title: Treatment engagement and response to CBT among Latinos with anxiety disorders in primary care.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Psychology, University of California-Los Angeles.
authors.forename: Denise A
authors.initials: DA
authors.lastname: Chavira
authors.affiliation: RAND Corporation.
authors.forename: Daniela
authors.initials: D
authors.lastname: Golinelli
authors.affiliation: RAND Corporation.
authors.forename: Cathy
authors.initials: C
authors.lastname: Sherbourne
authors.affiliation: Department of Psychiatry, University of California-San Diego.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences.
authors.forename: Greer
authors.initials: G
authors.lastname: Sullivan
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California-Los Angeles.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bystritsky
authors.affiliation: Department of Psychology, University of California-Los Angeles.
authors.forename: Raphael D
authors.initials: RD
authors.lastname: Rose
authors.affiliation: Veterans Affairs San Diego Health Care System Center of Excellence for Stress and Mental Health.
authors.forename: Ariel J
authors.initials: AJ
authors.lastname: Lang
authors.affiliation: Department of Psychiatry, University of California-San Diego.
authors.forename: Laura
authors.initials: L
authors.lastname: Campbell-Sills
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine.
authors.forename: Stacy
authors.initials: S
authors.lastname: Welch
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine.
authors.forename: Kristin
authors.initials: K
authors.lastname: Bumgardner
authors.affiliation: Department of Psychology, University of California-Los Angeles.
authors.forename: Daniel
authors.initials: D
authors.lastname: Glenn
authors.affiliation: Los Angeles County Department of Mental Health.
authors.forename: Velma
authors.initials: V
authors.lastname: Barrios
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine.
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
authors.affiliation: Department of Psychology, University of California-Los Angeles.
authors.forename: Michelle
authors.initials: M
authors.lastname: Craske
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology / Q000628:therapy; D001008:Anxiety Disorders / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D007802:Language; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods; D016896:Treatment Outcome; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data