Anxiety and OCD — Adjunctive Treatments — Clinical Pathway: Outpatient Behavioral Health and Primary Care

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

Adjunctive Treatments and Healthy Habits

Sleep Hygiene
  • Review the following with the patient:
    • Go to bed at same time every night and get up at the same time every morning
    • Have a calming and regular bedtime routine
    • Limit caffeine, sugar and exercise in afternoon/evening
    • Do not nap
    • Stop electronic/screen use 60 minutes prior to bedtime
  • When a patient cannot fall asleep in 10-15 minutes:
    • Get up, do something “boring” with low light until feeling sleepy, then go back to bed.
    • e.g “boring” activities reading a textbook, folding laundry, cleaning room
  • Melatonin
    • Consider if patient continues to struggle with sleep despite above suggestions
SMART Habits
  • Instruct patient to drink a minimum of calculated maintenance fluids daily
  • Avoid caffeine-containing substances
  • SMART Habits:
  • Stress importance of healthy behaviors and stress reduction strategies to reduce Anxiety.
    • Sleep: At least 8 hours (teens need more), go to sleep and awaken around the same time
    • Meals: At least 3, don’t skip, drink plenty of fluids
    • Activity: Exercise is really effective for treating and preventing HA
    • Relaxation: Music, massage, compresses, breathing, yoga, meditation
    • Triggers: Recognize them
School Accommodations
  • Support provided in the school setting to minimize the impact of symptoms on academic performance and to maximize day-to-day functioning can help all patients
  • Ensure that accommodations do not inadvertently reinforce avoidance as a long-term strategy, as avoidance reinforces anxiety).
  • Inform School professionals of the patient’s anxiety diagnosis, so that a collaborative. relationship is initiated. (e.g., guidance counselor, school psychologist, social worker, and teachers)
  • Accommodations aimed at meeting therapeutic goals may be beneficial. Examples include the following:
    • In school practice of approach behaviors / exposures guided by appropriate personnel
    • Breaking down of assignments into smaller chunks
    • Planning how the patient can most effectively make up missed work following school absences due to psychiatric symptoms or mental health treatment
    • Designation of a specific point-person at school