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Good morning, welcome to today's session on Worry Management, which forms part of your Module 3 content.

Please get in touch with Rosie or Zoe with any questions about today's content.

R.Dunn@exeter.ac.uk

Z.Mason-Priscott@exeter.ac.uk

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Today's slides can be downloaded from ELE.

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This guideline covers the care and treatment of people aged 18 and over with generalised anxiety disorder (chronic anxiety) or panic disorder (with or without agoraphobia or panic attacks). It aims to help people achieve complete relief of symptoms (remission), which is associated with better functioning and a lower likelihood of relapse.

In June 2020, we updated the information on the classes of antidepressants suitable for longer-term management of panic disorder and added links to MHRA advice on citalopram and selective serotonin reuptake inhibitors.

In July 2019, we updated footnotes and tables in this guideline to reflect a change in the law relating to pregabalin and gabapentin. As of 1 April 2019, because of a risk of abuse and dependence pregabalin and gabapentin are controlled under the Misuse of Drugs Act 1971 as class C substances and scheduled under the Misuse of Drugs Regulations 2001 as schedule 3.

MHRA advice on antiepileptic drugs in pregnancy: In July 2022, we linked to the MHRA safety advice on pregabalin risks during pregnancy in the recommendation on drug treatment for people with generalised anxiety disorder who cannot tolerate selective serotonin reuptake inhibitors or serotonin-noradrenaline reuptake inhibitors.

Recommendations

This guideline includes recommendations on:

Who is it for?

Healthcare professionals

Adults with a working diagnosis of generalised anxiety disorder or panic disorder (with or without agoraphobia), and their families and carers

Is this guideline up to date?

We checked this guideline in March 2020. We found no new evidence that affects the recommendations of this guideline but have updated information on medicines prescribed for anxiety.

Guideline development process
How we develop NICE guidelines
This guideline was previously called generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: management in primary, secondary and community care.

This guideline updates and replaces NICE guideline CG22 (December 2004) and evidence summary ESUOM12.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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Generalised anxiety disorder and panic disorder in adults: management

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This guideline covers the care and treatment of people aged 18 and over with generalised anxiety disorder (chronic anxiety) or panic disorder (with or without agoraphobia or panic attacks).

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9 . Scenario 1 (introducing Worry Management)

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9 . Scenario 1 (introducing Worry Management)

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Session 1 of worry management: Introducing the intervention, psycho-education and the worry diary

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Here is the adult 'managing your worries' CEDAR booklet. Please do feel free to have a browse through this.

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10. Scenario 2 - reviewing the worry diary

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10. Scenario 2 - reviewing the worry diary

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Session 2: Reviewing the worry diary and introducing the classification of worries

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10a. Homework (reviewing the worry diary) 

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10a. Homework (reviewing the worry diary) 

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Supporting resource for scenario two.

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Session 3: Introducing and scheduling worry time

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11a. Homework for scenario 3 to help guide worry time

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11a. Homework for scenario 3 to help guide worry time

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13. practicing mindfulness at home with children

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13. practicing mindfulness at home with children

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Support for Parents from Action For Children

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How to practise mindfulness at home with children - Support for Parents from Action For Children

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Mindfulness means being aware of the present moment. These activities help children feel calm and present.

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14. guidance for parents on support children with worries

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14. guidance for parents on support children with worries

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USING THE WORRY TREE TECHNIQUE WITH CHILDREN

The worry tree technique is appropriate for children with a little help from an adult, depending on their age. An important part of the worry tree technique is taking the worry out of your head and writing it down. Doing this with children is very effective. Together, you can write their worries down on an app, a piece of paper, or by drawing a picture.

Once a child has shared what it is that they are worrying about, reassure them. Don't try to resolve it for them or start coming up with ideas. It's more effective to support children with coming up with their own ideas, so ask them a few questions.

You might ask them:

What does it feel like when you're anxious? Help them start to recognise the signs.

What's the worst thing you can imagine happening? It's often not as bad as we think it might be.

Can you do anything about it? Usually there is something they can do. You might have to ask them some more questions to help them find the solution, depending on the scenario.

If their worry is something they can't do anything about, then we can support them in distracting themselves instead. Just writing the worry down is sometimes all they need for them to get distracted and go on with their day. At other times you might need to support them more, by finding something that they enjoy doing. Movement can help here as it takes us out of our heads and into our bodies.

When there is something they can do about their worry, the next thing is to make a plan for what they're going to do. Getting them to write this down, draw it, or log it on an app like WorryTree helps to turn this plan into something real. Follow up with them later to see if they took the action they had planned and find out how it went.

Encourage them to think about what they were worrying about, and whether it actually came to pass. Most of the time our worries don't turn out as bad as we thought they would be.

There are some beautiful drawings of the worry tree technique online, and we'll link a few in the notes below. These can be a great way to introduce children to the idea.

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How to Support Your Child's Worries: A Guide for Parents and Carers - WorryTree

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We'll explore a powerful approach that helps children and young people navigate their worries. An approach which also equips them with the resilience to face life's worries head-on. It's a method that empowers children and it all starts with the idea of why 'fixing' may not be the solution.