The National Institute for Health and Care Excellence (NICE) has issued standards to improve the quality of care and support for children, young people and adults with anxiety disorders.

Anxiety disorders are types of common mental health disorders that include generalised anxiety disorderⁱ, social anxiety disorderⁱⁱ, post-traumatic stress disorderⁱⁱⁱ, panic disorder^iv, obsessive-compulsive disorder^v and body dysmorphic disorder^vi, all of which are covered in the NICE quality standard. Although anxiety disorders vary considerably in their severity, they are associated with significant long-term disability and can have a lifelong course of relapse and remission. In children and young people they are also associated with an increased risk of other serious mental health problems, including depression and substance misuse.

Recognition of anxiety disorders is poor, particularly in primary care and as a consequence only a small minority of people experiencing anxiety disorders ever receive treatment. And even when anxiety disorders are diagnosed, treatment is often limited to the prescription of drugs rather than offering evidence-based psychological interventions which NICE recommends as first-line treatments.

A snapshot of anxiety disorders in adults in England over a 1-week period carried out by the Office of National Statistics in 2007 found that 4.4% of adults had generalised anxiety disorder, 3% had post-traumatic stress disorder, 1.1% had panic disorder and 1.1% had obsessive-compulsive disorder.

In summary:

• Accurate diagnosis of a person's specific anxiety disorder can help them understand their condition and ensure they are offered the most appropriate treatment at the earliest opportunity. Therefore, people with a suspected anxiety disorder should receive an assessment that identifies whether they have a specific anxiety disorder, the severity of symptoms and associated functional impairment.
• Evidence-based psychological interventions are effective treatments for anxiety disorders and should be offered as first-line treatments in preference to pharmacological treatment. They include both low-intensity interventions incorporating self-help approaches and high-intensity psychological therapies. Using the stepped care model allows the least intensive intervention that is appropriate for a person to be provided first, and people can step up or down the pathway according to changing needs and in response to treatment.
• People with anxiety disorders should not be prescribed benzodiazepines or antipsychotics unless there are specific clinical reasons why these treatments may be of short term benefit (for example, in anxiety disorder crisis).
• People receiving psychological or pharmacological treatment for an anxiety disorder should have their response to treatment recorded at each treatment session. This not only ensures that the effectiveness of treatment can be assessed and adjustments made if needed, but also provides an opportunity for the health practitioner to monitor other outcomes, such as the person's ability to continue or return to employment.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: "Anxiety disorders are surprisingly common, and many people will experience one or more periods of this type of illness during their life, or live and work with others who are affected. Yet many people who experience them do not receive the help or support they require. This is often because their symptoms are not picked up or the treatment they need is not available. Receiving an accurate and timely diagnosis, then following this up with the right type of care can be key in determining whether someone progresses towards recovery or whether their mental health further deteriorates. To support this quality standard, services should be commissioned from and co-ordinated across all relevant agencies encompassing the whole anxiety disorders care pathway. Such an approach should increase timely access to services, improve the cost-effectiveness of treating people with anxiety disorders and provide better outcomes for people who are affected by them."

Professor John Cape, Head of Psychology at Camden and Islington NHS Foundation Trust and member of the committee which developed the standards said: "Anxiety disorders are common, distressing and often disabling, yet people are often unaware they have a condition that can be helped by psychological or other treatment. The Anxiety Disorders Quality Standard makes clear to doctors and other health professionals the importance of identifying the specific anxiety disorder people are suffering from and ensuring they are offered an effective psychological treatment."

Dr Catharine Creswell, Honorary Consultant Clinical Psychologist (children and young people) at the University of Reading and member of the committee which developed the standards said: "This quality standard highlightskey principles to increase access to evidence-based treatments, as outlined in NICE guidelines. Ithas, critically, recognised the fact that anxiety disorders commonly have their onset in childhood and adolescence, and that the occurrence of these difficulties in young people presents a risk for long-term problems with anxiety and other serious mental health conditions. As such, the quality standard will guide commissioners in key mechanisms to increase access and improve the effectiveness of treatments for anxiety disorders across the life-span."

