Psychiatry and Primary CareTraining primary care staff to deliver a computer-assisted cognitive–behavioral therapy program for anxiety disorders
Section snippets
Training novice primary care staff to deliver a computer-assisted cognitive–behavioral therapy program for anxiety disorders
There is a substantial need for treatments for anxiety disorders in primary care that are both effective and easy to disseminate. Anxiety disorders are the most common mental health problem seen in primary care, outnumbering even depressive disorders [1]. Additionally, anxiety is poorly recognized by primary care physicians (PCPs), and when recognized, evidenced-based treatments such as cognitive–behavioral therapy (CBT) are used infrequently, and anxiolytic medications — though more common —
Subjects
Subjects were 15 primary care staff hired to work either part or full time as ACSs as part of the CALM study at one of the 13 primary care clinics among the four study sites: Los Angeles, San Diego, Seattle and Little Rock, AK. As Table 1 shows, the clinicians who took part in this study, ACSs, were nearly all Master's-level clinicians, female, licensed and experienced in working with a clinical population that includes medical as well as emotional problems. However, the ACSs had relatively
Training case proficiency
As Table 2 shows, across all study sites, the mean number of training cases was 2.13 (S.D. 0.35). The mean proficiency score, based on 1–7 Likert scale across all ACS training cases, was 6.37, with an S.D. of .97.
Role-play competence
The ACSs mean score on role-plays demonstrating CBT skills based on expert psychologist ratings on a 1–7 Likert scale was 6.31 (S.D.=2.21).
Quizzes
The mean score on quizzes assessing ACS knowledge of readings and didactic presentations was 98%.
ACS experience and training performance
Pearson product–moment correlations were conducted
Discussion and conclusions
Although a number of evidenced-based psychotherapies, including CBT, are known to be clinically effective, many do not have access to them in part because widespread dissemination and implementation of these practices have been challenging. The goal of our work was to develop and evaluate a system for training primary care staff to deliver evidenced-based treatment for anxiety disorders. Such a system would provide an important mechanism for dissemination of evidence-based care for anxiety
Acknowledgments
This work was supported by the following NIMH grants: U01 MH070018 to RAND (PI: Cathy Sherbourne), U01 MH058915 to UCLA (PI: Michelle Craske), U01 MH057835 and K24 MH64122 to the University of California, San Diego (PI: Murray Stein), UO1 MH057858 and K24 MH065324 to the University of Washington (PI: Peter Roy-Byrne), U01-MH070022 to UAMS (PI: Greer Sullivan). The authors would like to thank Daniel E. Glenn and Tomislav D. Zbozinek for their contributions to this manuscript.
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