The effectiveness of adhering to clinical-practice guidelines for anxiety disorders in secondary mental health care: the results of a cohort study in the Netherlands


  • Maarten K. van Dijk MSc,

    Corresponding author
    1. Health-care Psychologist and PhD Student, HSK Group, Arnhem, The Netherlands
    Search for more papers by this author
  • Desiree B. Oosterbaan MD PhD,

    1. Psychiatrist, Department of Psychiatry, UMC St. Radboud, Overwaal Centre for Anxiety Disorders, Nijmegen, The Netherlands
    Search for more papers by this author
  • Marc J. P. M. Verbraak MSc PhD,

    1. Extraordinary Professor of Health-care Psychology and Clinical Psychologist, SPON Postdoctoral Education, Academic Centre Social Sciences, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
    Search for more papers by this author
  • Anton J. L. M. van Balkom MD PhD

    1. Professor of Psychiatry, Department of Psychiatry and EMGO Institute, VU University Medical Center and GGZinGeest, Amsterdam, the Netherlands
    Search for more papers by this author

  • The work was carried out at: Dimence, PO Box 390, 7600 AJ Almelo, The Netherlands; at the time of the work, the first three authors were working at this mental health care institution.

Mr Maarten K. van Dijk, HSK Group, PO Box 134, 6800 AC Arnhem, The Netherlands, E-mail:


Background  While studies into the implementation of clinical practice guidelines for mental health care are scarce, studies on the effectiveness of implementing practice guidelines for anxiety disorders appear to be entirely non-existent.

Objective  To examine whether adherence to anxiety disorder clinical practice guidelines in secondary mental health care yields superior treatment results than non-adherence.

Method  A closed-cohort study of 181 outpatients with an anxiety disorder or hypochondriasis who were treated in a routine mental health setting. Preceding the inclusion of these 181 patients, a start was made on the implementation of the Dutch national multidisciplinary practice guidelines for anxiety disorders. Patients were asked to complete several questionnaires before the start of treatment and again 1 year later. The medical records of these patients were reviewed to assess guideline adherence. Ultimately, adherence or non-adherence to the different treatment algorithms described in the guidelines was related to changes in the severity of psychiatric symptomatology, psychiatric functioning, general well-being and satisfaction with treatment.

Results  Compared with patients whose treatment did not adhere to the guidelines, those whose treatment adhered to the guidelines were found to have greater symptom reduction after 1 year (P < 0.01). The latter group of patients also rated their satisfaction with their treatment significantly higher (P = 0.01). No significant differences were found after 1 year with respect to changes in impairment of functioning and quality of life in the two groups of patients.

Conclusions  Adherence to anxiety disorder guidelines yields superior treatment results and increased patient satisfaction with treatment when compared with patients whose treatment did not adhere to the clinical guidelines. These results should encourage a more widespread implementation of such guidelines in mental health care facilities.