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Guide to self-help resources for generalised anxiety disorder August 2011 NICE clinical guideline 113 Guide to self-help resources for generalised anxiety disorder The National Institute for Health and Clinical Excellence (NICE) published a clinical guideline about generalised anxiety disorder (GAD) and panic disorder in January 2011. The first part of the guideline gives advice to NHS healthcare professionals about what they should do to help people with GAD. NICE also published a version of the guideline written specifically for people with GAD and their families and carers. It is called ‘Understanding NICE guidance: Treating generalised anxiety disorder and panic disorder in adults’ and is available from www.nice.org.uk/guidance/CG113. This guide helps to direct people with GAD and their families and carers to self-help resources that may help them to manage the symptoms of GAD. All of the resources listed below are available free of charge on the internet. They have been produced by government organisations, large charities and other national organisations. Links to the resources are shown in green underlined type. To view a resource, place your cursor on the link and click. If this does not take you to the resource you wish to view, follow the link that shows the name of the organisation that produced the resource. This will take you to the organisation’s home page where you can search for the specific resource you want. This guide should be used on-line so that you can click on the links to view the resources. If you have been given a paper copy of this guide, you can use it on-line at http://guidance.nice.org.uk/CG113/SelfHelp Contents Understanding GAD 3 Information that explains what GAD is and practical ways of dealing with the symptoms of GAD Self-help for GAD 6 Self-help materials including relaxation videos and workbooks and information about helplines and support groups Understanding cognitive behavioural therapy (CBT) 9 Information that explains what CBT is and how it is carried out Information for families and carers of people with GAD 11 Information that families and carers of people with GAD may find useful Your views about this guide 14 About NICE 15 Understanding GAD The first step that you can take is to start to understand the nature of GAD and how it can be managed. This section lists resources that explain what GAD is and offer practical ways of dealing with the symptoms of GAD. ‘Anxiety’ video The Anxiety video shows a consultant psychiatrist who specialises in anxiety disorders discussing the symptoms of anxiety and how to identify when these symptoms become a cause for concern. There is also information about treatment options. The video has been produced by NHS Choices. ‘How to overcome fear and anxiety’ podcast The How to overcome fear and anxiety podcast explains what fear and anxiety are and what happens when they become overwhelming. It talks about triggers that cause the anxiety to become a cyclic event and how to know when help may be needed. The podcast includes tips on how to help yourself and a brief description of other ways to get help. The podcast has been produced by the Mental Health Foundation. ‘Anxiety’ factsheet The Anxiety factsheet describes the symptoms and causes of anxiety, the various treatment options such as medication and talking therapies, and self-help strategies such as relaxation, support forums and physical activity. The factsheet has been produced by SANE. 3 Guide to self-help resources for generalised anxiety disorder Understanding GAD ‘Fear and anxiety’ web page The Fear and anxiety web page contains a brief overview of fear and anxiety, listing some of the physical and emotional symptoms. It outlines methods of self-help as well as giving examples of other treatments. This web page has been produced by the Mental Health Foundation. ‘Anxiety, panic and phobias’ web page The Anxiety, panic and phobias web page explains the symptoms and causes of anxiety, some self-help strategies and other treatments that are available. The web page has been produced by the Royal College of Psychiatrists. ‘Generalised anxiety’ web pages The Generalised anxiety web pages describe how it can feel to have anxiety and include ‘coping statements’ for different situations and questions to think about to help deal with anxiety. The pages also have poetry and descriptive pieces written by people with anxiety. They have been produced by the Anxiety Network. ‘Anxiety disorders’ web page The Anxiety disorders web page contains information about the symptoms, causes and treatment of different types of anxiety conditions, including generalised anxiety disorder. The web page has been produced by BUPA. 4 Guide to self-help resources for generalised anxiety disorder Understanding GAD ‘Generalised anxiety disorder or chronic worrying’ booklet The Generalised anxiety disorder or chronic worrying booklet provides an introductory look at anxiety and includes tips, exercises and strategies to help manage the symptoms. It explains the difference between anxiety and 'normal worry', and there are personal accounts from people with anxiety describing their own symptoms, beliefs and coping techniques. Descriptions of treatment options and a self-diagnosis questionnaire are also included. The booklet has been produced by Anxiety UK. ‘How to overcome fear and anxiety’ booklet The How to overcome fear and anxiety booklet looks at anxiety and its causes and educates the reader on methods of self-help. The booklet has been produced by the Mental Health Foundation. ‘Understanding anxiety’ booklet The Understanding anxiety booklet guides the reader through an explanation of anxiety and its effects and considers why some people worry more than others. It includes a section on self-help management as well as a guide to other methods of treatment. There are links throughout the booklet to helpful information such as 'How to stop worrying', ‘How