommends CBT as a treatment for Anxiety Disorders:

N.I.C.E Link: http://publications.nice.org.uk/generalised-anxiety-disorder-and-panic-disorder-with-or-without-agoraphobia-in-adults-cg113/guidance
N.I.C.E PDF: http://guidance.nice.org.uk/CG113/NICEGuidance/pdf/English

Step 2: Diagnosed GAD that has not improved after step 1 interventions

Low-intensity psychological interventions for GAD

1.2.11 For people with GAD whose symptoms have not improved after education and active monitoring in step 1, offer one or more of the following as a first-line intervention, guided by the person’s preference:

  • individual non-facilitated self-help
  • individual guided self-help
  • psychoeducational groups. [new 2011]

1.2.12 Individual non-facilitated self-help for people with GAD should:

  • include written or electronic materials of a suitable reading age (or alternative media)
  • be based on the treatment principles of cognitive behavioural therapy (CBT)
  • include instructions for the person to work systematically through the materials over a period of at least 6 weeks
  • usually involve minimal therapist contact, for example an occasional short telephone call of no more than 5 minutes. [new 2011]

1.2.13 Individual guided self-help for people with GAD should:

  • include written or electronic materials of a suitable reading age (or alternative media)
  • be supported by a trained practitioner, who facilitates the self-help programme and reviews progress and outcome
  • usually consist of five to seven weekly or fortnightly face-to-face or telephone sessions, each lasting 20–30 minutes. [new 2011]

1.2.14 Psychoeducational groups for people with GAD should:

  • be based on CBT principles, have an interactive design and encourage observational learning
  • include presentations and self-help manuals
  • be conducted by trained practitioners
  • have a ratio of one therapist to about 12 participants
  • usually consist of six weekly sessions, each lasting 2 hours. [new 2011]

1.2.15 Practitioners providing guided self-help and/or psychoeducational groups should:

  • receive regular high-quality supervision
  • use routine outcome measures and ensure that the person with GAD is involved in reviewing the efficacy of the treatment. [new 2011]

Step 3: GAD with marked functional impairment or that has not improved after step 2 interventions

Treatment options

1.2.16 For people with GAD and marked functional impairment, or those whose symptoms have not responded adequately to step 2 interventions:

  • Offer either
    • an individual high-intensity psychological intervention (see 1.2.17–1.2.21) or
    • drug treatment (see 1.2.22–1.2.32).

     

  • Provide verbal and written information on the likely benefits and disadvantages of each mode of treatment, including the tendency of drug treatments to be associated with side effects and withdrawal syndromes.
  • Base the choice of treatment on the person’s preference as there is no evidence that either mode of treatment (individual high-intensity psychological intervention or drug treatment) is better. [new 2011]

High-intensity psychological interventions

1.2.17 If a person with GAD chooses a high-intensity psychological intervention, offer either CBT or applied relaxation. [new 2011]

1.2.18 CBT for people with GAD should:

  • be based on the treatment manuals used in the clinical trials of CBT for GAD
  • be delivered by trained and competent practitioners
  • usually consist of 12–15 weekly sessions (fewer if the person recovers sooner; more if clinically required), each lasting 1 hour. [new 2011]

1.2.19 Applied relaxation for people with GAD should:

  • be based on the treatment manuals used in the clinical trials of applied relaxation for GAD
  • be delivered by trained and competent practitioners
  • usually consist of 12–15 weekly sessions (fewer if the person recovers sooner; more if clinically required), each lasting 1 hour. [new 2011]

1.2.20 Practitioners providing high-intensity psychological interventions for GAD should:

  • have regular supervision to monitor fidelity to the treatment model, using audio or video recording of treatment sessions if possible and if the person consents
  • use routine outcome measures and ensure that the person with GAD is involved in reviewing the efficacy of the treatment. [new 2011]
1.2.21 Consider providing all interventions in the preferred language of the person with GAD if possible. [new 2011]