Anxiety

The RANZCP guidelines provide comprehensive recommendations on the assessment, diagnosis and treatment of panic disorder (PD) and agoraphobia, social anxiety disorder (SAD) and generalised anxiety disorder (GAD). The guidelines do not cover post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD).

Specific guidance is given on assessing and diagnosing anxiety disorders, including determining if an anxiety disorder is present, recognising specific anxiety disorders, and carrying out a differential diagnosis with respect to other conditions.

Treatment approaches based on a systematic review of the literature are given for anxiety disorders in general, and detailed recommendations are given for each anxiety disorder. The guidelines include recommendations for patient follow-up and monitoring, ensuring adequate trials of treatment options. The evidence for efficacy is given for each of the treatments considered, including first-line and other treatments.

Treatment is selected using a collaborative approach between the healthcare professional and the patient, beginning with psychoeducation and advice on lifestyle factors.

Cognitive behavioural therapy (CBT) (either face-to-face with a therapist or online) is the recommended first-line psychological treatment for anxiety disorders due to its extensive evidence base compared with other psychological treatments.

If medicines are appropriate, selective serotonin reuptake inhibitors (SSRIs) are first-line, or a serotonin-norepinephrine reuptake inhibitor (SNRI) if SSRIs are ineffective or not tolerated.

These 2014 Canadian guidelines cover diagnosis and treatment of PD and agoraphobia, specific phobias, SAD and GAD, as well as OCD and PTSD.

As the RANZCP guidelines do, these give specific guidance for assessment and diagnosis of anxiety disorders, general treatment principles and recommendations for the treatment of specific anxiety disorders. Evidence for efficacy is outlined for each treatment considered, including first-line and other treatments.

CBT is the recommended first-line psychological treatment for anxiety disorders. SSRIs are included in the first-line medicines. Other medicine options, together with their supporting evidence, are detailed.

These 2011 UK guidelines address the identification and assessment of depression, PD, GAD, SAD, OCD and PTSD, together with high-level advice for treatment. Treatment follows a stepped care approach starting with low-intensity interventions, followed by psychological treatments or medicines if required.

Therapeutic Guidelines address the diagnosis and treatment of anxiety disorders and related mental health disorders. As well as GAD, PD and agoraphobia and SAD, they address adjustment disorder with anxious mood, panic attack, OCD, specific phobias and post-traumatic mental health disorders (acute stress disorder and PTSD).

An overview of the assessment, diagnosis and treatment of anxiety disorders. Assessment and diagnosis includes differential diagnoses with other conditions and the diagnosis of specific anxiety disorders.

CBT is the first-line psychological therapy. It is the most empirically supported psychological treatment, and a summary of the evidence of efficacy is given.

SSRIs and SNRIs are effective first-line medicines.

The article also summarises evidence comparing medicines and psychological treatments. Medicines and psychological treatments are similarly effective for anxiety disorders as a group, and for PD or SAD. Comparisons were not available for the other disorders.

This overview paper gives a theoretical view of anxiety, examining how it can be interpreted as separate (possibly comorbid) anxiety disorders, or as an anxiety disorder with multiple dimensions. It explains how anxiety works based on the ABC model, how (A)larms interact with (B)eliefs resulting in (C)oping strategies, and how neurotransmitters combine in complex ways in the brain, resulting in anxiety.

The paper also gives an overview of treatment strategies. A wide range of treatment options are discussed. Again, CBT is the first-line psychological treatment, and SSRIs are first-line medicines.

This meta-analysis examines the efficacy of CBT for anxiety disorders PD, GAD and SAD as well as anxiety-related disorders OCD and PTSD. Findings demonstrated moderate placebo-controlled effects of CBT on target disorder symptoms, and small to moderate effects on other anxiety symptoms, depression and quality of life.

This paper gives a summary of e-mental health programs and describes different treatment programs with information on their evidence, cost and appropriateness for different mental health conditions.

This Cochrane review examines online CBT (eCBT) with and without support from a therapist. Traditional face-to-face CBT, eCBT supported by a therapist, and unsupported eCBT are all efficacious with little difference in efficacy between them. Comparisons between therapist-supported and unsupported eCBT should, however, be interpreted with caution due to the limited number of studies.