University of California, Los Angeles, Department of Psychology, Franz Hall, 405 Hilgard Avenue, Los Angeles, CA 90095, USA.
Behav Res Ther. 2009 Nov;47(11):931-7. doi: 10.1016/j.brat.2009.07.012. Epub 2009 Jul 14.
Anxiety disorders are common, costly and debilitating, and yet often unrecognized or inadequately treated in real world, primary care settings. Our group has been researching ways of delivering evidence-based treatment for anxiety in primary care settings, with special interest to preserving the fidelity of the treatment while at the same time promoting its sustainability once the research is over. In this paper, we describe the programs we have developed and our directions for future research. Our first study evaluated the efficacy of CBT and expert pharmacotherapy recommendations for panic disorder in primary care, using a collaborative care model of service delivery (CCAP). Symptom, disability and mental health functioning measures were superior for the intervention group compared to treatment as usual both in the short term and the long term, although also more costly. In our ongoing CALM study, we have extended our population to include panic disorder, social anxiety disorder, generalized anxiety disorder and posttraumatic disorder, while at the same time utilizing clinicians with limited mental health care experience. In addition to pharmacotherapy management, we developed a computer-assisted CBT that guides both novice clinician and patient, thereby contributing to sustainability once the research is over. We have also incorporated a measurement based approach to treatment planning, using a web-based tracking system of patient status. To date, the computer-assisted CBT program has been shown to be acceptable to clinicians and patients. Clinicians rated the program highly, and patients engaged in the program. Future directions for our research include dissemination and implementation of the CALM program, testing potential alternations to the CALM program, and distance delivery of CALM.
焦虑障碍很常见，费用高昂且使人衰弱，但在现实世界的初级保健环境中，往往未被识别或治疗不足。我们的团队一直在研究如何在初级保健环境中提供基于证据的焦虑治疗方法，特别关注在保持治疗的忠实性的同时，促进其在研究结束后的可持续性。在本文中，我们描述了我们开发的方案和未来研究的方向。我们的第一项研究使用协作式护理模式（CCAP）评估了认知行为疗法和专家药物治疗建议对初级保健中惊恐障碍的疗效。与常规治疗相比，干预组在短期和长期内的症状、残疾和心理健康功能指标都有更好的改善，尽管成本也更高。在我们正在进行的 CALM 研究中，我们将研究人群扩展到包括惊恐障碍、社交焦虑障碍、广泛性焦虑障碍和创伤后应激障碍，同时利用心理健康护理经验有限的临床医生。除了药物治疗管理，我们还开发了一种计算机辅助认知行为疗法，为新手临床医生和患者提供指导，从而为研究结束后的可持续性做出贡献。我们还采用了基于测量的治疗计划方法，使用基于网络的患者状态跟踪系统。迄今为止，计算机辅助认知行为疗法方案已被临床医生和患者认可。临床医生对该方案评价很高，患者也参与了该方案。我们研究的未来方向包括 CALM 方案的传播和实施、对 CALM 方案的潜在改变的测试，以及 CALM 的远程交付。
