This clinical guideline is an update of NICE’s previous guidance on generalised anxiety disorder. It was commissioned by NICE and developed by the National Collaborating Centre for Mental Health, and sets out clear evidence- and consensus-based recommendations for healthcare professionals on how to treat and manage generalised anxiety disorder in adults.

Around 4.4% of adults in England are affected by generalised anxiety disorder. It can become chronic if it is not treated, often co-occurs with other anxiety and depressive disorders and is associated with substantial disability. This guideline is an indispensable tool in enabling healthcare professionals to identify generalised anxiety disorder and provide the most effective treatments in a stepped-care framework.

This new guideline, which updates all the reviews of the previous guideline, presents and appraises the evidence for low- and high-intensity psychological interventions, drug treatment and other physical interventions, and also provides insight into the experience of care of people with generalised anxiety disorder. An important feature of the new guideline is the economic modelling that was undertaken in the areas of drug treatments and computerised cognitive behavioural therapy.

The guideline also partially updates the NICE Technology Appraisal 97, Computerised Cognitive Behaviour Therapy for Depression and Anxiety. This update focuses on CCBT for panic disorder only.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERS
• 1. PREFACE
  • 1.1. NATIONAL GUIDELINES
  • 1.2. THE NATIONAL GENERALISED ANXIETY DISORDER GUIDELINE
• 2. GENERALISED ANXIETY DISORDER
  • 2.1. INTRODUCTION
  • 2.2. THE DISORDER
  • 2.3. AETIOLOGY
  • 2.4. TREATMENT AND MANAGEMENT IN THE NHS
• 3. METHODS USED TO DEVELOP THIS GUIDELINE
  • 3.1. OVERVIEW
  • 3.2. THE SCOPE
  • 3.3. THE GUIDELINE DEVELOPMENT GROUP
  • 3.4. REVIEW QUESTIONS
  • 3.5. SYSTEMATIC CLINICAL LITERATURE REVIEW
  • 3.6. HEALTH ECONOMICS METHODS
  • 3.7. STAKEHOLDER CONTRIBUTIONS
  • 3.8. VALIDATION OF THE GUIDELINE
• 4. EXPERIENCE OF CARE
  • 4.1. INTRODUCTION
  • 4.2. PERSONAL ACCOUNTS – PEOPLE WITH GENERALISED ANXIETY DISORDER
  • 4.3. PERSONAL ACCOUNTS – CARERS
  • 4.4. REVIEW OF THE LITERATURE
  • 4.5. FROM EVIDENCE TO RECOMMENDATIONS
• 5. ASSESSMENT AND SERVICE DELIVERY
  • 5.1. INTRODUCTION
  • 5.2. RECOGNITION AND ASSESSMENT
  • 5.3. FROM EVIDENCE TO RECOMMENDATIONS
  • 5.4. STEPPED CARE
  • 5.5. COLLABORATIVE CARE
• 6. LOW-INTENSITY PSYCHOLOGICAL INTERVENTIONS
  • 6.1. INTRODUCTION
  • 6.2. NON-FACILITATED SELF-HELP
  • 6.3. GUIDED SELF-HELP
  • 6.4. PSYCHOEDUCATIONAL GROUPS
  • 6.5. MODES OF DELIVERY
  • 6.6. HEALTH ECONOMIC EVIDENCE
  • 6.7. FROM EVIDENCE TO RECOMMENDATIONS
• 7. HIGH-INTENSITY PSYCHOLOGICAL INTERVENTIONS
  • 7.1. INTRODUCTION
  • 7.2. REVIEW OF HIGH-INTENSITY INTERVENTIONS FOR GENERALISED ANXIETY DISORDER
  • 7.3. COGNITIVE BEHAVIOURAL THERAPY
  • 7.4. APPLIED RELAXATION
  • 7.5. PSYCHODYNAMIC THERAPY
  • 7.6. OTHER INTERVENTIONS
  • 7.7. COMBINED TREATMENTS
  • 7.8. MODE OF DELIVERY
  • 7.9. OVERALL CLINICAL SUMMARY
  • 7.10. HEALTH ECONOMIC EVIDENCE
  • 7.11. FROM EVIDENCE TO RECOMMENDATIONS
• 8. PHARMACOLOGICAL AND PHYSICAL INTERVENTIONS
  • 8.1. INTRODUCTION
  • 8.2. PHARMACOLOGICAL INTERVENTIONS COMPARED WITH PLACEBO
  • 8.3. HEAD-TO-HEAD TRIALS OF PHARMACOLOGICAL INTERVENTIONS
  • 8.4. EFFECTS OF DOSE
  • 8.5. MAINTENANCE TREATMENT
  • 8.6. MANAGEMENT OF NON-RESPONSE TO PHARMACOLOGICAL INTERVENTIONS
  • 8.7. SIDE EFFECTS OF PHARMACOLOGICAL INTERVENTIONS
  • 8.8. HEALTH ECONOMIC EVIDENCE
  • 8.9. FROM EVIDENCE TO RECOMMENDATIONS
  • 8.10. RECOMMENDATIONS
  • 8.11. OTHER INTERVENTIONS
• 9. COMPUTERISED COGNITIVE BEHAVIOURAL THERAPY FOR PANIC DISORDER
  • 9.1. INTRODUCTION
  • 9.2. CLINICAL EVIDENCE FOR COMPUTERISED COGNITIVE BEHAVIOURAL THERAPY FOR PANIC DISORDER
  • 9.3. HEALTH ECONOMIC EVIDENCE
  • 9.4. FROM EVIDENCE TO RECOMMENDATIONS
• 10. SUMMARY OF RECOMMENDATIONS
  • 10.1. PRINCIPLES OF CARE FOR PEOPLE WITH GENERALISED ANXIETY DISORDER (GAD)
  • 10.2. STEPPED CARE FOR PEOPLE WITH GENERALISED ANXIETY DISORDER
• APPENDICES
  • Appendix 1. Scope for the development of the clinical guideline
  • Appendix 2. Scope for the original anxiety guideline
  • Appendix 3. Declarations of interests by guideline development group members
  • Appendix 4. Stakeholders and experts who submitted comments in response to the consultation draft of the guideline
  • Appendix 5. Researchers contacted to request information about unpublished or soon-to-be published studies
  • Appendix 6. Review questions
  • Appendix 7. Review protocols
  • Appendix 8. Search strategies for the identification of clinical studies
  • Appendix 9. Clinical study data extraction form
  • Appendix 10. Quality checklists for clinical studies and reviews
  • Appendix 11. Search strategies for the identification of health economic evidence
  • Appendix 12. Methodology checklist for economic studies
  • Appendix 13. Network (mixed treatment comparison) meta-analytic methods used in the economic analysis of pharmacological treatments for people with GAD
  • Appendix 14. Economic Plan
  • Appendix 15. Clinical study characteristics tables
  • Appendix 16. Clinical evidence forest plots
  • Appendix 17. Completed methodology checklists for economic studies
  • Appendix 18. GRADE evidence profiles
• REFERENCES
• ABBREVIATIONS

The views presented in this book do not necessarily reflect those of the British Psychological Society, and the publishers are not responsible for any error of omission or fact. The British Psychological Society is a registered charity (no. 229642).