Raising the Expectations of Long-Term Treatment Strategies in Anxiety Disorders

This article describes the long-term course of anxiety disorders based on the findings of the Harvard/Brown Anxiety Research Program (HARP) study—a prospective, naturalistic, longitudinal study of patients with anxiety disorders. Data from the HARP study emphasize both the chronicity of anxiety disorders and their frequent psychiatric comorbidity with other anxiety disorders and depression. Social phobia and generalized anxiety disorder are more chronic than panic disorder, although the latter has higher rates of relapse following recovery. Anxiety disorders have a major impact on the everyday lives of sufferers. The detrimental effects on social, psychological, and physical functioning are comparable with other chronic medical and psychiatric conditions, including diabetes, heart disease, and depression. Comorbidity with depression significantly increases the probability of suicide and is associated with poorer outcome. Findings from the HARP study have significant implications for treatment, which currently tends to focus on short-term outcomes. Future studies should emphasize the role of preventive pharmacotherapy to improve the long-term course of anxiety and to reduce its associated suffering, suicide, and occupational and social impairment.