This page will explore clinical tools and DVA treatment options for veterans with anxiety.

 

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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. For more information on Australian veteran prevalence rates:

Anxiety disorders and their unique characteristics are:

  • generalised anxiety disorder (GAD) - 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 - repeated unexpected panic attacks, combined with persistent concern about having another attack or the consequences of the attack
  • agoraphobia - marked fear and/or avoidance of situations (such as crowded places) where escape might be difficult or help might not be available in the event of a panic attack
  • social anxiety - fear and avoidance of social or performance situations (such as 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) - frequent unwanted thoughts that are often accompanied by compulsive actions in an attempt to reduce anxiety
  • specific phobias - excessive fear and avoidance of a stimulus to such an extent that it causes distress and interferes with daily functioning

Treatment information

Recommended treatments

Cognitive behavioural therapy (CBT) is the most effective treatment for veterans with anxiety disorders.

The key components of CBT that are common to the treatment of anxiety disorders include:

  • 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, such as 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 (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

    Assessment and measures

    • Screening Questions generalised anxiety disorder, panic disorder and agoraphobia, and social anxiety may indicate that further assessment is required
    • There are several standardised assessment tools for anxiety that can help you develop a treatment plan, and assess symptom severity or treatment progress.
    • The Depression, Anxiety and Stress Scale - DASS 21 is an assessment tool for depression, anxiety and stress symptoms.
    • The GAD-7 and PSWQ (PDF) assess generalised anxiety disorder symptoms.
    • The Fear Questionnaire (FQ) (PDF) helps identify situations that trigger anxiety.

    Recommended readings and online resources

    Publications

    • DVA Evidence Compass: Summarises recent research on the effectiveness of stepped care for the delivery of treatment for depression and anxiety.
    • Mental Health Advice Book: A resource developed for clinicians who work with veterans

    Multimedia

    • Podcasts: The Anxiety and Depression Association of America interviews experts on a range of topics related to anxiety and depression.