title: Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  Seventeen US primary care clinics.
  
  
  METHODS
  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.
  
  
  METHODS
  CALM (cognitive behavior therapy and pharmacotherapy recommendations) and UC.
  
  
  METHODS
  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.
authors.affiliation: Department of Psychology, University of California at Los Angeles, Los Angeles, CA 90095-1563, USA. craske@psych.ucla.edu
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Craske
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
authors.forename: Greer
authors.initials: G
authors.lastname: Sullivan
authors.forename: Cathy
authors.initials: C
authors.lastname: Sherbourne
authors.forename: Alexander
authors.initials: A
authors.lastname: Bystritsky
authors.forename: Raphael D
authors.initials: RD
authors.lastname: Rose
authors.forename: Ariel J
authors.initials: AJ
authors.lastname: Lang
authors.forename: Stacy
authors.initials: S
authors.lastname: Welch
authors.forename: Laura
authors.initials: L
authors.lastname: Campbell-Sills
authors.forename: Daniela
authors.initials: D
authors.lastname: Golinelli
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
mesh_terms: D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D019317:Evidence-Based Medicine / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000379:methods*
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents