Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings

Abstract

Objectives: This article describes a computer-assisted cognitive behavioral therapy (CBT) program designed to support the delivery of evidenced-based CBT for the four most commonly occurring anxiety disorders (panic disorder, posttraumatic stress disorder, generalized anxiety disorder, and social anxiety disorder) in primary-care settings. The purpose of the current report is to (1) present the structure and format of the computer-assisted CBT program, and (2) to present evidence for acceptance of the program by clinicians and the effectiveness of the program for patients.

Methods: Thirteen clinicians using the computer-assisted CBT program with patients in our ongoing Coordinated Anxiety Learning and Management study provided Likert-scale ratings and open-ended responses about the program. Rating scale data from 261 patients who completed at least one CBT session were also collected.

Results: Overall, the program was highly rated and modally described as very helpful. Results indicate that the patients fully participated (i.e., attendance and homework compliance), understood the program material, and acquired CBT skills. In addition, significant and substantial improvements occurred to the same degree in randomly audited subsets of each of the four primary anxiety disorders (N=74), in terms of self ratings of anxiety, depression, and expectations for improvement.

Conclusions: Computer-assisted CBT programs provide a practice-based system for disseminating evidence-based mental health treatment in primary-care settings while maintaining treatment fidelity, even in the hands of novice clinicians.

Figure 1. Overall treatment plan for Calm Tools for Living over six sessions

Patient Activation = skills for enhancing motivation and reducing barriers to treatment involvement; Education = psycheducation about fear and anxiety; CALM Recording = self monitoring anxiety and fear; CALM List = generation of a hierarchy of feared situations; CALM Breathing = breathing retraining as a coping tool for interrupting anxiety; CALM Thinking = identifying anxious thinking and learning skills for generating more evidence-based, rational thinking; CALM Living = exposure to feared situations; CALM Feeling = exposure to feared sensations, images, or memories; Keep Going = skills for relapse prevention.