Disorder-specific Impact of Coordinated Anxiety Learning and Management Treatment for Anxiety Disorders in Primary Care

Published In: Archives of General Psychiatry, v. 68, no. 4, Apr. 2011, p. 378-388

Posted on RAND.org on April 01, 2011

by Michelle G. Craske, Murray Stein, Greer Sullivan, Cathy D. Sherbourne, Alexander Bystritsky, Raphael D. Rose, Ariel J. Lang, Stacy Shaw Welch, Laura Campbell-Sills, Daniela Golinelli, Peter Roy-Byrne

Read More

Access further information on this document at Archives of General Psychiatry

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

CONTEXT: Anxiety disorders commonly present in primary care, where evidence-based mental health treatments often are unavailable or suboptimally delivered. OBJECTIVE: To compare evidence-based treatment for anxiety disorders with usual care (UC) in primary care for principal and comorbid generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and posttraumatic stress disorder (PTSD). DESIGN: A randomized controlled trial comparing the Coordinated Anxiety Learning and Management (CALM) intervention with UC at baseline and at 6-, 12-, and 18-month follow-up assessments. SETTING: Seventeen US primary care clinics. PATIENTS: Referred primary care sample, 1004 patients, with principal DSM-IV diagnoses of GAD (n = 549), PD (n = 262), SAD (n = 132), or PTSD (n = 61) (mean [SD] age, 43.7 [13.7] years; 70.9% were female). Eighty percent of the participants completed 18-month follow-up. INTERVENTIONS: CALM (cognitive behavior therapy and pharmacotherapy recommendations) and UC. MAIN OUTCOME MEASURES: Generalized Anxiety Disorder Severity Scale, Panic Disorder Severity–Self-report Scale, Social Phobia Inventory, and PTSD Checklist–Civilian Version scores. RESULTS: CALM was superior to UC for principal GAD at 6-month (–1.61; 95% confidence interval [CI], –2.42 to –0.79), 12-month (–2.34; –3.22 to –1.45), and 18-month (–2.37; –3.24 to –1.50), PD at 6-month (–2.00; –3.55 to –0.44) and 12-month (–2.71; –4.29 to –1.14), and SAD at 6-month (–7.05; –12.11 to –2.00) outcomes. CALM was superior to UC for comorbid SAD at 6-month (–4.26; 95% CI, –7.96 to –0.56), 12-month (–8.12, –11.84 to –4.40), and 18- month (–6.23, –9.90 to –2.55) outcomes. Effect sizes favored CALM but were not statistically significant for other comorbid disorders. CONCLUSIONS: CALM (cognitive behavior therapy and pharmacotherapy medication recommendations) is more effective than is UC for principal anxiety disorders and, to a lesser extent, comorbid anxiety disorders that present in primary care.

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.

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.