Measurable results

Symptom scores were significantly lower for patients in the intervention group at 6 months, 12 months, and 18 months.
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Research

Research

Based on earlier promising studies, a multi-site, randomized controlled trial was conducted to test the effectiveness of the CALM approach and, specifically, the CALM Tools for Living web-based program. This program helped non-expert care managers to deliver evidence-based CBT, as well as facilitating measurement of care.


Between June 2006 and April 2008, 1004 primary care patients with panic disorder, generalized anxiety disorder, social anxiety disorder, or posttraumatic stress disorder were enrolled in the study. The study was conducted in 17 clinics in four locations across the country. Eligible patients were 18-75 years old; met the DSM-IV diagnostic criteria for one of these four anxiety disorders; and indicated at least moderate anxiety symptoms on a validated scale. Two-thirds of the sample had comorbid depression.

Patients in the intervention group received their preferred treatment; medication, CBT, or both; over a period of 10-12 weeks. The program included five generic modules (education, self-monitoring, hierarchy development, breathing training, and relapse prevention) and modules tailored to the specific anxiety disorder or depression (cognitive restructuring and exposure to internal and external stimuli).

Symptom scores were significantly lower for patients in the intervention group at 6 months, 12 months, and 18 months.

The clinical specialist tracked patient outcomes using a web-based system. The goal was clinical remission, improvement such that patients did not want further treatment, or improvement with residual symptoms requiring a non-protocol psychotherapy. Patients who remained symptomatic and thought to benefit from additional treatment could receive more of the same treatment or switch to the alternative treatment. All patients received follow-up phone calls to reinforce CBT skills and/or medication adherence.

Outcome measures for the intervention group patients were significantly better for all measures, except physical health and satisfaction with medical care. A significantly higher proportion of patients in the intervention responded and remitted their anxiety and depression symptoms.