Exploration of effective dissemination mechanisms to increase uptake of scientifically-informed treatments is a high priority for the Division of Servics and Intervention Research of the National Institute of Mental Health (NIMH). Dissemination of effective treatments for anxiety disorders is particularly important because anxiety is the most prevalent form of mental illness. Although effective, empirically-supported treatments exist, the vast majority of individuals experiencing clinical levels of anxiety do not receive treatment. Dissemination efforts thus far have focused on increasing access, but have not appropriately addressed the need for cost-efficient interventions that target those individuals suffering from anxiety who are not yet willing to attend treatment or not yet ready to take difficult actions necessary to address their anxiety. The Transtheoretical Model of Behavior Change (TTM) provides a theoretical basis for interventions that could address both access and willingness owing to its emphasis on readiness and utility in organizing effective, computerized interventions. The key organizing feature of the TTM is the five stages of change, which define an individual's progress in preparing for and adopting changes. The TTM posits that movement through five stages of change, is mediated by three core constructs: Decisional Balance (relative importance of pros and cons of behavior change);Self-efficacy (one's confidence that change can be maintained across a range of challenging situations);and frequency of engagement in 10 Processes of Change (involving cognitive, behavioral, and experiential activities). Computerized interventions guided by the TTM involve alternating assessment of these core constructs and individually-tailored feedback. Before a TTM-based intervention targeting management of anxiety can be developed, however, precursor empirical work is required. The proposed research will carry out the steps needed to apply the TTM to the management of anxiety.
The specific aims are to: (1) Develop valid and reliable measures of stage of change, decisional balance, self- efficacy, and the experiential and behavioral processes of change as they pertain to management of anxiety;(2) Build data-driven guidelines for expected scores on measures of core TTM variables for participants in each stage of change in three treatment groups (individuals receiving psychotherapy for anxiety, those receiving medication only, and those not in any treatment). The study will recruit 360 participants with clinical levels of anxiety to complete an online survey. A sequential process of measurement development will be used. It will consist of exploratory and confirmatory analyses, followed a series of regression and group difference analyses to evaluate external validation. This work will pave the way for the next step in an intended program of research: to develop and evaluate effectiveness of a computer-tailored, TTM-based intervention aimed at enhancing the reach of anxiety disorder treatments to the full population of individuals in need.
The proposed research will create valid and reliable measures (of variables that have been found to mediate change in a variety of problematic behaviors) for use in the treatment of anxiety. Data collected and measures developed will be building blocks for an intervention to disseminate effective components of anxiety treatment, targeting both individuals ready to make behavior changes required to reduce anxiety and the far larger population of individuals not yet ready to change.
