Nice | Anxiety quick reference guide

10th February 2011 by Louise Hudman

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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