Nice | Anxiety quick reference guide

This guideline from Nice puts psychological interventions first. The following stepwise interventions should be considered. Start at any step, depending on severity:

1st line: Explain the disorder and explore their worries. Suggest self-help:

  • NHS choices
  • RCPysch has a good leaflet (These are my suggestions – NICE gives no specifics)

2nd line – Choose one of the following, based on patient preference:

  • Individual non-facilitated self-help. (NICE – rather unhelpfully – don’t actually advise what books etc have been shown to work. I suggest:
    • Books on Prescription scheme
    • Moodgym
  • Individual guided self-help (Talking changes/i-talk).
  • Psychoeducational groups (Talking changes/i-talk)

3rd line – either one or other of the below. If one doesn’t work, try the other.

  • Individual high-intensity psychological (ie Talking changes/i-talk)
  • Drug treatment – sertraline as first line as it’s cheapest, then other SSRIs/SNRIs. Pregabalin can be used if the others aren’t suitable or don’t work. Patients need close follow-up (eg within a week for < 30s due to the risk of increased suicidal thoughts). If there’s no response at 12 weeks, consider swapping to psychological treatment.

4th line - referral

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