Diagnosis and prevalence
Anxiety disorders are the most common mental health disorders in Australia, with approximately one in four people experiencing an anxiety disorder in their lifetime. Anxiety disorders and their unique characteristics are listed below.
- Generalised anxiety disorder (GAD) involves persistent and excessive anxiety and worry about a range of events, and other symptoms such as restlessness, fatigue, irritability, concentration or sleep difficulties.
- Panic disorder involves repeated unexpected panic attacks, combined with persistent concern about having another attack or the consequences of the attack.
- Agoraphobia involves marked fear and/or avoidance of situations (e.g., crowded places) where escape might be difficult or help might not be available in the event of a panic attack.
- Social anxiety involves fear and avoidance of social or performance situations (e.g., meeting new people, speaking, eating or drinking in public) in which a person worries about being scrutinised or negatively evaluated by others.
- Obsessive-compulsive disorder (OCD) involves frequent unwanted thoughts that are often accompanied by compulsive actions in an attempt to reduce anxiety.
- Specific phobias involve excessive fear and avoidance of a stimulus to such an extent that it causes distress and interferes with daily functioning.
Cognitive behavioural therapy (CBT) is the most effective treatment for veterans with anxiety disorders.
- Cognitive therapy: this assists in identifying and challenging the negative and catastrophic beliefs that trigger and maintain feelings of anxiety and worry. For example, in the case of social anxiety, cognitive therapy would be used to challenge the person’s beliefs about perceived negative evaluation from others.
- Anxiety management: This helps to manage the physical consequences of anxiety with strategies such as breathing retraining and progressive muscle relaxation.
- Exposure therapy: this involves graded exposure to places, activities and situations currently avoided or endured with significant distress. In the case of panic, exposure can be to internal cues. e.g., induce hyperventilation in order to challenge fear about its dangerousness.
- Further information on anxiety disorders and recommended treatments is available in the Mental Health Advice Book that was developed for clinicians who work with veterans.
- Access the CBT-based treatment workbooks to use with veterans who have an anxiety disorder.
Newer antidepressants (i.e., SSRIs, SNRIs) may be beneficial for veterans who are unable to engage in psychological treatment or when it is unavailable.
New treatment approaches: Mindfulness-based therapies
Over recent decades, mindfulness-based therapies (MBT) have become increasingly popular. Despite its popularity, more research is needed before conclusions can be drawn about its benefit for people with anxiety disorders. MBT adds elements of eastern philosophies (e.g., Buddhism and yoga) to CBT, and refers to therapies such as acceptance and commitment therapy (ACT), mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR). Further information is available in this meta-analytic review.
Clinical treatment guidelines
- WHO Management of mental health disorders: Anxiety disorders chapters.
- Australian and New Zealand clinical practice guideline (PDF) for the treatment of panic disorder and agoraphobia.
- NICE clinical guidelines: Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: Management in primary, secondary and community care. Social anxiety disorder: recognition, assessment and treatment of social anxiety disorder.
Assessment and measures
There are several standardised assessment tools for anxiety that can help you develop a treatment plan, and assess symptom severity or treatment progress. The GAD-7 and PSWQ (PDF) assess Generalised anxiety disorder symptoms, while the Fear Questionnaire (PDF) helps identify situations that trigger anxiety. Other measures of psychosocial functioning include:
- DASS21 (PDF) .
- Audit (PDF) for alcohol use.
- DAST (PDF) for other substance use.
- WHOQoL-Bref for measure of overall quality of life.
Recommended readings and online resources
- Prevalence of anxiety disorders in the Australian population (PDF) .
- Medical Journal of Australia anxiety and depression supplements: provides access to peer-reviewed articles on depression, anxiety and other comorbid conditions.
- DVA Evidence Compass: Summarises recent research on the effectiveness of stepped care for the delivery of treatment for depression and anxiety.
- Podcasts: The Anxiety and Depression Association of America interviews experts on a range of topics related to anxiety and depression.
The following are recently published papers of interest. They have not been reviewed or validated by the Department of Veteran's Affairs.
The objective of this study was to describve and explore the associations between PTSD symptoms, experience of military sexual trauma, expectancies for alcohol use and coping skills in predicting drinkign behaviour. Findings highlight the importance of considering the function of alcohol use when delivering clinical interventions.
Milanak, M.E., Gros, D.F., et al, "Prevalence and features of generalized anxiety disorder in Department of Veteran Affairs (US) primary care settings", Psychiatry Research (May 2013)
This study investigated the prevalence, comorbidity, physical and mental health impairment and healthcare utilisation of veterans suffering from Generalised Anxiety Disorder, as well as comparing symptoms of GAD and PTSD. Findings showed evidence of high prevalence of GAD in veterans and highlight the need for improved recognition, assessment and treatments for GAD.
- Home-based exposure monitoring sheet (PDF)
- Subjective units of distress scale (PDF)
- Progressive muscle relaxation (PDF)
- Breathing retraining instructions (PDF)
- CRUfAD patient treatment manual for GAD, OCD, panic disorder, social anxiety and specific phobias
- Centre for Clinical Interventions (CCI) consumer CBT-based workbooks for panic, social anxiety, health anxiety and worry