NICE: ‘Primary care must improve understanding of anxiety’

Primary care has had a “lack of understanding” around anxiety disorders, which a new National Institute for Health and Care Excellence (NICE) standard aims to fix. 

Anxiety disorders are types of common mental health disorders that include generalised anxiety disorder, social anxiety disorder, post-traumatic stress disorder, panic disorder, obsessive-compulsive disorder and body dysmorphic disorder, all of which are covered in the NICE quality standard. 

Anxiety disorders are associated with significant long-term disability and can have a lifelong course of relapse and remission. 

In children and young people they are also associated with an increased risk of other serious mental health problems, including depression and substance misuse. 

A snapshot of anxiety disorders in adults in England over a 1-week period carried out by the Office of National Statistics in 2007 found that 4.4% of adults had generalised anxiety disorder, 3% had post-traumatic stress disorder, 1.1% had panic disorder and 1.1% had obsessive-compulsive disorder. 

NICE claims that recognition of anxiety disorders is poor, particularly in primary care and as a consequence only a small minority of people experiencing anxiety disorders ever receive treatment. 

When anxiety disorders are diagnosed, treatment is often limited to the prescription of drugs rather than offering evidence-based psychological interventions, NICE has said. 

Nicky Lidbetter, Anxiety UK CEO, said: “Anxiety UK welcomes the anxiety disorders NICE quality standard. It recognises the experience many affected by anxiety have had, including a lack of understanding in primary care, treatment being limited to the prescription of drugs and the patient’s anxiety presentation being frequently seen as secondary to depression when anxiety is the primary presenting problem.


Professor Gillian Leng, director of health and social care at NICE said: “Anxiety disorders are surprisingly common, and many people will experience one or more periods of this type of illness during their life, or live and work with others who are affected. Yet many people who experience them do not receive the help or support they require. This is often because their symptoms are not picked up or the treatment they need is not available. 

“Receiving an accurate and timely diagnosis, then following this up with the right type of care can be key in determining whether someone progresses towards recovery or whether their mental health further deteriorates.” 

The NICE quality standard calls for: 

 – People with a suspected anxiety disorder should receive an assessment that identifies whether they have a specific anxiety disorder, the severity of symptoms and associated functional impairment. Accurate diagnosis of a person’s specific anxiety disorder can help them understand their condition and ensure they are offered the most appropriate treatment at the earliest opportunity. 

 – Evidence-based psychological interventions should be offered as first-line treatments in preference to drug prescriptions.  Using the stepped care model allows the least intensive intervention that is appropriate for a person to be provided first, and people can step up or down the pathway according to changing needs and in response to treatment. 

 – People with anxiety disorders should not be prescribed benzodiazepines or antipsychotics unless there are specific clinical reasons why these treatments may be of short term benefit (for example, in anxiety disorder crisis). 

 – People receiving psychological or pharmacological treatment for an anxiety disorder should have their response to treatment recorded at each treatment session. This not only ensures that the effectiveness of treatment can be assessed and adjustments made if needed, but also provides an opportunity for the health practitioner to monitor other outcomes, such as the person’s ability to continue or return to employment. 

The full quality standard is available to view on the NICE website