How should I approach the management of anxiety disorders in patients who are hesitant to start medication?

Approach to managing anxiety disorders in patients hesitant to start medication:

• Begin with education and active monitoring: Identify and assess the anxiety disorder, provide education about the condition and treatment options, and monitor symptoms without immediately starting medication ¹.
• Offer low-intensity psychological interventions first: For generalised anxiety disorder (GAD), consider individual non-facilitated or guided self-help and psychoeducational groups as initial steps before medication ¹.
• Discuss treatment options thoroughly: Before prescribing medication, discuss the benefits and potential side effects, addressing common concerns such as fears of addiction and side effects to support informed decision-making ¹.
• Respect patient preferences and previous treatment experiences: Consider the patient’s preferences and any prior treatment outcomes when deciding on management strategies ¹.
• Offer high-intensity psychological interventions: If low-intensity interventions are insufficient or the patient declines medication, offer cognitive behavioural therapy (CBT) tailored to the anxiety disorder, which is effective and preferred by many patients ¹,².
• For social anxiety disorder, prioritise individual CBT: Individual CBT based on established models is recommended over group CBT or medication for those hesitant about drugs ².
• Address reasons for declining medication: Explore and discuss the patient’s reasons for hesitancy, providing reassurance and information to help them make an informed choice ².
• Consider alternative psychological therapies: If both CBT and medication are declined, short-term psychodynamic psychotherapy may be offered as an alternative ².
• Maintain ongoing support and monitoring: Continue to monitor symptoms and functional impairment, and revisit treatment options as appropriate, ensuring shared decision-making throughout ¹.