Treatment Outlines for the Management of Anxiety States

Abstract

The Quality Assurance Project is developing explicit and detailed treatment outlines for each of the major psychiatric disorders. Three sources of information are used: a meta-analysis of the treatment outcome literature, the opinions of a sample of practising psychiatrists, and the views of a panel of nominated experts. The recommendations for the treatment of anxiety states were as follows: Phenelzine and then the tricyclic antidepressants were the treatments of choice for panic disorder. Behaviour therapy—cognitive anxiety management, relaxation and hyperventilation control—being recommended as an essential adjunct to drug therapy. Relaxation and dynamic psychotherapy separately, or in combination, were the treatments of choice for generalised anxiety disorder with cognitive procedures being of value and benzodiazepines only being recommended for short-term use. In complicated cases of either panic disorder or generalised anxiety disorder a long-term supportive psychotherapeutic relationship was regarded as essential to ensure smooth progress in treatment. In adjustment disorder with anxious mood, procedures to permit adaptation to the stressor were recommended, while in post-traumatic stress disorder psychotherapeutic techniques to allow the trauma to be reexperienced and worked through were favoured.