Brief Cognitive Behavioral Therapy for Anxiety
Condition: Anxiety
MeSH terms: Anxiety Disorders
Study type: Interventional

Summary: 
      The proposed clinical intervention is a modular skills-based intervention for flexible
      delivery of care, measurement-based care practices, and integration of exposure strategies
      critical for anxiety symptom reduction. Notably, the treatment targets anxiety symptoms
      rather than diagnoses to improve use in PCMHI and CBOC settings. The pilot study will develop
      and conduct preliminary testing of bCBT for anxiety using Veterans Affairs (VA) Video Connect
      to Home (VVC-H) to deliver care.
    

Detailed description: 
      Anxiety disorders are identified in over 30% of primary care patients and are associated with
      substantial functional impairment, poor health-related quality of life, and suicide; however,
      rates of treatment are low. In contrast to advances in improving treatment of depression and
      posttraumatic stress disorder in VA, far less attention has been given to anxiety disorders.
      In the absence of VA clinical practice guidelines for anxiety disorders, evidence-based
      treatment practices are unstandardized in VA primary care and Community Based Outpatient
      Clinics (CBOCs). Cognitive behavioral therapy (CBT) is an evidence-based intervention for the
      anxiety disorders but was developed for use in specialty mental health settings and often
      targets individual anxiety disorders (e.g.generalized anxiety, panic, and social phobia) with
      diagnosis-specific treatment packages. These interventions are not practical for primary care
      and CBOC settings where treatment must be brief and focused on reduction of anxiety symptoms
      rather than targeted anxiety diagnoses. Further complicating the delivery of CBT for anxiety
      disorders is that repeated exposure to feared cues is considered a critical component of CBT
      for anxiety but is rarely used in these settings. Providers within VA currently have no
      standardized options for delivering brief evidence-based psychotherapy for Veterans with
      anxiety. Although Primary Care Mental Health Integration (PCMHI) and CBOCs increase access to
      mental health services, VA recognizes the need to deliver mental health services using video
      to home technology to increase access, decrease barriers (i.e., geographic distance,
      transportation, travel time, stigma, child care) and provide more Veteran-centric care. VA is
      pioneering implementation of VA Video Connect to Home (VVC-H) technology in specialty mental
      health clinics, but VVC-H continues to be rarely used and little is known about the
      implementation potential of VVC-H to improve psychotherapy access and outcomes in primary
      care and CBOC settings. In summary, VA needs a flexible evidence-based approach for anxiety
      that fits within primary care and CBOC settings and offers innovative delivery strategies to
      increase access to care. Although treatment in PCMHI and CBOC settings must be time-limited,
      it must also be highly effective. The investigators have developed robust brief CBT (bCBT)
      interventions and provider support programs for depression and is now seeking to address
      anxiety using a similar approach. The proposed clinical intervention will use
      state-of-the-art practices including delivery of services via VVC-H. This open trial seeks to
      recruit 12 Veterans who have significant anxiety symptoms according to the GAD-7 (standard
      assessment tool for VA clinical settings). Veterans will be recruited from the Michael E.
      DeBakey VAMC primary care clinic and affiliated Community Based Outpatient Clinics (CBOCs).
    

Intervention name(s): Brief CBT for Anxiety
Intervention type(s): Behavioral
Intervention description(s): All participants will receive psychoeducation on anxiety and bCBT treatment approach, work on setting goals, begin self-monitoring, and select skill sessions that fit his/her most pressing needs. Available skills: Relaxation-Diaphragmatic breathing is a simple relaxation technique that increases oxygen flow and reduces the unpleasant physiological sensations associated with anxiety; Exposure - designed to educate Veterans about the role of avoidance in maintaining anxiety problems, as well as information about how to reduce avoidance through exposure exercises; Cognitive - Veterans may opt to address anxiety and worry through modifying negative thinking patterns. Two available options - Increasing Helpful Thoughts and Managing Unhelpful Thoughts.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: brief Cognitive Behavioral Therapy; VA Video Connect to home