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NICE is currently updating existing guidance published in December 2004 on the management of anxiety. As part of this process, draft recommendations have been published on the NICE website for public consultation.

The 2004 NICE guidance included the care of adults who have panic disorder (with or without agoraphobia) or generalised anxiety disorder (GAD). This update only covers the recommendations on the management of adults with a diagnosis of GAD.

Christine Carson, Programme Director for the Centre for Clinical Practice at NICE, said: “Generalised anxiety disorder (GAD) is a common condition that develops in about 1 in 50 people at some stage in life. It can be recognised by chronic, excessive worry about a number of different events associated with heightened tension. GAD can vary in its severity and complexity for each person, and for this reason it is very important to consider how each patient should be treated individually.

“Since NICE published guidance on the condition in December 2004, new evidence has emerged for how to manage GAD in adults. Therefore this particular section of the guideline was prioritised for updating. The new recommendations include health professionals considering a diagnosis of GAD in patients presenting with anxiety or significant worry, and in those frequently attending primary care who have a chronic physical health problem, or do not have a physical health problem but are seeking re-assurance about somatic symptoms or are repeatedly worrying about a range of different issues.”

The draft recommendations are now available for public consultation. Anyone wishing to submit comments should visit our website for more information on the consultation process.

Draft recommendations issued for consultation include:

• Recognition and communication of the diagnosis of GAD should occur as early as possible to help people with GAD understand the disorder and lead to more effective treatment.
• For people with GAD whose symptoms do not improve with education and active monitoring, offer one or more of the following as a first-line intervention, guided by the person’s preference: individual pure self-help, individual guided self-help or psycho-educational groups1.
• Offer an individual high-intensity psychological intervention or a pharmacological intervention to people with GAD with marked functional impairment or those whose symptoms have not adequately responded to Low-intensity psychological interventions such as pure self-help, guided self help and psycho-educational groups.
• Offer cognitive behavioural therapy (CBT) or applied relaxation to people with GAD with marked functional impairment or those whose symptoms have not adequately responded to Low-intensity psychological interventions
• Do not offer an antipsychotic for the treatment of GAD in primary care.

Notes to Editors

About the guidance

1. The draft guidance will be available on the NICE website (http://guidance.nice.org.uk/CG/WaveR/86) from 20 July, 2010.

About NICE

2. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

3. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

1 A psycho-educational group is a specific type of group therapy that focuses on educating clients about their disorders and ways of coping. Many psycho-educational groups consist of members that all share the same diagnosis. In this case, the education tends to focus on coping with that specific disorder. In other groups, members may have very different diagnoses, and the educational focus is on practical life skills such as living within a community or accepting rules.