Collaborative Care For Anxiety Disorders Research Articles

Collaborative Care for Anxiety Disorders in Primary Care: a Systematic Review and Meta-Analysis.

(Reprinted with permission from BMC Family Practice (2016) 17:62).

Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis.

BackgroundStudies evaluating collaborative care for anxiety disorders are recently emerging. A systematic review and meta-analysis to estimate the effect of collaborative care for adult patients with anxiety disorders in primary care is therefore warranted.MethodsA literature search was performed. Data sources: PubMed, Psycinfo, Embase, Cinahl, and the Cochrane library. Study eligibility criteria: Randomized controlled trials examining the effects of collaborative care for adult primary care patients with an anxiety disorder, compared to care as usual or another intervention. Synthesis methods: Standardized mean differences (SMD) on an anxiety scale closest to twelve months follow-up were calculated and pooled in a random effects meta-analysis.ResultsOf the 3073 studies found, seven studies were included with a total of 2105 participants. Included studies were of moderate to high quality. Collaborative care was superior to care as usual, with a small effect size (SMD = 0.35 95 % CI 0.14–0.56) for all anxiety disorders combined and a moderate effect size (SMD = 0.59, 95 % CI 0.41–0.78) in a subgroup analysis (five studies) on patients with panic disorder.ConclusionsCollaborative care seems to be a promising strategy for improving primary care for anxiety disorders, in particular panic disorder. However, the number of studies is still small and further research is needed to evaluate the effectiveness in other anxiety disorders.

Training primary care staff to deliver a computer-assisted cognitive–behavioral therapy program for anxiety disorders

Objectives This paper describes the training approach used with primary care staff to deliver an evidence-based computer-assisted cognitive–behavioral therapy (CBT) program for anxiety disorders within a collaborative care treatment delivery model. Methods We describe the training and proficiency evaluation procedures utilized in the Coordinated Anxiety Learning and Management (CALM) study, a large multisite study of collaborative care for anxiety disorders in primary care. Training incorporated readings, didactic presentations, video demonstrations of CBT skills, role-plays, computer-assisted practice, CBT training cases and ongoing group supervision provided by study psychologists. Results Proficiency training case data from 15 clinicians are presented. The anxiety clinical specialists (ACSs) were highly proficient at delivering the CBT component of the CALM intervention. The ACSs also provided Likert-scale ratings and open-ended responses about their experiences with the training. Overall, the training was rated very positively and was described as very thorough, indicating a high level of acceptability to clinicians. Recommendations for future training are described. Conclusions Primary care staff with none or minimal prior CBT experience can be trained to deliver a computer-assisted, evidence-based treatment for anxiety disorders. The implications for dissemination and transportability of evidenced-based interventions are discussed.

Ask the Expert: Treatments for Panic Disorder

Ask the Expert: Treatments for Panic Disorder

Design of the Coordinated Anxiety Learning and Management (CALM) study: innovations in collaborative care for anxiety disorders

Background Despite a marked increase in the number of persons seeking help for anxiety disorders, the care provided may not be evidence based, especially when delivered by nonspecialists. Since anxiety disorders are most often treated in primary care, quality improvement interventions, such as the Coordinated Anxiety Learning and Management (CALM) intervention, are needed in primary care. Research Design This study is a randomized controlled trial of a collaborative care effectiveness intervention for anxiety disorders. Subjects Approximately 1040 adult primary care patients with at least one of four anxiety disorders (generalized anxiety disorder, panic disorder, posttraumatic stress disorder or social anxiety disorder) will be recruited from four national sites. Intervention Anxiety clinical specialists (ACSs) deliver education and behavioral activation to intervention patients and monitor their symptoms. Intervention patients choose cognitive–behavioral therapy, antianxiety medications or both in “stepped-care” treatment, which varies according to clinical needs. Control patients receive usual care from their primary care clinician. The innovations of CALM include the following: flexibility to treat any one of the four anxiety disorders, co-occurring depression, alcohol abuse or both; use of on-site clinicians to conduct initial assessments; and computer-assisted psychotherapy delivery. Evaluation Anxiety symptoms, functioning, satisfaction with care and health care utilization are assessed at 6-month intervals for 18 months. Conclusion CALM was designed for clinical effectiveness and easy dissemination in a variety of primary care settings.