Design of the Coordinated Anxiety Learning and Management (CALM) Study

Innovations in Collaborative Care for Anxiety Disorders

Published in: General Hospital Psychiatry, v. 29, no. 5, Sep. 2007, p. 379-387

Posted on on January 01, 2007

by Greer Sullivan, Michelle G. Craske, Cathy D. Sherbourne, Mark J. Edlund, Raphael D. Rose, Daniela Golinelli, Denise A. Chavira, Alexander Bystritsky, Murray Stein, Peter Roy-Byrne

Read More

Access further information on this document at General Hospital Psychiatry

This article was published outside of RAND. The full text of the article can be found at the link above.

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.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.