Barb-SAN
08-22-2010, 05:14 PM
http://www.nimh.nih.gov/science-news/2010/coordinated-treatment-approach-improves-anxiety-symptoms.shtml
Science Update May 18, 2010
Coordinated Treatment Approach Improves Anxiety Symptoms
A coordinated, multi-component treatment approach was more effective in treating anxiety disorders than usual care found in primary care settings, according to an NIMH-funded study published May 19, 2010, in a special issue of the Journal of the American Medical Association devoted to mental health.
Background
Research has found that a collaborative care approach, in which one care manager coordinates a team of treatment providers, is effective in treating depression. However, research is limited on whether the same type of approach could work to treat anxiety disorders, which are commonly treated in primary care settings.
In response, Peter Roy-Byrne, M.D., of the University of Washington Seattle, and colleagues designed a flexible collaborative treatment model for anxiety disorders—Coordinated Anxiety Learning and Management (CALM)—and compared it to usual care. CALM included cognitive behavioral therapy (CBT) that was tailored to any one of four anxiety disorders—panic disorder, generalized anxiety disorder, social anxiety disorder or post traumatic stress disorder. It also included strategies to improve medication delivery and adherence. Of the 1,004 participants recruited from 17 primary care clinics in four U.S. cities, half were randomized to CALM and were allowed to choose whether they received CBT, medication, or both. The other participants were referred to usual care which could include medication, brief counseling with a physician, or referral to a mental health specialist. All participants were diagnosed with at least one of the four anxiety disorders addressed in the CBT program.
CALM participants received their initial treatment for 10 to 12 weeks. Those who still had symptoms after 12 weeks could receive additional CBT or medication, or both. They then received monthly follow-up phone calls to reinforce CBT skills or medication management advice for up to a year.
CALM relied on a computerized program to help train care managers in CBT techniques and ensure consistency of care. The computer program employed CBT principles common to all anxiety disorders, but included specific techniques designed to address the four anxiety disorders in the study, thus allowing for personalized treatment.
Care managers also encouraged participants to stay in treatment and monitored their reactions to medication, relaying any observations and suggestions for changes to the primary care provider. CALM tracked participants' progress and outcomes through a web-based monitoring system as well.
Results of the Study
Participants in the CALM group showed significantly greater symptom improvement than those receiving usual care. After 12 months, about 63.6 percent receiving CALM had responded to treatment compared to 44.7 percent in usual care, and 51.5 percent receiving CALM had remitted compared to 33 percent in usual care.
CBT appeared to be the most popular treatment choice among those in the CALM group—57 percent chose CBT and medication combination treatment, and 34 percent chose CBT-only treatment, while 9 percent chose medication-only treatment. This preference is consistent with research that finds those with anxiety disorders tend to favor psychosocial treatment approaches over medication to treat their illness, said the researchers.
Significance:
Because CALM included flexible treatment options, targeted multiple anxiety disorders, and was effective across a range of patients and clinics, it is broadly applicable in primary care settings. It could serve as a model for developing effective collaborative care of people with anxiety disorders as well as those with coexisting psychiatric disorders like depression, a situation commonly found in clinical settings.
What's Next:
Research is needed to determine how the strategy could best be implemented in primary care settings. In addition, a cost analysis of CALM is needed to determine whether it is a financially feasible option for payers and clinical settings.
Reference:
Roy-Byrne P, Craske MG, Sullivan G, Rose RD, Edlund MJ, Lang AJ, Bystritsky A, Welch SS, Chavira DA, Golinelli D, Campbell-Sills, L, Sherbourne CD, Stein MB. Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. Journal of the American Medical Association. 19 May 2010. 303(19).
About those results in the CALM group:
57% CBT & medication
34% CBT only
9% medication only
So, yes, according to the article, CBT was the most popular treatment, used by 91% of the patients in the study.
However, 66% used medication, 34 % did not. So, at least in this study a clear majority chose to use medication (most in addition to CBT). (In spite of "research that finds that those with anxiety disorders tend to favor psychosocial treatments over medication to treat their illness").
Also unclear in this article; of the 63.6% of the CALM group who responded favorably, how is that broken down by type of treatment? (CBT or medication alone, or combined)?
It would be interesting to know WHICH medications, side effects of medications, costs, etc., all the pros and cons that go into making that decision. Also were medications discontinued after 12 months, continued indefinitely, etc? Many questions to consider, and presumably the researchers did.
The actual study was reported in the JAMA (which requires a subscription to access online...alas...).
I first read about the study in the Oct.2010 issue of Psychology Today. Some conclusions made in an excerpt from their article:
Patients in Roy-Byrne's system learned their options - medication, cognitive behavioral therapy (CBT), or both - and decided what to try. "Research shows that patients given their preferred treatment are more likely to adhere to it,", he says.
Roy-Byrne's team trained nurses and social workers to deliver treatment, aided by a computer program that led them through CBT and moderated drug dosage. Specialty mental health care is underfunded in the public sector, so offering treatment in primary care boosts accessibility.
