Offer psychological interventions for anxiety disorders

People with a suspected anxiety disorder, such as post-traumatic stress or obsessive compulsive disorder, should be offered psychological interventions as a first-line treatment, as set out in new NICE standards.

People with a suspected anxiety disorder, such as post-traumatic stress or obsessive compulsive disorder, should be offered psychological interventions as a first-line treatment, as set out in new NICE standards.

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

However, many anxiety disorders go unrecognised and only a small minority of people ever receive treatment. When anxiety disorders coexist with depression, the depressive episode may be recognised without detecting the underlying and more persistent anxiety disorder.

The quality standard on anxiety disorders contains four statements designed to address this situation and improve outcomes for children, young people and adults with anxiety disorders.

The first statement calls for people with a suspected anxiety disorder to receive an assessment that identifies whether they have a specific anxiety disorder, the severity of symptoms and associated functional impairment.

This is important to ensure that people with an anxiety disorder are offered the most appropriate treatment at the earliest opportunity.

People with an anxiety disorder should be offered psychological interventions as a first-line treatment in preference to drug treatment. Cognitive behavioural therapy (CBT), for example, has been specifically developed to treat social anxiety disorders in adults, children and young people.

Benzodiazepines or antipsychotics should not be prescribed for people with an anxiety disorder unless specifically indicated. Benzodiazepines are associated with tolerance and dependence, and antipsychotics are associated with a number of adverse effects.

NICE recommends people receiving treatment for an anxiety disorder have their response to treatment recorded at each treatment session. Regular monitoring of psychological and pharmacological treatment response ensures that the effectiveness of treatment can be assessed and treatment adjusted if needed.

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 who was also involved in the development of the standards said: “This quality standard highlights key principles to increase access to evidence-based treatments, as outlined in NICE guidelines.

“It has, 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.”

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE added: “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.”