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Brief Intervention for Anxiety in Primary Care Patients

Department of Psychiatry and Behavioral Sciences (PRB, JPV, SSW), University of Washington School of Medicine, Harborview Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), Seattle
Department of Psychiatry and Biobehavioral Sciences (AB), University of California, Los Angeles
Department of Psychology (MGC, RR), University of California, Los Angeles
Department of Psychiatry (MJE, GS), University of Arkansas for Medical Sciences, Little Rock
Department of Psychiatry (MBS), University of California, San Diego

Correspondence: Corresponding author: Peter Roy-Byrne, MD, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine at Harborview Medical Center, 325 9th Ave, Box 359911, Seattle, WA 98104 (E-mail: roybyrne{at}u.washington.edu)

To address the difficulty of assessing and managing multiple anxiety disorders in the primary care setting, this article provides a simple, easy-to-learn, unified approach to the diagnosis, care management, and pharmacotherapy of the 4 most common anxiety disorders found in primary care: panic, generalized anxiety disorders, social anxiety disorders, and posttraumatic stress disorder. This evidence-based approach was developed for an ongoing National Institute of Mental Health-funded study designed to improve the delivery of evidence-based medication and psychotherapy treatment to primary care patients with these anxiety disorders. We present a simple, validated method to screen for the 4 major disorders that emphasizes identifying other medical or psychiatric comorbidities that can complicate treatment; an approach for initial education of the patient and discussion about treatment, including provision of some simple cognitive behavioral therapy skills, based on motivational interviewing/brief intervention approaches previously used for substance use disorders; a validated method for monitoring treatment outcome; and an algorithmic approach for the selection of initial medication treatment, the selection of alternative or adjunctive treatments when the initial approach has not produced optimal results, and indications for mental health referral.

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