Global Experts in Psychiatry and Psychotherapy Reach a Consensus on the Definition of Treatment-Resistant Anxiety Disorder

38 psychiatrists and psychotherapists from around the world have joined their efforts to reach a consensus on internationally agreed and consistent guidelines for the evaluation of treatment-resistant anxiety disorders in adults. Two researchers at the Lithuanian University of Health Sciences (LSMU) represented our country in this expert group.

Anxiety disorders, including specific phobias, social anxiety disorder, panic disorder, agoraphobia, generalised anxiety disorder, as well as separation anxiety disorder and selective mutism, are among the most common mental disorders, affecting 10–14% of the global population.

Anxiety disorders impose a substantial societal and economic burden, driven by the rising costs of treatment and diminished functioning of affected individuals. Studies conducted in the past decade indicate that one-third of individuals with anxiety disorders recover only partially, and one-tenth of those with anxiety disorders develop a chronic or untreatable condition.

The persistence of long-term symptoms associated with anxiety disorders and the decline in the quality of life indicate that certain individuals affected may be classified as “treatment-resistant”. Studies, guidelines, and evidence-based therapeutic interventions are needed to assist psychiatrists and psychotherapists in aiding these individuals in overcoming long-term anxiety disorders. However, until this point, there has been no unified and clear definition of treatment-resistant anxiety disorders, which could serve as a foundation for initiating such studies and developing treatment recommendations.

To achieve this objective, 38 psychiatrists and psychotherapists from across the globe have joined their efforts to agree on internationally coordinated and consistent guidelines for the evaluation of treatment-resistant anxiety disorders in adults. Lithuania was represented in the expert group by researchers from the Behavioural Medicine Laboratory of the LSMU Neuroscience Institute: Prof. Dr. Vesta Steiblienė, psychiatrist and psychotherapist, and Dr. Julius Burkauskas, clinical psychologist and psychotherapist.

In total, a group of 38 experts from around the world have agreed on a set of 14 recommendations for the definition of criteria for the evaluation of treatment-resistant anxiety disorders. Detailed criteria have been formulated for both medication-assisted treatment and psychotherapeutic interventions.

The recommendations specify that the evaluation of treatment-resistant anxiety disorders should include both clinical interviews and self-report questionnaires. The recommendations include specific questionnaires for evaluating the severity of anxiety symptoms and tracking improvement over the course of treatment, outline the duration of treatment, and provide guidelines on the medication-assisted and psychotherapeutic treatment of anxiety disorders (except for cognitive-behavioural therapy).

Researchers and clinical practitioners anticipate that this effort will lead to more effective evidence-based stepped-care treatment algorithms for patients with anxiety disorders. The definition of treatment-resistant anxiety disorders is doubtlessly valuable for both medication-assisted and psychotherapeutic clinical studies, which are being conducted to discover new effective treatment approaches.

The publication text can be accessed here.