Question 1

When should I manage anxiety in primary care vs refer to a specialist?

Accepted Answer

The NICE stepped-care model provides the structural logic: Step 1 (psychoeducation, active monitoring) → Step 2 (guided self-help, digital CBT) → Step 3 (formal CBT or SSRI) → Step 4 (specialist referral). Primary care is appropriate for mild-moderate anxiety (GAD-7 5-14) without active suicidal ideation. Specialist referral is indicated for: active suicidal ideation with plan, severe functional impairment, psychotic features, complex diagnostic uncertainty, treatment resistance after adequate first-line trials, active severe substance dependence, or need for specialist medications (MAOIs, antipsychotic augmentation). The global treatment gap is stark: only 9.8% of people with anxiety disorders receive minimally adequate treatment *(Alonso 2018; PMID 29356216; ch07/lesson-01)*. The therapy desert is real — 160 million Americans live in Mental Health Professional Shortage Areas.

Question 2

What's the stepped care model for anxiety?

Accepted Answer

The NICE stepped-care model provides the structural logic: Step 1 (psychoeducation, active monitoring) → Step 2 (guided self-help, digital CBT) → Step 3 (formal CBT or SSRI) → Step 4 (specialist referral). Primary care is appropriate for mild-moderate anxiety (GAD-7 5-14) without active suicidal ideation. Specialist referral is indicated for: active suicidal ideation with plan, severe functional impairment, psychotic features, complex diagnostic uncertainty, treatment resistance after adequate first-line trials, active severe substance dependence, or need for specialist medications (MAOIs, antipsychotic augmentation). The global treatment gap is stark: only 9.8% of people with anxiety disorders receive minimally adequate treatment *(Alonso 2018; PMID 29356216; ch07/lesson-01)*. The therapy desert is real — 160 million Americans live in Mental Health Professional Shortage Areas.

Question 3

When is watchful waiting appropriate for sub-threshold anxiety?

Accepted Answer

The NICE stepped-care model provides the structural logic: Step 1 (psychoeducation, active monitoring) → Step 2 (guided self-help, digital CBT) → Step 3 (formal CBT or SSRI) → Step 4 (specialist referral). Primary care is appropriate for mild-moderate anxiety (GAD-7 5-14) without active suicidal ideation. Specialist referral is indicated for: active suicidal ideation with plan, severe functional impairment, psychotic features, complex diagnostic uncertainty, treatment resistance after adequate first-line trials, active severe substance dependence, or need for specialist medications (MAOIs, antipsychotic augmentation). The global treatment gap is stark: only 9.8% of people with anxiety disorders receive minimally adequate treatment *(Alonso 2018; PMID 29356216; ch07/lesson-01)*. The therapy desert is real — 160 million Americans live in Mental Health Professional Shortage Areas.

Question 4

What does collaborative care look like?

Accepted Answer

The NICE stepped-care model provides the structural logic: Step 1 (psychoeducation, active monitoring) → Step 2 (guided self-help, digital CBT) → Step 3 (formal CBT or SSRI) → Step 4 (specialist referral). Primary care is appropriate for mild-moderate anxiety (GAD-7 5-14) without active suicidal ideation. Specialist referral is indicated for: active suicidal ideation with plan, severe functional impairment, psychotic features, complex diagnostic uncertainty, treatment resistance after adequate first-line trials, active severe substance dependence, or need for specialist medications (MAOIs, antipsychotic augmentation). The global treatment gap is stark: only 9.8% of people with anxiety disorders receive minimally adequate treatment *(Alonso 2018; PMID 29356216; ch07/lesson-01)*. The therapy desert is real — 160 million Americans live in Mental Health Professional Shortage Areas.

Question 5

How do I build an efficient referral pathway?

Accepted Answer

The NICE stepped-care model provides the structural logic: Step 1 (psychoeducation, active monitoring) → Step 2 (guided self-help, digital CBT) → Step 3 (formal CBT or SSRI) → Step 4 (specialist referral). Primary care is appropriate for mild-moderate anxiety (GAD-7 5-14) without active suicidal ideation. Specialist referral is indicated for: active suicidal ideation with plan, severe functional impairment, psychotic features, complex diagnostic uncertainty, treatment resistance after adequate first-line trials, active severe substance dependence, or need for specialist medications (MAOIs, antipsychotic augmentation). The global treatment gap is stark: only 9.8% of people with anxiety disorders receive minimally adequate treatment *(Alonso 2018; PMID 29356216; ch07/lesson-01)*. The therapy desert is real — 160 million Americans live in Mental Health Professional Shortage Areas.

PsychHQ

Stepped Care for Anxiety: When to Manage in Primary Care vs. Refer to a Specialist