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However, an explicit definition of treatment\u2010resistant anxiety disorders (TR\u2010AD) informing such trials is currently lacking. We used a Delphi method\u2010based consensus approach to provide internationally agreed, consistent and clinically useful operational criteria for TR\u2010AD in adults. Following a summary of the current state of knowledge based on international guidelines and an available systematic review, a survey of free\u2010text responses to a 29\u2010item questionnaire on relevant aspects of TR\u2010AD, and an online consensus meeting, a panel of 36 multidisciplinary international experts and stakeholders voted anonymously on written statements in three survey rounds. Consensus was defined as \u226575% of the panel agreeing with a statement. The panel agreed on a set of 14 recommendations for the definition of TR\u2010AD, providing detailed operational criteria for resistance to pharmacological and\/or psychotherapeutic treatment, as well as a potential staging model. The panel also evaluated further aspects regarding epidemiological subgroups, comorbidities and biographical factors, the terminology of TR\u2010AD vs. \u201cdifficult\u2010to\u2010treat\u201d anxiety disorders, preferences and attitudes of persons with these disorders, and future research directions. This Delphi method\u2010based consensus on operational criteria for TR\u2010AD is expected to serve as a systematic, consistent and practical clinical guideline to aid in designing future mechanistic studies and facilitate clinical trials for regulatory purposes. This effort could ultimately lead to the development of more effective evidence\u2010based stepped\u2010care treatment algorithms for patients with anxiety disorders.<\/jats:p>","DOI":"10.1002\/wps.21177","type":"journal-article","created":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T09:55:54Z","timestamp":1705053354000},"page":"113-123","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["The definition of treatment resistance in anxiety disorders: a Delphi method\u2010based consensus guideline"],"prefix":"10.1002","volume":"23","author":[{"given":"Katharina","family":"Domschke","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Medical Center \u2010 University of Freiburg, Faculty of Medicine University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrik D.","family":"Seuling","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Medical Center \u2010 University of Freiburg, Faculty of Medicine University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam A.","family":"Schiele","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Medical Center \u2010 University of Freiburg, Faculty of Medicine University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borwin","family":"Bandelow","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy University Medical Center  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeltje M.","family":"Batelaan","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Amsterdam Public Health Research Institute Amsterdam University Medical Center, Vrije Universiteit  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wicher A.","family":"Bokma","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Amsterdam Public Health Research Institute Amsterdam University Medical Center, Vrije Universiteit  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Branchi","sequence":"additional","affiliation":[{"name":"Center for Behavioral Sciences and Mental Health Istituto Superiore di Sanit\u00e0  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Broich","sequence":"additional","affiliation":[{"name":"Federal Institute for Drugs and Medical Devices  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Burkauskas","sequence":"additional","affiliation":[{"name":"Laboratory of Behavioral Medicine Neuroscience Institute, Lithuanian University of Health Sciences  Palanga Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon J.C.","family":"Davies","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Toronto  Toronto ON Canada"},{"name":"Centre for Addiction and Mental Health  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo","family":"Dell'Osso","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Clinical Sciences University of Milan  Milan Italy"},{"name":"Department of Mental Health and Addictions ASST Fatebenefratelli\u2010Sacco  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Fagan","sequence":"additional","affiliation":[{"name":"Clinical and Experimental Sciences, Faculty of Medicine University of Southampton  Southampton UK"},{"name":"Southern Health NHS Foundation Trust  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi A.","family":"Fineberg","sequence":"additional","affiliation":[{"name":"University of Hertfordshire &amp; 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