February 2020

In This Issue: Advancements in VA Primary Care
» Table of Contents

Improving Primary Care Anxiety Treatment Engagement and Effectiveness

Feature Article

Takeaway: This project addresses a critical need for evidence-based anxiety interventions that are feasible within VA’s Primary Care-Mental Health Integration setting for Veterans experiencing anxiety who prefer to be treated in primary care rather than a mental healthcare setting.

Many VA primary care patients experience anxiety symptoms that impair their quality of life, but treatment rates are low, and any treatment provided is usually pharmacological despite most patients preferring behavioral treatment. VA 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 effective anxiety treatment. However, brief behavioral anxiety interventions suitable for use in the PC-MHI setting are needed to address a gap in VA treatment options.   

This ongoing HSR&D study (April 2017 – March 2022) will develop, refine, and evaluate a brief transdiagnostic intervention for anxiety (generalized anxiety, social anxiety, phobias, panic attacks, and adjustment-related anxiety) that will be acceptable to Veterans and feasible for PC-MHI providers. Investigators are:

• Examining PC-MHI providers' usual care practices for anxiety treatment and perceived feasibility of using evidence-based anxiety intervention techniques in PC-MHI practice;
• Developing a brief, Veteran-centered PC-MHI intervention for anxiety, conducting a small open trial, and refining the treatment manual based on patient and PC-MHI provider feedback; and 
• Conducting a pilot randomized controlled trial (RCT) to evaluate the feasibility, acceptability, and effectiveness of the anxiety intervention (versus PC-MHI usual care), as well as identifying potential implementation barriers and facilitators.

Preliminary Findings

• In qualitative interviews, providers reported that being able to tailor interventions to individual patient presentations is critical for feasibility in PC-MHI practice.
• Providers perceived high feasibility of the anxiety intervention’s format and modular design.
• In the open trial, Veterans reported very high satisfaction with the intervention content and format.
• The pilot RCT is still ongoing, so findings are not yet available.

Impact

This project addresses a critical need for evidence-based anxiety interventions suitable for the PC-MHI setting for Veterans experiencing anxiety who prefer to be treated in primary care. Attending to Veterans' treatment preferences will enhance the acceptability of treatment—and incorporating PC-MHI provider feedback regarding implementation challenges will improve the feasibility of delivery.

Principal Investigator: Robyn L. Shepardson, PhD, is an HSR&D Career Development Awardee and part of the Center for Integrated Healthcare at the Syracuse VA Medical Center in Syracuse, NY.

Publications

Shepardson R, Buchholz L, Weisberg R, and Funderburk J. Psychological interventions for anxiety in adult primary care patients: A review and recommendations for future research. Journal of Anxiety Disorders. March 2018; 54:71-86.

View study abstract