In September of this year,
the U.S. Preventive Services Task Force recommended
that all adults under age 65
should be screened for an anxiety disorder.
What does this mean practically?
I'm going to give you more details
from inside the recommendations.
I'm Dr. Tracey Marks,
a psychiatrist and I make mental health education videos.
So here's what happened.
The U.S. Preventive Services Task Force
is a panel of medical experts,
and in this case
the experts came from Kaiser Permanente's research division.
They are an independent research arm
of the U.S. Department of Health and Human Services.
Why does this detail matter?
Because this isn't just any group
saying anxiety screening would be nice.
The Affordable Healthcare Act mandates
that insurances must cover all services recommended
by this task force free to its members
without a co-payment or deductible applied to the service.
So that's the significance of any recommendation
that comes from as high up
as the U.S. Preventive Services Task Force.
They aren't just saying, this is a good idea.
They're saying it's good
and do it without requiring people to pay extra.
So that's the context of this.
Here's where we are with this.
The task force published a draft recommendation
that says adults under age 65 should be screened
for anxiety by their primary care providers.
In April of this year,
they published similar results for children.
And this is a timely recommendation
because the task force noticed that anxiety and depression
has risen about 6% from 2020 to 2021.
So how do we screen for this?
The recommendation suggested a few screening questionnaires,
but the one with the greatest evidence
for flagging anxiety is the GAD-2,
which has two questions,
or the GAD-7, which has, can you guess?
Seven questions.
Here is what the questionnaire looks like.
Over the last two weeks,
how often have you been bothered by the following problems?
For each statement, you score a three
if it occurs nearly every day,
two if it happens more than half the days,
one if it's several days,
and zero for not at all.
Then when you're done, you add up your total score.
So here are the statements.
Number one, feeling nervous, anxious, or on edge.
Number two, not being able to stop or control worrying.
Three, worrying too much about different things.
Four, trouble relaxing.
Five, being so restless that it's hard to sit still.
Six, becoming easily annoyed or irritable.
And seven, feeling afraid
as if something awful might happen.
The GAD-2 stops after the first two statements
and scoring three or higher suggests
that you may have generalized anxiety disorder
and you should be further evaluated.
The screener was developed for generalized anxiety disorder,
but it is also sensitive
for panic disorder and social anxiety disorder.
The GAD-7 includes all seven statements
and the cutoff scores for that are as follows.
A score of zero to four is minimal anxiety.
A score of five to nine is mild anxiety.
10 to 14 is moderate anxiety.
And a score of greater than 15 corresponds
to severe anxiety.
The task force data recommended using a cutoff score
of nine as a signal to do further evaluation
for an anxiety disorder.
And as you can see from the scores,
nine is on the edge of mild to moderate anxiety.
I think the GAD-7 is a more useful tool
because it better separates out
the people who have some distress,
but it may not rise to the level of a disorder.
Also, keep in mind this GAD questionnaire is a screen
that alerts you and your doctor to look further
to see if you have a disorder.
The questions alone don't diagnose you.
So if this recommendation is implemented,
the way it would work is your doctor could make
the screening questions part of the paperwork
that you complete before the appointment.
They may send it to you in your patient portal
or it could be given to you in the waiting room.
What if you score high?
What's next?
Well, that's still to be determined.
Your doctor first needs to establish
that you have a disorder that should be treated.
The treatments that generate the most improvement
were medication, cognitive behavior therapy,
problem solving therapies, and mindfulness.
As for medications,
the most common ones in the study that were effective
were venlafaxine, brand name Effexor,
escitalopram, brand name Lexapro,
and buspirone, brand name Buspar.
Now, this doesn't mean that if you're being treated
with a different serotonin antidepressant
that your doctor is doing something wrong.
But these were the more common medications
that were used in the studies.
Benzodiazepines, like Klonopin and Xanax,
were most used for panic disorder.
Now, what's not clear from the recommendations
is whether the possible treatments are something
that will also be covered
or will it only be the screening that's covered.
There probably aren't many primary care doctors
who will feel equipped or have the time
to do therapy with you.
Probably the best it will get is
that they give you a referral list.
Unless, of course, you belong
to a large multi-specialty organization like Kaiser
where, if your primary doctor thinks you need a service
that they don't do,
another clinician within the same organization
can see you for that treatment.
With this setup, you don't have to go around looking
for a doctor on your own or looking for a therapist.
Suppose you look at this screener
and say, I think I experience most
of these things several days a week,
but I don't have a doctor or insurance.
If your symptoms are severe
and are interfering with your day-to-day responsibilities,
you may not be able to get
around seeing a professional for help.
You can do a search for providers in your area
who have sliding-scale fees.
Sliding-scale fees are when the provider
will allow you to pay what you can afford,
rather than they're charging you their standard fee.
But don't expect any and everyone to have this setup.
Many times clinics with sliding-scale fees are subsidized
by nonprofit groups to make up the difference
so that they can charge lower fees.
Also, clinicians are required by most states
to have a license in the state where the patient lives.
So that's why it's important for you
to do a local search for someone in your area.
But suppose your symptoms are bad,
but you're still functioning
and meeting your responsibilities.
This could look like you're still keeping up
with your work or your school.
You may be falling behind,
but you haven't gotten into trouble
because of falling behind.
You may have trouble sleeping a lot of nights,
but not all nights.
And you may feel like you're just not enjoying life,
but you're not ready to check out from it.
One of the interventions used by a primary care group
in the research studies
was a suite of apps called IntelliCare.
IntelliCare is free,
and it was created
by researchers at Northwestern University.
The development of the app was funded
in part by the National Institute of Health,
another government agency.
The app was shown to decrease symptoms of anxiety
and depression when people used it for at least eight weeks.
IntelliCare is available in both iOS and Android.
You start by downloading the IntelliCare Hub app.
This is the main app where you take assessments
for anxiety and depression.
They use GAD-7 questions for anxiety.
They have a mood journal where you can track your moods
during the day or throughout the week.
There's a resources section
with some great education on topics
like self care and identifying unhelpful thoughts.
Then there are five other apps within the suite of apps
that you can use based on what you need.
The five apps are Daily Feats,
which helps you stay engaged by celebrating small wins.
The Day To Day app teaches you a weekly skill
for five weeks.
You get a daily message to help you apply the skill.
So it's like having a coach.
My Mantra develops simple phrases and images
to curate your positive self-talk.
Thought Challenger is an application of cognitive therapy
that guides you on how to change unhelpful thinking.
And the last app is Worry Knot,
which teaches you how to distract yourself
from worry and diffuse the intense emotions worry produces.
That's some good stuff that is completely free.
I have links in the description
for how to download the apps.
For more education on anxiety
and at least 20 other self-help tools,
including thought challenging,
there's my book, "Why Am I So Anxious?"
It's available wherever books are sold
as hardcover, digital, or audio.
For a completely free experience,
get my book from your local library
and read it along with using the IntelliCare app.
So I've just given you two great resources
for managing your anxiety
if you get screened or screen yourself
and find that you're frequently experiencing
several anxiety symptoms.
I've also linked the 700-page task force recommendations,
if you're looking for some light reading.
The recommendations are still in draft form
and you're able to submit public comments
about the recommendations up until October 17th.
After that date, comments are closed
and they will eventually finalize the recommendations.
It's not clear yet what benefits will come
from the recommendations, but at the very least,
it will start a conversation about anxiety
in people who may not recognize
that they have anxiety
and set people up to go to the next step
of mitigating their anxiety,
either with professional help or self-help.
For more on what some different anxiety disorders look like,
take a look at my anxiety playlist.
Thanks for watching.
See you next time.