1. Understanding the Anxiety Spectrum

• Generalized Anxiety Disorder (GAD) – persistent worry, restlessness

• Panic Disorder – sudden attacks, fear of dying or losing control

• Social Anxiety Disorder – fear of being judged or embarrassed

• Phobias – irrational fear of specific triggers

• Functional/Atypical Anxiety – insomnia, GI issues, somatic complaints

• Note: OCD and PTSD are no longer grouped under anxiety but share treatment overlaps

2. First-Line Pharmacologic Treatments

• SSRIs: sertraline, escitalopram, fluoxetine

• SNRIs: venlafaxine XR, duloxetine

• Buspirone: limited efficacy; useful if SSRIs are not tolerated

Augmentation Strategies:

• Hydroxyzine – PRN for acute episodes

• Propranolol – performance anxiety

• Low-dose atypical antipsychotics – in refractory anxiety

• Gabapentin – off-label but often helpful

• Benzodiazepines – short-term or bridging; avoid long-term use

Supervision Tip:

• Always ask: Is the patient sensitive to medications?

• Consider slow titration and frequent check-ins

3. Psychotherapy Essentials

• CBT – cognitive distortions, avoidance, behavioral exposure

• ACT – acceptance, mindfulness, defusion techniques

• Exposure therapy – for panic and phobias

• EMDR – trauma-linked anxiety

• DBT – for emotional dysregulation and comorbid traits

Ask during supervision:
“Is this patient in therapy? If not, what’s the barrier?”

4. When Treatment Isn’t Working

• Confirm:

  • Medication adherence

  • Dose sufficiency

  • Presence of comorbid ADHD, trauma, substance use

  • Medical contributors (thyroid, cardiac, GI)

Supervision Use:

• Bring complex cases to group for collaborative reflection

• Reframe through function, not just symptom severity

5. Functional Goals & Communication

• Don’t treat a checklist—treat a life

• Ask:

  • “Can you go to work?”

  • “What are you avoiding?”

  • “What makes this week harder than last?”

• Reframe for patient:

  • “We’re not eliminating anxiety—we’re learning to manage it.”

6. Supervision Highlights

• Monitor for polypharmacy

• Avoid unnecessary benzo prescriptions

• Track function over symptom reduction

• Normalize gradual improvement and relapse learning