NICE, the healthcare guidance body, is currently developing a clinical guideline on the recognition and management of social anxiety disorder. As part of this process, draft recommendations have been published on the NICE website today (11 December) for public consultation.

Social anxiety disorder is the most common anxiety disorder, with around one in ten people affected to some extent¹. The disorder involves a persistent fear of one or more anxiety-provoking situations, such as meeting people, talking in meetings or in groups, going to school, going shopping, being seen in public and public performances such as public speaking. Although worries about some of these situations are common in the general population, people with social anxiety disorder can find it hard to control their anxieties and worry excessively about them sometimes for weeks in advance.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: "Social anxiety disorder isn't about being shy at parties or feeling anxious about a job interview, it's about experiencing a level of anxiety that can disrupt normal life, interfering with social relationships and affecting performance at work or school. In these cases, it is really important that the individual is able to get the right help.

“Despite the existence of effective treatments, recognition of social anxiety disorder can be difficult and it is often overlooked or misdiagnosed as another condition, such as depression. Also individuals may not access treatment due to perceived stigma and the avoidance behaviour associated with the condition. Despite the extent of distress and impairment, only about half of those with the disorder ever seek treatment. Instead they may become withdrawn, avoiding social situations and in some cases turn to alcohol or other drugs to try to reduce their anxiety, which can in turn potentially lead to substance abuse.

“This draft guidance issued for public consultation includes a number of recommendations to support healthcare professionals to accurately diagnose and manage social anxiety disorder. We hope that the development of NICE guidance in this area will help ensure that those affected by this disorder receive the best possible support."

Draft recommendations issued for consultation include:

Principles for working with all people with social anxiety disorder

• Primary and secondary care clinicians, managers and commissioners should consider arranging services flexibly to promote access and avoid exacerbating social anxiety disorder symptoms by offering:
  
  - appointments at times when the service is least crowded or busy
  
  - appointments before or after normal hours, or at home
  
  - self check-in and other ways to reduce distress on arrival
  
  - opportunities to complete forms or paperwork before or after an appointment in a private space
  
  - support with concerns related to social anxiety (for example, using public transport).

Identification and referral of adults with possible social anxiety disorder

• Be alert to possible anxiety disorders (particularly in people with a past history of an anxiety disorder, possible somatic symptoms of an anxiety disorder or in those who have experienced a recent traumatic event). Consider asking the person about their feelings of anxiety and their ability to stop or control worry, using the 2-item Generalized Anxiety Disorder scale (GAD-2)².

Interventions for adults with social anxiety disorder

• Offer adults with social anxiety disorder individual cognitive behavioural therapy (CBT)³ specifically developed for social anxiety disorder (based on the Clark and Wells model or the Heimberg model.
• For adults who decline individual CBT and wish to consider another psychological intervention, offer supported self-help.
• For adults who decline individual CBT and express a preference for a pharmacological intervention, discuss their reasons for declining CBT and address any concerns. If the person wishes to proceed with a pharmacological intervention, offer a selective serotonin reuptake inhibitor (SSRI) (fluvoxamine or escitalopram). Monitor the person carefully for adverse reactions.

Interventions for children and young people with social anxiety disorder

• Offer group-based CBT to children and young people with social anxiety disorder aged 7 years and older.
• Consider parent-delivered individual CBT for children with social anxiety disorder aged 4-12 years.

The full draft recommendations will be available on the NICE website from 11 December.

Ends

Notes to Editors

Explanation of terms

1. Estimates of lifetime prevalence vary but have been as high as 12%, compared with estimates of around 6% for generalised anxiety disorder (GAD), 5% for panic disorder, 7% for post-traumatic stress disorder (PTSD) and 2% for obsessive-compulsive disorder.

2. The GAD-2 is a short screening tool used to assess anxiety

3. CBT is a psychological treatment for depression that helps people examine the way they think and respond to situations. CBT encourages people to engage in activities and to write down their thoughts and problems, thereby helping them to understand their condition and develop skills to deal with it, such as challenging negative thoughts and monitoring their own behaviour.

There are various types of CBT:

• Group based - typically run by two healthcare professionals in groups of 8-10 people.
• Individual - one-to-one sessions with a therapist.
• Computerised - the person works through a computer programme, as reviewed and supported by a healthcare professional.

About the guidance

4. The draft recommendations will be available on the NICE website from 11 December 2012: CG159. Embargoed copies are available on request from the NICE press office.

About NICE

5. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

6. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies -guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

7. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
• Commissioning Outcomes Framework - NICE develops the potential indicators for the COF, the scheme starting in 2013, which will help measure the health outcomes and quality of care commissioned by Clinical Commissioning Groups.

8. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.