During CALM, care managers assess patients at each session then consult with supervising specialists and adjust treatment when it fails to produce results.
Science Update May 18, 2010
Coordinated Treatment Approach Improves Anxiety Symptoms
A coordinated, multi-component treatment approach was more effective in treating anxiety disorders than usual care found in primary care settings, according to an NIMH-funded study published May 19, 2010, in a special issue of the Journal of the American Medical Association devoted to mental health.
Background
Research has found that a collaborative care approach, in which one care manager coordinates a team of treatment providers, is effective in treating depression. However, research is limited on whether the same type of approach could work to treat anxiety disorders, which are commonly treated in primary care settings.
In response, Peter Roy-Byrne, M.D., of the University of Washington Seattle, and colleagues designed a flexible collaborative treatment model for anxiety disorders—Coordinated Anxiety Learning and Management (CALM)—and compared it to usual care. CALM included cognitive behavioral therapy (CBT) that was tailored to any one of four anxiety disorders—panic disorder, generalized anxiety disorder, social anxiety disorder or post traumatic stress disorder. It also included strategies to improve medication delivery and adherence. Of the 1,004 participants recruited from 17 primary care clinics in four U.S. cities, half were randomized to CALM and were allowed to choose whether they received CBT, medication, or both. The other participants were referred to usual care which could include medication, brief counseling with a physician, or referral to a mental health specialist. All participants were diagnosed with at least one of the four anxiety disorders addressed in the CBT program.
CALM participants received their initial treatment for 10 to 12 weeks. Those who still had symptoms after 12 weeks could receive additional CBT or medication, or both. They then received monthly follow-up phone calls to reinforce CBT skills or medication management advice for up to a year.
CALM relied on a computerized program to help train care managers in CBT techniques and ensure consistency of care. The computer program employed CBT principles common to all anxiety disorders, but included specific techniques designed to address the four anxiety disorders in the study, thus allowing for personalized treatment.
Care managers also encouraged participants to stay in treatment and monitored their reactions to medication, relaying any observations and suggestions for changes to the primary care provider. CALM tracked participants' progress and outcomes through a web-based monitoring system as well.
Results of the Study
Participants in the CALM group showed significantly greater symptom improvement than those receiving usual care. After 12 months, about 63.6 percent receiving CALM had responded to treatment compared to 44.7 percent in usual care, and 51.5 percent receiving CALM had remitted compared to 33 percent in usual care.
CBT appeared to be the most popular treatment choice among those in the CALM group—57 percent chose CBT and medication combination treatment, and 34 percent chose CBT-only treatment, while 9 percent chose medication-only treatment. This preference is consistent with research that finds those with anxiety disorders tend to favor psychosocial treatment approaches over medication to treat their illness, said the researchers.
Significance:
Because CALM included flexible treatment options, targeted multiple anxiety disorders, and was effective across a range of patients and clinics, it is broadly applicable in primary care settings. It could serve as a model for developing effective collaborative care of people with anxiety disorders as well as those with coexisting psychiatric disorders like depression, a situation commonly found in clinical settings.
What's Next:
Research is needed to determine how the strategy could best be implemented in primary care settings. In addition, a cost analysis of CALM is needed to determine whether it is a financially feasible option for payers and clinical settings.
Reference:
Roy-Byrne P, Craske MG, Sullivan G, Rose RD, Edlund MJ, Lang AJ, Bystritsky A, Welch SS, Chavira DA, Golinelli D, Campbell-Sills, L, Sherbourne CD, Stein MB. Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. Journal of the American Medical Association. 19 May 2010. 303(19).
About those results in the CALM group:
57% CBT & medication
34% CBT only
9% medication only
So, yes, according to the article, CBT was the most popular treatment, used by 91% of the patients in the study.
However, 66% used medication, 34 % did not. So, at least in this study a clear majority chose to use medication (most in addition to CBT). (In spite of "research that finds that those with anxiety disorders tend to favor psychosocial treatments over medication to treat their illness").
Also unclear in this article; of the 63.6% of the CALM group who responded favorably, how is that broken down by type of treatment? (CBT or medication alone, or combined)?
It would be interesting to know WHICH medications, side effects of medications, costs, etc., all the pros and cons that go into making that decision. Also were medications discontinued after 12 months, continued indefinitely, etc? Many questions to consider, and presumably the researchers did.
The actual study was reported in the JAMA (which requires a subscription to access online...alas...).
I first read about the study in the Oct.2010 issue of Psychology Today. Some conclusions made in an excerpt from their article:
Patients in Roy-Byrne's system learned their options - medication, cognitive behavioral therapy (CBT), or both - and decided what to try. "Research shows that patients given their preferred treatment are more likely to adhere to it,", he says.
Roy-Byrne's team trained nurses and social workers to deliver treatment, aided by a computer program that led them through CBT and moderated drug dosage. Specialty mental health care is underfunded in the public sector, so offering treatment in primary care boosts accessibility.
During CALM, care managers assess patients at each session then consult with supervising specialists and adjust treatment when it fails to produce results.