Managing anxiety and associated disorders in adults and young people

Manage an anxiety disorder in adults and young people with psychosocial interventions and, when required, drug treatment.

At the time that an anxiety disorder is diagnosed, provide psychoeducation to the patient: discuss the diagnosis (including its natural history with and without treatment) with the patient and, if appropriate, their family, carers or significant others; identify acute or chronic stressors that can be addressed with psychosocial interventions; and explain the available treatments, the likelihood of response to treatment and possible adverse effects. Showing support and providing reassurance can lessen anxiety symptoms and encourage treatment adherence.

Psychoeducation should be accompanied by support to help the patient modify their lifestyle, if necessary. Lifestyle modification can include improving sleep hygiene, undertaking adequate physical activity (see below), consuming a healthy diet (see below), minimising alcohol and caffeine consumption, reducing stress, reviewing daily routines and encouraging social support.

Exercise may be a helpful adjunct for people experiencing anxiety¹; exercise may decrease panic symptoms by lowering a person’s sensitivity to internal symptoms that are similar to panic, and their sensitivity to carbon dioxide (which plays a role in inducing anxiety symptoms).

Anxiety can affect eating habits (eg patients may restrict their eating or overeat in response to their symptoms). Enquire about patients’ specific eating habits, address any issues that may be related or contributing to their anxiety, and provide advice about a healthy and balanced diet².

Use a shared decision-making approach when discussing treatment options (psychosocial interventions, pharmacotherapy or both) with patients. Psychosocial interventions or pharmacotherapy may be appropriate as initial treatment options, depending on the patient and the specific anxiety disorder being treated—see Common anxiety and associated disorders for types of anxiety disorders.

Managing patients with anxiety disorders may involve the concurrent use of psychosocial and pharmacological treatments. Historically there were concerns that combining benzodiazepines with psychosocial treatment may lead to poorer outcomes. It was thought that patients may attribute a reduction in anxiety to drug use rather than to exposure therapy, and experience a re-emergence of anxiety after stopping the drug. However, this association has now been challenged and there may be circumstances where patients use both treatment modalities simultaneously. Clinicians involved in the patient’s care should collaborate to ensure that psychosocial interventions and pharmacotherapy work synergistically to support the patient in managing their anxiety disorder.

Anxiety disorders are often relapsing or chronic conditions that require an adequate duration of therapy for the benefits to be evident. Symptoms may not completely resolve regardless of the type of therapy used.

When evaluating treatment options for a young person, also consider:

• there are few data on psychotropic use in young people because young people are poorly represented in clinical trials
• young people are more susceptible to developing activation and suicidal thoughts when starting treatment with an antidepressant; this effect has most often been observed with selective serotonin reuptake inhibitors (SSRIs)
• if pharmacotherapy is used, it should ideally be started by a clinician with expertise in using psychotropics in young people.

For treatment considerations for females of childbearing potential, including advice on contraception, preconception planning and psychotropic use, see here.

For considerations in managing anxiety disorders in the perinatal period, see here or for considerations in partners, see here.

For management of anxiety and associated disorders in patients receiving palliative care, see here.