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Coordinated multi-component treatment in primary care improves anxiety in adults with multiple anxiety disorders compared with usual care

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Question

Question

Is a flexible treatment delivery model for anxiety disorders in primary care better than usual care?

Patients

1004 primary care patients (18–75 years) with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition anxiety disorders, who scored ≥8 on the Overall Anxiety Severity and Impairment Scale. Participants could have one or more diagnoses of panic, generalised anxiety, social anxiety or post-traumatic stress disorder, with or without major depression. Exclusions: psychosis, bipolar I disorder, substance abuse or dependence (except marijuana and alcohol), unstable medical conditions, marked cognitive impairment, active suicidal intent or plan, already receiving cognitive behavioural therapy (CBT) or medication from a psychiatrist.

Setting

17 primary care clinics in four US cities; June 2006 to April 2008.

Intervention

Coordinated Anxiety Learning and Manage-ment (CALM) or usual care. CALM involved a blended package of treatment, which included the patient's preference out of CBT, medication or both for 10–12 weeks, plus web outcomes monitoring. Participants could switch from CBT to medication or combine the treatments …

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