Summary

Effective treatment for anxiety disorders does exist and we have good evidence that symptoms and disability can be significantly reduced for the majority of patients who complete treatment. Furthermore, treatment protocols of randomized controlled trials and the associated patient improvement can be replicated in routine care, given the availability of clinicians with appropriate expertise. However, we can also present evidence that many patients who fail to receive such specialist treatment have a poor long-term outcome when treated in the community. This problem is a serious challenge for mental health services, for these services are unable to offer specialist treatment programs to the majority of individuals in the community who meet diagnostic criteria for an anxiety disorder. But does every individual who meets such criteria require specialist treatment? Data from a community survey and from patients attending a specialist anxiety disorders unit are presented in an attempt to answer the following questions: (1) does the level of disability associated with a diagnosis in the community match the level of disability of patients who reach specialist care?; (2) are different experiences of an anxiety disorder in the general population associated with different levels of disability?; and (3) if we are able to identify different levels of ‘disorder’ and disability, are these levels related to health service utilization and the perceived need for treatment? Answering these questions will provide the first step towards determining whether different levels of care might produce comparable outcomes in individuals with different levels of disorder and disability.

Introduction

Cognitive-behavioral treatments effectively reduce the panic, anxiety and associated avoidance behavior in panic disorder and agoraphobia, as well as the social anxiety and avoidance behavior in social phobia.