Anxiety Disorder and OCD Clinical Pathway – Outpatient Behavioral Health and Primary Care – Course of Treatment

Anxiety Disorder and OCD Clinical Pathway – Outpatient Behavioral Health and Primary Care

Course of Treatment

Behavioral Health Specialist/ Primary Care

Initial Acute Phase: Weeks 0 - 12
Reassess symptoms and functioning at least every 4 weeks to monitor response
Screen for Suicide Risk at every visit
  • At some point between weeks 4 - 8, assess overall progress
  • If started with supportive psychotherapy
  • Adequate clinical response, continue as is
  • If still mildly anxious, then a trial of CBT is recommended
  • If now moderately or severely anxious, then medication and/or CBT is recommended
  • If started with CBT or ERP:
    • If clinical response continue as is
    • If now moderately or severely anxious, consider adding medication
Acute Phase:
Months 4 - 9
Reassess symptoms and functioning at least every 4 weeks to monitor response
Screen for Suicide Risk at every visit
  • If CBT, ERP, or supportive psychotherapy:
    • If clinical response continue to treat until remission then move to continuation treatment or discharge
    • If minimal, no response, or worsening provider may choose to increase the level of care, switch to (or augment with) a different therapy modality, or augment the therapy with medication
  • If treating solely with medication:
    • If clinical response continue treatment until remission then move to continuation, treatment or discharge
    • If minimal, no response, or worsening provider may choose to increase the level of care, change the medication and/or or augment with CBT
  • If combined treatment (medication and therapy):
    • If clinical response, continue treatment until remission then move to continuation, treatment or discharge
    • If minimal, no response, or worsening provider may choose to increase the level of care, switch to (or augment with) a different therapy modality, and/or change the medication
Continuation Phase:
Reassess symptoms and functioning every 3 months to monitor response
Screen for Suicide Risk at every visit
  • Continue treatment for 6 - 12 months or at least until recovery at this point options include:
    • Discharge
    • Maintenance
Maintenance Phase:
Reassess symptoms and functioning every 3 months to monitor response
Screen for Suicide Risk at every visit
  • Continue treatment for 6 - 12 months or at least until recovery at this point options include:
    • Continue maintenance for 6 - 12 months until discharge