Ho-ho-ho! Gather ’round, my curious elves, for a tale of the quest to conquer the elusive, slippery beast known as treatment-resistant anxiety disorders, or TR-AD for short. In the bustling workshop of mental health, where the clatter of research and the hum of expert opinions never cease, a group of 36 multidisciplinary international experts, akin to a council of wise old elves, embarked on a mission most grand.

With the Delphi method as their sleigh and consensus as their guiding star, these dedicated souls ventured through the frosty realm of clinical uncertainty. They began by decking the halls with a summary of knowledge, much like I check my list, and then sent out a 29-item questionnaire, as if asking children what they wished for Christmas.

Through the power of the internet, much like the magic that powers my sleigh, they convened an online meeting, where ideas were exchanged like gifts on Christmas morn. The experts, in their wisdom, voted anonymously on written statements, not once, not twice, but thrice, seeking a consensus as eagerly as children peering for the first star on Christmas Eve.

And lo! Consensus was achieved when at least 75% of the panel, like a chorus of carolers in harmony, agreed on a statement. They crafted a set of 14 recommendations, a veritable advent calendar of criteria, defining what makes anxiety disorders so stubbornly resistant to both the potions of pharmacology and the enchantments of psychotherapy.

They even pondered a potential staging model, much like I consider the stages of toy production, from design to wrapping. They delved into the mysteries of epidemiological subgroups, comorbidities, and biographical factors, as if investigating who’s been naughty or nice.

The terminology of TR-AD versus “difficult-to-treat” anxiety disorders was weighed with the care of choosing the perfect Christmas tree. They sought the preferences and attitudes of those bearing the burden of these disorders, much like I listen to the wishes of children around the world.

And what of the future, you ask? Well, my merry band, the panel set forth directions for research as surely as I chart the course for my Christmas Eve journey. This Delphi method-based consensus on TR-AD is a gift that keeps on giving, expected to light the way for future studies and clinical trials, much like Rudolph’s red nose guides my sleigh through the fog.

In the end, this grand effort could lead to the creation of more effective, evidence-based stepped-care treatment algorithms, a veritable recipe for gingerbread cookies that brings joy to all patients with anxiety disorders. And with that, my dear friends, may your days be merry and bright, and may all your anxieties be light! 🎅🎄