Although it is now well established that collaborative, chronic disease management approaches are clinically and cost effective for treating depression in primary care, we know very little about how such models perform for anxiety disorders, which occur more commonly than depression in primary care and are particularly difficult to manage. To address this gap, we propose the first large-scale effectiveness study to test a collaborative care approach to treating primary care anxiety. This work builds directly on our Collaborative Care for Panic study, key informant interviews of clinicians, patients and clinic administrators, and more recent studies in primary care depression. Based on these considerations, we have developed a single, specially designed intervention called CALM (Coordinated Anxiety Learning and Management), that can deliver evidence-based treatment to patients with any of four anxiety disorders prevalent in primary care (Panic Disorder [PD], Generalized Anxiety Disorder [GAD], Social Anxiety Disorder [SAD], and Posttraumatic Stress Disorder [PTSD]), including those patients with comorbid depression and/or moderate substance abuse. This intervention allows patients treatment choice (CBT and/or medication), uses techniques to maximize patient engagement, and includes stepped care algorithms - approaches successfully employed in large-scale studies of primary care depression. We have also included an ethnically diverse study population, as well as Spanish-speaking patients, and propose qualitative studies to better understand how CALM should be tailored to individual clinics and to examine the acceptability of CALM for disadvantaged patients. These qualitative studies will provide valuable information needed for future dissemination of this approach. The primary aims are: (1) to use experimental, quantitative methods to determine the clinical effectiveness of CALM compared to treatment as usual (TAD) for the above four anxiety disorders (as a group and individually) and to compare CALM and TAU in terms of intermediate outcomes such as quality of care, self-efficacy, and social stigma;and (2) to use qualitative methods to assess acceptability and barriers to sustainability of CALM in participating clinics, providers, and patients. The secondary aims are: (1) to use quasi-experimental methods (e.g. instrumental variables) to examine the effects of appropriate treatment, independent of intervention assignment, on functioning and other clinical outcomes;and (2) to estimate health care costs and cost effectiveness of CALM.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01MH070018-05
Application #
7631183
Study Section
Special Emphasis Panel (ZMH1-ERB-I (07))
Program Officer
Rudorfer, Matthew V
Project Start
2005-09-27
Project End
2011-05-31
Budget Start
2009-06-01
Budget End
2011-05-31
Support Year
5
Fiscal Year
2009
Total Cost
$486,464
Indirect Cost
Name
Rand Corporation
Department
Type
DUNS #
006914071
City
Santa Monica
State
CA
Country
United States
Zip Code
90401
Escovar, Emily L; Craske, Michelle; Roy-Byrne, Peter et al. (2018) Cultural influences on mental health symptoms in a primary care sample of Latinx patients. J Anxiety Disord 55:39-47
Niles, Andrea N; Loerinc, Amanda G; Krull, Jennifer L et al. (2017) Advancing Personalized Medicine: Application of a Novel Statistical Method to Identify Treatment Moderators in the Coordinated Anxiety Learning and Management Study. Behav Ther 48:490-500
Niles, Andrea N; Dour, Halina J; Stanton, Annette L et al. (2015) Anxiety and depressive symptoms and medical illness among adults with anxiety disorders. J Psychosom Res 78:109-15
Wolitzky-Taylor, Kate; Brown, Lily A; Roy-Byrne, Peter et al. (2015) The impact of alcohol use severity on anxiety treatment outcomes in a large effectiveness trial in primary care. J Anxiety Disord 30:88-93
Bomyea, Jessica; Lang, Ariel; Craske, Michelle G et al. (2015) Course of symptom change during anxiety treatment: Reductions in anxiety and depression in patients completing the Coordinated Anxiety Learning and Management program. Psychiatry Res 229:133-42
Grubbs, Kathleen M; Cheney, Ann M; Fortney, John C et al. (2015) The role of gender in moderating treatment outcome in collaborative care for anxiety. Psychiatr Serv 66:265-71
Brown, L A; Krull, J L; Roy-Byrne, P et al. (2015) An examination of the bidirectional relationship between functioning and symptom levels in patients with anxiety disorders in the CALM study. Psychol Med 45:647-61
Dour, Halina J; Wiley, Joshua F; Roy-Byrne, Peter et al. (2014) Perceived social support mediates anxiety and depressive symptom changes following primary care intervention. Depress Anxiety 31:436-42
Brown, Lily A; Wiley, Joshua F; Wolitzky-Taylor, Kate et al. (2014) Changes in self-efficacy and outcome expectancy as predictors of anxiety outcomes from the CALM study. Depress Anxiety 31:678-89
Niles, Andrea N; Sherbourne, Cathy D; Roy-Byrne, Peter P et al. (2013) Anxiety treatment improves physical functioning with oblique scoring of the SF-12 short form health survey. Gen Hosp Psychiatry 35:291-6

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