Step 4: Care for people with anxiety spectrum disorders in specialist mental health services

  • Reassess the patient, their environment and their social circumstances. Evaluate:  

    • previous treatments, including effectiveness and concordance  

    • any substance use, including nicotine, alcohol, caffeine and recreational drugs. comorbidities

    • day to day functioning  

    • social networks  

    • continuing chronic stressors  

    • the role of agoraphobic and other avoidant symptoms

  • Undertake a comprehensive risk assessment.  

  • Develop an appropriate risk management plan.




Generalised Anxiety Disorder and Panic Disorder

  • Consider
    • treatment of comorbid conditions
    • CBT with an experienced therapist if not offered already, including home-based CBT if attendance at clinic is difficult
    • structured problem solving
    • full exploration of pharmaco-therapy
    • day support to relieve carers and family members
    • referral for advice, assessment or management to tertiary centres.

Social Phobia

  • Secondary care management consists of intensified and individualised psychotherapies with specialist follow-up, specialist tailoring of drug regimens, and treatment of comorbid conditions


To carry out these evaluations, and to develop and share a full formulation, more than one session may be required and should be available.


Ensure accurate and effective communication between all healthcare professionals – particularly between primary care clinicians (GP and teams) and secondary care clinicians (community mental health teams) if there are existing physical health conditions that also require active management.


If Anxiety Spectrum Disorder is causing a severe risk of suicide/self harm, go to Step 5