to cope with panic attacks' and a 'Guide to managing stress'. The booklet is available in other languages, in both a written and an audio format. The booklet has been produced by Mind. 5 Guide to self-help resources for generalised anxiety disorder Self-help for GAD This section provides links to self-help materials such as relaxation videos and workbooks and information about helplines and support groups. ‘Simple relaxation exercises’ video The Simple relaxation exercises video and transcript demonstrate relaxation exercises. The video has been produced by BUPA ‘Deep breathing exercises’ video The Deep breathing exercises video and transcript demonstrate a deep breathing technique. The video has been produced by BUPA ‘Stress and relaxation: full works’ podcast The Stress and relaxation podcast guides the listener through a number of breathing techniques designed to relieve stress. The podcast has been produced by the Mental Health Foundation. ‘Ten ways to fight your fears’ web page The Ten ways to fight your fears web page describes ways of confronting and managing the symptoms of anxiety. The web page has been produced by NHS Choices ‘Structured problem solving’ worksheet The Structured problem-solving worksheet is for people who are worrying or anxious about a problem. It encourages you to look at the problem in a structured way in order to identify the best solution. The worksheet has been produced by the BBC. 6 Guide to self-help resources for generalised anxiety disorder Self-help for GAD ‘Graded exposure’ worksheet The Graded exposure worksheet shows you how to use ‘graded exposure’ to overcome your fear of a specific thing that is causing anxiety. The worksheet has been produced by the BBC. ‘Anxiety: Moodjuice self-help guide’ workbook The Anxiety: Moodjuice self-help guide workbook contains exercises that help you understand how anxiety affects you, how to challenge unhelpful thoughts and how to reduce the amount of time you spend worrying. There are also exercises to help you cope with situations that make you anxious. The workbook includes relaxation exercises and a structured method for dealing with problems that might be making you feel more anxious. It has been produced by Moodjuice, which is run by two NHS organisations in Scotland. ‘Living life to the full’ life skills course The Living life to the full life skills course helps you to understand why you feel as you do and to make changes in your thinking, activities, sleep and relationships. Each module is presented with audio, video and text. The course has been produced by Living Life to the Full. ‘Relapse prevention pack’ booklet The Relapse prevention pack booklet looks at ways to prevent a relapse after recovery from an anxiety condition. It helps you to identify the triggers that may lead to a relapse and the warning signs that a relapse is starting. It also helps you to identify and put in place helpful preventive strategies, and advises on what to do if you have a relapse. It includes a relapse prevention checklist. The booklet has been produced by Anxiety UK. 7 Guide to self-help resources for generalised anxiety disorder Self-help for GAD ‘Overcoming’ – books on prescription Overcoming is a range of self-help books for mental health problems. They are included in the 'books on prescription' scheme which is available across the UK. This scheme allows GPs to write a 'prescription' for a book that you can borrow from your local library service. This website shows some of the books that are available on this scheme for people with anxiety. The website has been produced by Overcoming Ltd. ‘Emotional support’ helpline, email and online support forum The Emotional support helpline, email and online support forum provides emotional support to anyone experiencing a mental health problem or their family, friends or carers. Users can access support through a helpline, email or online support forum. This support package has been provided by SANE 8 Guide to self-help resources for generalised anxiety disorder Understanding cognitive behavioural therapy (CBT) Some people with GAD choose to have cognitive behavioural therapy (CBT). The information resources in this section help to explain what CBT is and how it is carried out. ‘Cognitive behavioural therapy’ factsheet The Cognitive behavioural therapy online factsheet contains general information about CBT and how it works. The factsheet has been produced by BUPA ‘Cognitive behavioural therapy’ web page The Cognitive behavioural therapy web page provides general information about CBT and accounts from people who have had CBT. The web page has been produced by Anxiety UK ‘Cognitive behavioural therapy’ web page The Cognitive behavioural therapy web page provides written and video information about CBT, including a general overview, examples of how CBT can help and real stories of people who have used CBT to deal with a problem. The web page has been produced by NHS Choices. ‘Cognitive behavioural therapy’ leaflet The Cognitive behavioural therapy leaflet (which is available in different languages) explains how CBT works by giving examples of real-life situations. It also describes what is involved in CBT treatment. The leaflet has been produced by the Royal College of Psychiatrists 9 Guide to self-help resources for generalised anxiety disorder Understanding cognitive behavioural therapy (CBT) ‘Making sense of CBT’ booklet The Making sense of CBT booklet describes what CBT is and how it works. It includes a case study of someone who has benefitted from CBT. The booklet has been produced by MIND. ‘CBT Register for the United Kingdom’ The CBT register UK website contains the details of all officially accredited cognitive behavioural therapists in the UK. All the practitioners listed are accredited members of the lead organisation for CBT in the UK, the British Association for Behavioural and Cognitive Psychotherapies (BABCP) or of the Association for Rational Emotive Behaviour Therapy (AREBT). 