The Unrecognized Impact of Anxiety in Complex and Costly Patients

Strategies to reduce suffering and expense for complex and costly patients have met with limited success. This may be due to both the ongoing dependence on transactional relationships and the failure to recognize anxiety spectrum disorders as a primary driver of medical complexity. The authors describe an emerging current of thought regarding a universal approach to the conceptualization of anxiety disorders and extend it for application to medical complexity. Using 4 cases, they illustrate distinct anxiety-complexity patterns and describe how a relational intervention untangled and identified treatment targets within that process, with excellent results for patients, providers, and payors. They go on to propose future directions and implications of this intervention.