The Effectiveness of Evidence-Based Treatment in Combating Multiple Anxiety Disorders

researchlogo72x65bl-new.jpgA recent study published in The Journal of the American Medical Association compared the effectiveness of Evidence-Based Treatment against usual care for multiple types of anxiety disorders.  The participants consisted of 1004 patients with varying anxiety disorders including panic, generalized anxiety, social anxiety, and post-traumatic stress disorder in 17 primary care clinics in 4 US cities.The researchers used a Brief Symptom Inventory (BSI) to measure both anxiety and somatic symptoms.  These initial scores were compared with follow-up measurements taken after 6, 12 and 18 months of either Coordinated Anxiety Learning and Management (CALM) or usual care.

The CALM model allowed participants in the intervention group to choose between Cognitive Behavior Therapy (CBT), medication alone, or CBT combined with medication. Real-time web-based outcomes monitoring was also incorporated to optimize treatment decisions, as well as a computer-assisted program to optimize the delivery of CBT.

Results showed that CALM techniques were significantly more effective than usual care in reducing global anxiety symptoms.  Patients undergoing CALM treatment had significantly reduced scores on the Brief Symptom Inventory.  These patients also had higher response and remission rates.   Response was defined as at least a 50% reduction on the BSI or meeting the definition of remission.  Remission was defined as an anxiety score between none and mild.

The results of this trial illustrate the effectiveness of Evidence-Based Treatment, specifically Coordinated Anxiety Learning and Management in real-world practice settings. CALM proved to be more effective than usual care for multiple types of anxiety disorders.  This trial indicated that Evidence-Based Treatment may be of greater help to patients with anxiety disorders than those measures currently being used.

Roy-Byrne, P., Craske, M. G., Sullivan, G., Rose, R. D., Edlund, M. J., Lang, A. J., Bystritsky, A., Welch, S. S., Chavira, D. A., Golinelli, D., Campbell-Sills, L., Sherbourne, C. D., & Stein, M. B.  (2010).  Delivery of evidence-based treatment for multiple anxiety disorders in primary care.  The Journal of the American Medical Association, 303, 1921-1928.

CBT Found to Be Clinically Effective for Depressed Older Adults in Primary Care

NewStudy-Graphic-72x72_edited-3A new study published in the Archives of General Psychiatry investigated the clinical effectiveness of cognitive behavior therapy (CBT) for older adults in primary care. A total of 204 men and women aged 65 years or older with geriatric depression were randomly assigned to one of three groups: treatment as usual (TAU), TAU plus a talking control (TC), and TAU plus CBT. The CBT and TC treatments were offered over a period of four months and participants were followed up at 10 months. Depressive levels were measured with the Beck Depression Inventory-II (BDI-II) at baseline, at four months (the end of therapy), and again at 10 months. Based on BDI-II scores per session, a significant benefit of CBT versus the TAU and TC was observed, pointing to CBT as an effective treatment for depression in older adults.

This study was the largest CBT study conducted by general practitioner of their patients.

All-male CBT workshops effective for men with insomnia

CBT has been successfully used to treat insomnia in both men and women, but according to a recent article men tend to seek treatment less often than women. Even when they consult their primary care providers, those providers are often unaware of CBT’s effectiveness and may have limited CBT resources to offer their patients.

To address this, researchers offered group CBT in the form of 1-day, all-male CBT workshops. The study ran six months, and drew 111 inquiries, some of them self-referred. The researchers noted that roughly half of the participants had not mentioned their insomnia to their primary care providers. In a six-week follow-up, the men “reported significant improvements in their sleep, as well as reductions in their depression.”

–Read more about CBT for insomnia.

What does Cognitive Therapy have to do with Nursing?

As Advanced Practice Nurses (APNs) interact with patients who have health problems, many of them find that their patients also suffer from mental health problems, including depression, anxiety, and other illnesses. So how can APNs best address the mental health needs of their patients? Two articles published this fall in Medscape’s Advanced Practice Nursing ejournal discuss how Cognitive Therapy (CT), also referred to as Cognitive Behavior Therapy (CBT), is an effective, time-limited, clinically tested treatment that is ideal for nursing settings. (To view these articles, you have to be registered with Medscape – registration is free.)

In Cognitive Behavioral Therapy in Advanced Practice Nursing: An Overview, Dr. Sharon Morgillo Freeman, a psychologist and certified Cognitive Therapist, discusses how CBT meets APNs’ need for effective, empirically based treatment — it’s a great overview for any APN interested in CBT, and includes a case example of a depressed patient treated with CBT. In Nurses Integrate Cognitive Therapy Treatment Into Primary Care: Description and Clinical Application of a Pilot Program, Dr. Judith Beck and Dr. Christine Reilly describe a pilot program that trained 12 APNs in CT, and monitored their success in implementing CT with low-income, underserved patients. This pilot program, conducted by the Beck Institute and the National Nursing Centers Consortium (NNCC), showed that APNs were able to integrate CT techniques in their primary care practices, with better patient results. We expect that in the future, we’ll see more and more integration of CT in nurse settings…