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:
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
- 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.