What is the role of a healthcare provider regarding anxiety?

Role of Healthcare Providers in Managing Anxiety

Healthcare providers should separate normal from pathological anxiety (Option B), intervene to improve overall functioning (Option C), and intervene to lower anxiety (Option D), as psychotherapy is within the scope of primary care practice through brief evidence-based interventions. 1

Core Provider Responsibilities

Assessment and Differentiation (Option B)

• Providers must distinguish between normal anxiety responses and pathological anxiety disorders that cause marked distress, functional impairment, or reduced quality of life 1, 2
• Anxiety disorders affect 15-20% of primary care patients, with subthreshold symptoms being equally or more common than diagnostic-level disorders 1
• Brief screening measures like the GAD-7 aid in diagnosis with sensitivity of 57.6-93.9% and specificity of 61-97% 2

Functional Improvement (Option C)

• The primary goal is to improve overall functioning and health, not merely symptom reduction, as this is the foundation of the Primary Care Behavioral Health (PCBH) model 1, 3
• Anxiety confers immense burden including functional impairment and reduced quality of life that must be addressed 1
• Focusing only on symptom reduction without addressing functional improvement limits treatment outcomes 3

Symptom Reduction (Option D)

• Providers should actively intervene to lower anxiety symptoms through evidence-based psychological and pharmacological interventions 1, 3
• 65.9% of psychological interventions in primary care effectively reduce anxiety symptoms, with 77.8% maintaining gains at follow-up 1, 3
• First-line treatments include cognitive-behavioral therapy and SSRIs (e.g., sertraline), both showing small to medium effect sizes 3, 2

Why Option A is Incorrect

Psychotherapy is Within Primary Care Scope

• Behavioral health providers embedded in primary care deliver brief psychological interventions as part of the PCBH model, not just referrals 1
• Most primary care patients prefer psychological treatments over medication and are more likely to seek treatment in primary care than specialty mental health settings 1, 3
• Brief CBT adapted for primary care (ideally 6 or fewer sessions of 15-30 minutes) fits within the provider's scope 1

When to Refer vs. Treat

• Providers should deliver brief interventions for subthreshold, mild, or moderate anxiety 1
• Referral to specialty care is reserved for severe or long-standing symptoms requiring intensive treatment, not all psychotherapy 1
• Integration of behavioral health providers into primary care teams is the most promising implementation strategy 3

Clinical Algorithm for Provider Action

Step 1: Screen and Assess

• Use structured assessments (e.g., GAD-7) to identify anxiety disorders 2
• Differentiate normal anxiety from pathological levels requiring intervention 1

Step 2: Educate Patient

• Provide information about symptoms, diagnosis, and evidence-based treatments as a first step 2, 4
• Discuss both psychological and pharmacological options, noting most patients prefer psychological treatments 1, 3

Step 3: Initiate Brief Intervention

• Deliver brief CBT elements including psychoeducation, relaxation techniques, cognitive restructuring, and graduated exposure 3
• Consider self-help materials or computer-delivered interventions for mild symptoms in a stepped care approach 1

Step 4: Monitor and Adjust

• Track progress using standardized anxiety rating scales 3
• Advance to higher intensity treatment (medication, longer therapy, or specialty referral) only if brief interventions fail 1

Common Pitfalls to Avoid

• Relying solely on medication without addressing underlying cognitive and behavioral patterns is ineffective 3
• Anxiety remains undertreated in primary care, with only 28% of patients receiving potentially adequate treatment 3
• Insufficient exposure practice or allowing avoidance behaviors to persist hinders treatment progress 3
• Failing to integrate behavioral health providers into the primary care team limits treatment access 3