Table 1.

Assessment and Treatment Approach, with Strength of Recommendation Taxonomy Levels A, B, C

Clinical FocusSORT Criteria17Assessment and Treatment Approach
Screening and AssessmentBFour anxiety disorder questions: ADD
ATwo depression questions
AAlcohol screen: AUDIT-C
CPain: one question
BSuicide evaluation: thoughts, plan, intent, reasons for living
BBipolar disorder: MDQ good specificity, poor sensitivity
Severity of AnxietyAGAD-7: symptom severity
BOASIS: functional impairment plus global symptoms
Treatment HistoryCSpecify response: little, moderate, a lot
Engaging the Patient-Brief InterventionBExpectations for outcome: 0–10
BExpectation for role in outcome: 0–10
CUse these and MI techniques
CHelp patient weight positives/negatives
Education and SkillsCFocus on avoidance: make list of avoided activities
CCognitive restructuring to help with exposure
CBreathing techniques to help with exposure
CExposure (easiest to hardest) over 8–12 weeks
Initial MedicationASSRI/SNRI: start low and go slow, but go
BBenzodiazepines: if >4 times per week, keep taking for 12 weeks, then taper slowly
BBenzodiazepines: may use as monotherapy in select cases
Treatment Resistant AnxietyCAdd another antidepressant or benzodiazepine
BConsider in rare cases adding atypical neuroleptic
Medication DiscontinuationCAfter 1 year of therapy
CDepending on comorbid psych and medical illness, avoidance, ongoing stress
  • ADD, Anxiety Depression Detector; AUDIT-C, Alcohol Use Disorder Identification Test; MDQ, Mood Disorders Questionairre; GAD, generalized anxiety disorder; OASIS, Overall Anxiety Severity and Impairment Scale; MI, motivational interviewing; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin-norepinephrine reuptake inhibitor.