10 Guide to self-help resources for generalised anxiety disorder Information for families and carers of people with GAD This section includes a range of information resources that families, friends and carers might find useful. ‘Family, friends and carers’ web page The Family, friends and carers web page is a resource for the family and friends of people experiencing anxiety. It describes how family and friends can sometimes feel, gives some advice on what they can do to help the person with anxiety and lists other resources. The web page has been produced by Anxiety UK. ‘Anxiety and phobias’ leaflet The Anxiety and phobias leaflet is for people who care for someone with an anxiety condition. It gives an overview of the changes in behaviour that can occur during the early stages of an anxiety disorder, and some common worries that carers experience. It outlines the ways that carers can work with healthcare professionals to help the person with anxiety, and it includes a useful list of ‘questions to ask the doctor’ and advice on how to deal with confidentiality issues. The leaflet has been produced by the Royal College of Psychiatrists. ‘How can friends and family help’ web page The How can friends and family help web page explores the ways in which family and friends can support someone with anxiety and gives advice on how carers can also look after themselves. The web page has been produced by Mind. 11 Guide to self-help resources for generalised anxiety disorder Information for families and carers of people with GAD ‘Colleagues’ web page The Colleagues web page is for people who work with someone who may be experiencing a mental health difficulty. It outlines the signs of common mental health conditions, how colleagues and managers can help and what the law says about mental health issues in the workplace. The web page has been produced by the Mental Health Foundation. ‘How to cope as a carer’ booklet The How to cope as a carer booklet gives information on providing emotional and practical support to a friend or relative who is experiencing mental health problems and how to cope with the pressure of being a carer. The booklet has been produced by Mind. ‘Carers and confidentiality’ leaflet The Carers and confidentiality leaflet looks at issues related to confidentiality for carers of someone with a mental health problem. It outlines what some of the barriers are to sharing information with carers and what is good practice. The leaflet has been produced by the Royal College of Psychiatrists. ‘Looking after someone’ guide The Looking after someone guide to carers’ rights and benefits provides information for carers about finances, practical help, employment and carers support groups. The guide has been produced by Carers UK. 12 Guide to self-help resources for generalised anxiety disorder Information for families and carers of people with GAD ‘How do I get help?’ web page The How do I get help? web page describes who is entitled to a carer’s assessment from social services, how to get an assessment done and what to do to prepare for one. It links to another web page that shows what help is available, such as help in the home or services that give carers a break. The web page has been produced by Carers UK. ‘Carers assessment’ factsheet The Carers assessment factsheet covers how to get a carer’s assessment, what is included in the assessment, what type of support is available and what to do if you are not happy with the process or outcome. The factsheet has been produced by Rethink. 13 Guide to self-help resources for generalised anxiety disorder Your views about this guide For people with GAD and their families and carers What do you think? Has this guide met your requirements? Has it helped you to find information and selfhelp resources that you will find useful? We value your opinion, so if you would like to give us any feedback, or if you are experiencing problems using this guide, please email [email protected] For healthcare professionals What do you think? Has this guide met your requirements, and will it help you to put the NICE guidance into practice? We value your opinion and are looking for ways to improve our implementation tools. Please complete a short online evaluation form. If you are experiencing problems using this guide, please email [email protected] 14 Guide to self-help resources for generalised anxiety disorder About NICE NICE produces guidance (advice) for the NHS about preventing, diagnosing and treating medical conditions. The guidance is written by independent experts including healthcare professionals and people representing patients and carers. They consider the evidence on the condition and treatments, the views of service users and carers and the experiences of doctors, nurses and other healthcare professionals. Staff working in the NHS are expected to follow this guidance. To find out more about NICE, its work and how it reaches decisions, see www.nice.org.uk/AboutGuidance The guideline is available at www.nice.org.uk/guidance/CG113 The NICE website has a screen reader service called Browsealoud, which allows you to listen to our guidance. Click on the Browsealoud logo on the NICE website to use this service. Disclaimer: NICE is not responsible for the quality or accuracy of any information or advice provided by other organisations. Amendment made for this edition: The resource ‘Therapy services and self-help groups’ produced by Anxiety UK was removed as a significant proportion of therapists offered hypnotherapy, for which NICE found there was limited and inconclusive evidence. National Institute for Health and Clinical Excellence MidCity Place, 71 High Holborn, London WC1V 6NA; www.nice.org.uk © National Institute for Health and Clinical Excellence, 2011. All rights reserved. This material may be freely reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the express written permission of NICE. 15 Guide to self-help resources for generalised anxiety disorder