NICE anxiety guideline campaign

We are calling for an urgent update to the outdated NICE guideline on anxiety, ensuring it reflects current evidence, expands patient choice of therapies and addresses barriers to access through meaningful stakeholder engagement.

The National Institute for Health and Care Excellence (NICE) creates recommendations for care in the NHS. The NICE guideline for generalised anxiety disorder and panic disorder in adults was initially published in 2011 and has not been meaningfully updated since.

We are calling for an urgent update to the anxiety guideline that addresses our key concerns. As part of this campaign, we are asking organisations in the sector and policymakers to sign a joint letter to NICE asking for the guideline to be updated.

Key concerns

1. The guideline is out of date:

- Despite previous scheduled reviews, the guideline has not been meaningfully updated in over a decade.
- The guideline is not compatible with the newly updated NICE guideline for depression in adults, with concerning contradictions between their clinical recommendations.

2. The guideline does not address barriers to access:

- The current guideline does not address barriers to access for marginalised and hard-to-reach populations. Guidance on addressing these barriers needs to be incorporated into the guideline.

3. The review of evidence is biased:

- NICE reviews a variety of studies to determine the clinical and cost effectiveness of their recommendations. Their review of evidence is biased towards what NICE already recommends and each study is not treated equally.
- Their review overemphasises randomised controlled trials (RCTs) and neglects valuable evidence from service user experience, long term and follow-up studies.

4. The guideline limits choice of therapy:

- Only two therapies are recommended (CBT and applied relaxation), despite well-established evidence that other talking therapies are also effective in treating anxiety.
- There is little emphasis on collaborative care and patient choice within the guideline.

Key asks

We are calling for NICE to:

Meet with key stakeholders from the coalition to discuss the concerns raised by the campaign and agree on next steps.

conduct a multi-step review of the whole guideline that includes a representative range of stakeholders and evidence. Organisations must have the opportunity to comment on any updates before publishing.

Make changes to the guideline to address the key concerns of the campaign, including ensuring it is up to the standard of the depression guideline, making it more readable and accessible for clinicians and including collaborative approach to care throughout.

This will result in a guideline that:

recommends a wider variety of therapies

recognises the importance of patient choice

highlights barriers to access for marginalised populations.

How you can get involved

We are reaching out to organisations to support the campaign and sign our joint letter to NICE. If you are leading or involved in an organisation that is interested in signing, please email research@ukcp.org.uk.