Treatment Engagement and Response to CBT Among Latinos with Anxiety Disorders in Primary Care

Published In: Journal of Consulting and Clinical Psychology, 2014

Posted on RAND.org on January 01, 2014

by Denise A. Chavira, Daniela Golinelli, Cathy D. Sherbourne, Murray Stein, Greer Sullivan, Alexander Bystritsky, Raphael D. Rose, Ariel J. Lang, Laura Campbell-Sills, Stacy Shaw Welch, Kristin Bumgardner, Daniel E. Glenn, Velma Barrios, Peter Roy-Byrne, Michelle G. Craske

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OBJECTIVE: In the current study, we compared measures of treatment outcome and engagement for Latino and non-Latino White patients receiving a cognitive behavioral therapy (CBT) program delivered in primary care. METHOD: Participants were 18–65 years old and recruited from 17 clinics at 4 different sites to participate in a randomized controlled trial for anxiety disorders, which compared the Coordinated Anxiety Learning and Management (CALM) intervention (consisting of CBT, medication, or both) with usual care. Of those participants who were randomized to the intervention arm and selected CBT (either alone or in combination with medication), 85 were Latino and 251 were non-Latino White; the majority of the Latino participants received the CBT intervention in English (n = 77). Blinded assessments of clinical improvement and functioning were administered at baseline and at 6, 12, and 18 months after baseline. Measures of engagement, including attendance, homework adherence, understanding of CBT principles, and commitment to treatment, were assessed weekly during the CBT intervention. RESULTS: Findings from propensity-weighted linear and logistic regression models revealed no statistically significant differences between Latinos and non-Latino Whites on symptom measures of clinical improvement and functioning at almost all time points. There were significant differences on 2 of 7 engagement outcomes, namely, number of sessions attended and patients' understanding of CBT principles. CONCLUSIONS: These findings suggest that CBT can be an effective treatment approach for Latinos who are primarily English speaking and likely more acculturated, although continued attention should be directed toward engaging Latinos in such interventions.

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