Reducing Anxiety and Stress in Primary Care Patients: Pilot RCT of a Brief Intervention (CDA 15-262)
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Anxiety
- Sponsor
- VA Office of Research and Development
- Enrollment
- 35
- Locations
- 1
- Primary Endpoint
- Generalized Anxiety Disorder-7 at Post-Assessment
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
Anxiety is common among primary care patients, but is undertreated. The purpose of this study is to evaluate whether a brief anxiety treatment designed for VA primary care is more effective at reducing anxiety symptoms in Veterans compared to usual care. The investigators will also examine whether Veterans like the brief treatment and whether the treatment can be feasibly delivered in primary care. Forty-eight adult Veteran primary care patients from the Syracuse VAMC who are experiencing anxiety symptoms will be recruited and randomly assigned to receive the brief anxiety treatment or usual care. The brief treatment consists of up to six 30-minute sessions with a cognitive-behavioral skills focus. The investigators will compare anxiety symptom severity between the two groups at baseline and at post-assessment 16 weeks later.
Detailed Description
Background/Rationale: Many Veteran primary care patients experience impairing symptoms of anxiety, but rates of treatment are low. Primary Care-Mental Health Integration (PC-MHI), in which mental health clinicians provide brief treatment in the primary care setting, can bridge the gap between demand for, and availability of, anxiety treatment. However, brief anxiety interventions suitable for use in the PC-MHI setting are needed. Developing an effective brief PC-MHI intervention for anxiety would address a gap in VA treatment options and facilitate high quality healthcare that improves treatment engagement, clinical outcomes, and patient experience. To ensure maximum reach, this intervention should accommodate a variety of subthreshold and diagnostic anxiety presentations, as well as comorbid depression. Objectives: The overall goal of this research program is to develop, refine, and evaluate a brief anxiety intervention that will be acceptable to Veterans and feasible for PC-MHI providers. The primary aim of the current study is to conduct a pilot randomized controlled trial to evaluate feasibility, acceptability, potential implementation barriers and facilitators, and effectiveness of the intervention compared to usual care. Methods: This will be a pilot hybrid type I effectiveness-implementation randomized controlled trial (N = 35). The primary goal is to evaluate feasibility, acceptability, and effectiveness of the intervention in reducing anxiety symptom severity compared to usual care. The secondary goal is to collect preliminary data on implementation barriers and facilitators that may affect future real-world uptake.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Age 18 years or older
- •Veteran seen in the Syracuse VA Medical Center primary care clinic in the past year
- •Screen positive for current (past 2 weeks) clinically significant anxiety symptoms (8 on Generalized Anxiety Disorder-7)
Exclusion Criteria
- •Inability to communicate in English (as assessed by study staff)
- •Report or demonstrate hearing impairment that would preclude telephone screening (as assessed by study staff)
- •Inability to demonstrate informed consent
- •defined as not being able to comprehend the study description as assessed by study staff and/or not being able to answer the comprehension of consent questions
- •have a diagnosis of dementia or severe cognitive impairment (defined by primary care provider or self-report, or having a diagnosis in Problem List)
- •screen positive for cognitive impairment (3 or more errors on cognitive screener)
- •Have a diagnosis of obsessive-compulsive disorder (OCD) or serious mental illness (SMI) in Problem List
- •i.e., psychotic disorders, bipolar disorder
- •Have an encounter diagnosis of post-traumatic stress disorder (PTSD) within the past 2 years OR screen positive for PTSD (3 or more on PC-PTSD-5)
- •Currently in psychotherapy/counseling for anxiety and/or depression, defined as any of the following within the past 30 days:
Outcomes
Primary Outcomes
Generalized Anxiety Disorder-7 at Post-Assessment
Time Frame: Baseline & Post-Assessment (at 16 weeks)
The primary outcome of anxiety symptom severity will be measured by the Generalized Anxiety Disorder-7 (GAD-7) self-report questionnaire, a validated measure that is widely used in VA primary care. Participants rate how much they have been bothered by each of 7 anxiety symptoms over the last 2 weeks on a Likert scale from 0 (not at all) to 3 (nearly every day). Scores are summed to create a total score ranging from 0 to 21 indicating severity of anxiety symptoms; higher scores indicate more severe symptoms. The total score is sensitive to change from treatment across the anxiety disorders. The GAD-7 has demonstrated reliability and validity and is a good screening tool for multiple anxiety disorders.
Secondary Outcomes
- Patient Health Questionnaire-9 at Post-Assessment(Baseline & Post-Assessment (at 16 weeks))
- Depression Anxiety Stress Scale-21 Anxiety Subscale Change(Baseline, 4 weeks, 8 weeks, 12 weeks, & Post-Assessment (at 16 weeks))
- Depression Anxiety Stress Scale-21 Depression Subscale Change(Baseline, 4 weeks, 8 weeks, 12 weeks, & Post-Assessment (at 16 weeks))
- Depression Anxiety Stress Scale-21 Stress Subscale Change(Baseline, 4 weeks, 8 weeks, 12 weeks, & Post-Assessment (at 16 weeks))
- Overall Anxiety Severity and Impairment Scale Change(Baseline, 4 weeks, 8 weeks, 12 weeks, & Post-Assessment (at 16 weeks))
- Overall Depression Severity and Impairment Scale Change(Baseline, 4 weeks, 8 weeks, 12 weeks, & Post-Assessment (at 16 weeks))