Anxiety: Treatment overview
All patients should receive education, including information about their disorder, treatment choices and where they can get reliable self-help material.
Both psychopharmacological and psychotherapeutic treatments provide high response rates for all the anxiety disorders. Specific phobias rarely need medication and should be treated with psychological interventions.
Treatment choice depends on the acuity and severity of the presenting condition. In most cases the symptoms have been present for months or years before patients seek treatment.
Where there is a severe onset or exacerbation of an anxiety disorder with marked impairment of functioning and there is no contraindication, benzodiazepines are a very effective short-term option. In PTSD there is no observed benefit from administering benzodiazepines acutely.
In the absence of a crisis, initial treatment includes reducing or excluding caffeine and alcohol. Give patients information about their anxiety disorder and direct them to reliable sources for self-help strategies. Review the patient's progress in two weeks. If the anxiety continues and time is available, initiate supported self management.
If the patient makes progress, continue with self-help. If not, discuss medication or cognitive-behavioural therapy (CBT). If the patient selects CBT, advise them to continue with self-help using a CBT-based resource and refer them to a CBT provider.
Generalised anxiety disorder and panic disorder in adults: management (NICE guideline CG113 2011)
Social anxiety disorder: recognition, assessment and treatment (NICE guidelines CG159, 2013)