What non-pharmacological interventions are effective for managing anxiety disorders in primary care?

Effective non-pharmacological interventions for managing anxiety disorders in primary care follow a stepped-care model, starting with less intensive options ¹,².

• Step 1: Initial Assessment and Education

  For all known and suspected presentations of generalised anxiety disorder (GAD), initial management involves identification and assessment ¹. Education about GAD and available treatment options should be provided ¹,². Active monitoring of the person's symptoms and functioning is also recommended ¹,².

• Step 2: Low-Intensity Psychological Interventions

  If GAD symptoms have not improved after education and active monitoring, low-intensity psychological interventions are offered ¹,². These include:

  • Individual non-facilitated self-help: This involves self-administered written or electronic materials, usually based on cognitive behavioural therapy (CBT) principles, worked through systematically over at least 6 weeks ¹,². Minimal therapist contact, such as occasional short telephone calls of no more than 5 minutes, may be involved ¹,².
  • Individual guided self-help: This uses suitable written or electronic materials, supported by a trained practitioner who facilitates the programme and reviews progress ¹,². It typically consists of 5–7 weekly or fortnightly face-to-face or telephone sessions, each lasting 20–30 minutes ¹,².
  • Psychoeducational groups: These groups are based on CBT principles, designed to be interactive, and encourage observational learning through presentations and self-help manuals ¹,². They are conducted by trained practitioners, usually consisting of 6 weekly 2-hour sessions ¹,².
• Step 3: High-Intensity Psychological Interventions

  For people with GAD and marked functional impairment, or those whose symptoms have not improved after Step 2 interventions, a high-intensity psychological intervention may be offered ¹,². These include Cognitive Behavioural Therapy (CBT) or applied relaxation ¹,². These interventions usually consist of 12 to 15 weekly sessions, each lasting 1 hour, and are delivered by trained and competent practitioners ¹.

• General Self-Care Advice

  For all people with GAD managed in primary care, it is beneficial to consider providing advice on self-care strategies ². This includes advice on sleep hygiene, such as maintaining consistent sleep times, avoiding alcohol after 6 pm, and caffeine after 3 pm ². The benefits of regular exercise should also be discussed, as it can improve overall health and anxiety symptoms, with high-intensity regimens potentially being more effective ². Information about support groups, where available, should also be offered ¹.