What criteria should a clinician and patient use to determine that therapeutic goals have been met and the client with anxiety can be discharged from active treatment?

Discharge Criteria for Clients with Anxiety

Discharge from active treatment for anxiety should occur when the patient demonstrates sustained symptom reduction with standardized scores in the mild or minimal range, restoration of functional abilities in major life domains, and confidence in maintaining gains independently—typically after 8-12 weeks of stable improvement following successful treatment.

Core Discharge Criteria

Symptom Resolution

• Sustained reduction in anxiety symptoms documented by standardized validated instruments showing scores in the mild or minimal range for at least 8-12 weeks 1
• Absence of significant distress that previously interfered with daily functioning 2
• Resolution of physical manifestations including palpitations, shortness of breath, and dizziness that characterized the anxiety presentation 2

Functional Restoration

• Return to baseline functioning in self-care, usual activities, and mobility without anxiety-related limitations 1
• Restoration of social and occupational pursuits that were previously impaired by anxiety symptoms 3
• Ability to engage in previously avoided situations without significant distress or safety behaviors 4

Treatment Response Documentation

• Regular assessment using standardized instruments at baseline, 4 weeks, 8 weeks, and end of treatment showing progressive improvement 1, 4
• Clinically significant improvement by week 6 and maximal benefit achieved by week 12 if pharmacotherapy was used 4
• Patient satisfaction with treatment outcomes and symptom relief 1

Behavioral and Cognitive Indicators

Skill Acquisition and Independence

• Demonstrated ability to use anxiety management techniques independently, including breathing techniques, progressive muscle relaxation, grounding strategies, and mindfulness practices 4
• Successful cognitive restructuring of catastrophic thoughts without ongoing therapist support 4
• Reduction or elimination of reassurance-seeking and body checking behaviors if health anxiety was present 4

Environmental Stability

• Primary environmental sources of anxiety are no longer present or patient demonstrates effective coping with ongoing stressors 1
• Absence of new significant life stressors that could precipitate relapse 1

Medication Tapering Considerations

Timing for Medication Discontinuation

• Symptoms under control for 6-12 months before considering medication taper 5
• Gradual tapering process implemented collaboratively with the patient 1
• Longer tapering periods required for benzodiazepines if these were used, though they should have been time-limited 1

Monitoring During Taper

• Close observation during dose reduction to assess for symptom recurrence 1
• Patient confidence in managing potential withdrawal symptoms and understanding that these can be safely managed 1

Risk Assessment Before Discharge

Factors Requiring Continued Treatment

• Presence of comorbid depression that has not fully remitted, as this should be prioritized 1
• History of multiple relapses or chronic anxiety disorder suggesting need for maintenance treatment 3
• Ongoing substance use or other psychiatric comorbidities 1
• Membership in socially or economically marginalized groups with limited access to re-engagement if needed 1

Relapse Prevention Planning

• Patient education about early warning signs of symptom recurrence and when to contact the clinician 1
• Clear plan for re-accessing care if symptoms worsen, avoiding barriers to follow-through 1
• Family psychoeducation completed about anxiety symptoms and what warrants clinical attention 4

Documentation Requirements

Treatment Response Evidence

• Pre- and post-treatment standardized assessment scores demonstrating clinically significant improvement 1
• Documentation of treatment adherence throughout the course of therapy 1
• Patient-reported satisfaction with treatment outcomes and readiness for discharge 1

Common Pitfalls to Avoid

Do not discharge prematurely if symptoms have only been stable for less than 8 weeks, as anxiety disorders are chronic conditions with high relapse potential 3. Ensure the patient has not simply learned to suppress anxiety symptoms but has genuinely developed adaptive coping mechanisms 4. Avoid abandonment by ensuring the patient knows how to re-access care if needed, rather than making "cold referrals" or abrupt terminations 1.