Behavioral interventions for office-based care: stress and anxiety disorders.

Numerous behavioral therapies have been investigated in the management of anxiety- and stress-related disorders. There is strong evidence to support cognitive behavioral therapy (CBT) in the management of generalized anxiety disorder (GAD), posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, and social phobias. Adjunctive behavioral sleep intervention may enhance results for GAD, and initiation of a selective serotonin reuptake inhibitor for GAD before CBT also may enhance response. Several randomized clinical trials showed benefit of Internet-based CBT for GAD, but additional studies are needed before conclusions can be drawn regarding its effectiveness for posttraumatic stress disorder. Although outcome data are limited, family physicians can offer patients screening for anxiety disorders, psychological first aid (ie, listening to and comforting patients, teaching about emotional and physiologic responses to traumatic incidents, and encouraging engagement with social supports and coping) after trauma, education about anxiety disorders, and referral to evidence-based self-help resources. Family physicians also can ensure linkage with behavioral health care physicians and encourage adherence to self-help protocols.