NHS Evidence have published an evidence update on generalised anxiety disorder in adults. Evidence updates are summaries of selected high quality evidence that has appeared since the relevant guideline was published, in this case NICE clinical guideline 113 ‘Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: management in primary, secondary and community care’ (2011).

The NICE guideline has ‘panic disorder’ in the title, but the scope of the 2011 update did not include panic disorder, so that condition is also missing from this evidence update.  That’s not confusing at all is it?

The update authors conducted a systematic search for evidence published from July 2010 to April 2012.  They found 5 new pieces of evidence to highlight (2 systematic reviews and 3 randomised controlled trials) around the following themes:

• Principles of care for people with generalised anxiety disorder (GAD)
• Stepped care for people with GAD
• Principles of care for people with panic disorder
• Stepped care for people with panic disorder

None of the evidence found has any significant impact on the existing guidance, but here are the highlights:

Step 2: Diagnosed generalised anxiety disorder (GAD) that has not improved after step 1 interventions

• Low-intensity psychological interventions for GAD
  • Internet-based cognitive behavioural therapy (CBT) may be effective for treating GAD whether support is given by clinicians or non-clinicians 

Step 3: GAD with marked functional impairment or that has not improved after step 2 interventions

• Meta-cognitive therapy and intolerance of uncertainty therapy
  • Meta-cognitive therapy and intolerance of uncertainty therapy may be effective methods of CBT in GAD
• Treatments for GAD in older people
  • Psychotherapy and drug treatment may both have a higher likelihood of being effective for treating GAD in older people compared with control; however, the effect size of CBT may not be significantly larger than control 

Step 4: Complex, treatment-refractory GAD and very marked functional impairment or high risk of self-harm

• Collaborative care
  • Collaborative care with patient’s choice of drug treatment, CBT or both drug treatment and CBT may be effective in treating GAD

Links

Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: management in primary, secondary and community care. NICE clinical guideline 113, 2011.

Robinson E, Titov N, Andrews G et al. Internet treatment for generalized anxiety disorder: a randomized controlled trial comparing clinician vs. technician assistance. PloS One 2010;5: e10942.

van der Heiden C, Muris P, van der Molen HT (2012) Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder. Behaviour Research and Therapy 2012;50:100–9.

Gonçalves DC, Byrne GJ Interventions for generalized anxiety disorder in older adults: Systematic review and meta-analysis. Journal of Anxiety Disorders 2012:26;1–11.

Gould RL, Coulson MC, Howard RJ. Efficacy of cognitive behavioural therapy for anxiety disorders in older people: a meta-analysis and meta-regression of randomized controlled trials. Journal of the American Geriatrics Society 2012:60;218– 229.

Craske MG, Stein MB, Sullivan G et al. Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care. Archives of General Psychiatry 2011:68;378–88.