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. 2021 Dec:6:100202.
doi: 10.1016/j.jadr.2021.100202. Epub 2021 Jul 20.

A randomized controlled trial comparing a manual and computer version of CALM in VA community-based outpatient clinics

Michael A Cucciare  1   2   3 , Kathy Marchant  1 , Traci Abraham  1   2   3 , Anthony Ecker  4   5   6 , Xiaotong Han  1   2   3 , Penny White  3 , Michelle G Craske  7   8   9 , Jan Lindsay  4   5   6
Affiliations

A randomized controlled trial comparing a manual and computer version of CALM in VA community-based outpatient clinics

Michael A Cucciare et al. J Affect Disord Rep. 2021 Dec.

Abstract

Background: This study compared a computer and manual version of a tailored Coordinated Anxiety Learning and Management (VA CALM) protocol on provider fidelity to CBT and patient outcomes.

Methods: This study was a cluster randomized controlled trial. Providers (N = 32) were randomized to deliver VA CALM by computer or manual. Veteran patients (N = 135), treated by study providers, were recruited. The primary outcome was CBT fidelity, measured by rating audiotaped sessions. Secondary outcomes were Veterans' general (BSI-18 GSI, SF-12) and disorder-specific (GAD-7, PCL-5, PHQ-9) outcomes assessed at baseline, three and six month follow-up.

Results: We found a large (d = 0.88) but not statistically significant difference in mean fidelity rating scores between conditions. Compared with the manual, participants with generalized anxiety disorder receiving VA CALM by computer reported lower GAD-7 scores at three (-5.88; 95% CI=-11.37, -0.39) and six month (-5.25; 95% CI=-10.29, -0.22) follow-ups (d = 0.37 to 0.55). Participants in the computer and manual conditions reported lower PHQ-9 (-3.11; 95% CI=-5.51, -0.71; -4.06; 95% CI=-7.22, -0.90, respectively) and BSI-18 GSI (0.78; 95% CI=0.68,0.90; 0.71; 95% CI=0.58, 0.87, respectively) scores from baseline to six month follow-up. We did not find statistically significant differences over time or between conditions on SF-12 or PCL-5 scores.

Limitations: This study was underpowered to test the primary outcome. Small samples sizes in the disorder-specific subgroup analysis may limit the generalizability of findings.

Conclusions: Neither modality proved to be superior on VA CALM fidelity. The computer version of VA CALM, compared to the manual, may provide modest benefit to Veterans with GAD.

Keywords: CBT; Coordinated anxiety learning and management; Treatment fidelity; US military veterans.

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Conflict of interest statement

Declaration of Competing Interest The authors have no disclosures to report.

Figures

Fig. 1.
Fig. 1.
CONSORT flow diagram of Veteran participants.
See this image and copyright information in PMC

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