Nicky Lidbetter, Anxiety UK CEO, said: "Anxiety UK welcomes the anxiety disorders NICE quality standard. It recognises the experience many affected by anxiety have had, including a lack of understanding in primary care, treatment being limited to the prescription of drugs and the patient's anxiety presentation being frequently seen as secondary to depression when anxiety is the primary presenting problem.

"We particularly applaud the recognition of the value of a person-centred approach to service provision in order to provide high-quality care to those affected by anxiety. Highlighting the need for an assessment that identifies a person's global experience of anxiety, ensuring they are offered the least intrusive evidence-based psychological interventions and that their responses to treatment are regularly monitored, are excellent steps towards providing a better service to those affected by anxiety. Finally, highlighting that those who need them for short-term care and/or anxiety disorder crises can still be prescribed benzodiazepines and antipsychotics is a welcome addition, as we know that these medications can be helpful for some people affected by anxiety.

"We look forward to continuing to work with NICE to ensure that our members' experience of anxiety informs future quality standards and recommendations."

Ends

For more information, please call the NICE press office on 0845 003 7782 or out of hours on 07775 583 813, or email pressoffice@nice.org.uk

Notes to Editors

References

i. Generalised anxiety disorder is characterised by excessive worry about a number of different events, associated with heightened tension. A person with generalised anxiety disorder may also feel irritable and have physical symptoms such as restlessness, feeling easily tired and having tense muscles. They may also have trouble concentrating or sleeping. For the disorder to be diagnosed, symptoms should be present for at least 6 months and should cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

ii. Social anxiety disorder (previously known as 'social phobia'), is persistent fear of or anxiety about 1 or more social situations that involve interaction, observation and performance that is out of proportion to the actual threat posed by the social situation.

iii. Post-traumatic stress disorder can develop after a stressful event or situation of an exceptionally threatening or catastrophic nature that is likely to cause pervasive distress in almost anyone. People might develop the disorder in response to 1 or more traumatic events such as deliberate acts of interpersonal violence, severe accidents, disasters or military action. Post-traumatic stress disorder does not develop after upsetting situations that are described as 'traumatic' in everyday language, for example, divorce, loss of a job or failing an exam.

iv. Panic disorder can be characterised by the presence of recurring, unforeseen panic attacks followed by at least 1 month of persistent worry about having another panic attack and concern about the consequences of a panic attack, or a significant change in behaviour related to the attacks. At least 2 unexpected panic attacks are necessary for diagnosis and the attacks should not be accounted for by the use of a substance, a general medical condition or another psychological problem.

v. Obsessive-compulsive disorder is characterised by the presence of obsessions or compulsions, or commonly both. An obsession is defined as an unwanted intrusive thought, image or urge that repeatedly enters the person's mind. Compulsions are repetitive behaviours or mental acts that the person feels driven to perform. The symptoms can cause significant functional impairment and distress.

vi. Body dysmorphic disorder is characterised by excessive worry about appearance and a distorted view of how the person looks. For example, they may be convinced that a barely visible scar is a major flaw that everyone is staring at, or that their nose looks abnormal.

About the anxiety disorders quality standard

1. The NICE quality standard for anxiety disorders is available on the NICE website from 00:01hrs on Thursday 6 February.

Embargoed copies are available on request; please contact the press office.

2. The NICE quality standard for anxiety disorders is based on the following NICE accredited guidelines:

• Social anxiety disorder. NICE clinical guideline 159 (2013).
• Common mental health disorders. NICE clinical guideline 123 (2011).
• Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults. NICE clinical guideline 113 (2011).
• Obsessive-compulsive disorder and body dysmorphic disorder. NICE clinical guideline 31 (2005).
• Post-traumatic stress disorder. NICE clinical guideline 26 (2005).

Related NICE quality standards

Published

• Mental wellbeing of older people in care homes. NICE quality standard 50 (2013).
• Depression in children and young people. NICE quality standard 48 (2013).
• Patient experience in adult NHS services. NICE quality standard 15 (2012).
• Service user experience in adult mental health. NICE quality standard 14 (2011).
• Depression in adults. NICE quality standard 8 (2011).

Future quality standards

• Antenatal and postnatal mental health.
• Managing the transition from children's to adult services.
• Mental health problems with learning disability.

About NICE quality standards

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