Cited by 134Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and AccessPsychotherapy Techniques and Applications

The DOI matches its Crossref record, with a small difference in title or year; 51 of the 51 references it cites were found in a registry or an index; none of the 34 sources its claims cite is checked for support yet.

Disorder-Specific Impact of Coordinated Anxiety Learning and Management Treatment for Anxiety Disorders in Primary Care

Open access

Abstract

CONTEXT: Anxiety disorders commonly present in primary care, where evidence-based mental health treatments often are unavailable or suboptimally delivered. OBJECTIVE: To compare evidence-based treatment for anxiety disorders with usual care (UC) in primary care for principal and comorbid generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and posttraumatic stress disorder (PTSD). DESIGN: A randomized controlled trial comparing the Coordinated Anxiety Learning and Management (CALM) intervention with UC at baseline and at 6-, 12-, and 18-month follow-up assessments. SETTING: Seventeen US primary care clinics. PATIENTS: Referred primary care sample, 1004 patients, with principal DSM-IV diagnoses of GAD (n = 549), PD (n = 262), SAD (n = 132), or PTSD (n = 61) (mean [SD] age, 43.7 [13.7] years; 70.9% were female). Eighty percent of the participants completed 18-month follow-up. INTERVENTIONS: CALM (cognitive behavior therapy and pharmacotherapy recommendations) and UC. MAIN OUTCOME MEASURES: Generalized Anxiety Disorder Severity Scale, Panic Disorder Severity-Self-report Scale, Social Phobia Inventory, and PTSD Checklist-Civilian Version scores. RESULTS: CALM was superior to UC for principal GAD at 6-month (-1.61; 95% confidence interval [CI], -2.42 to -0.79), 12-month (-2.34; -3.22 to -1.45), and 18-month (-2.37; -3.24 to -1.50), PD at 6-month (-2.00; -3.55 to -0.44) and 12-month (-2.71; -4.29 to -1.14), and SAD at 6-month (-7.05; -12.11 to -2.00) outcomes. CALM was superior to UC for comorbid SAD at 6-month (-4.26; 95% CI, -7.96 to -0.56), 12-month (-8.12, -11.84 to -4.40), and 18- month (-6.23, -9.90 to -2.55) outcomes. Effect sizes favored CALM but were not statistically significant for other comorbid disorders. CONCLUSIONS: CALM (cognitive behavior therapy and pharmacotherapy medication recommendations) is more effective than is UC for principal anxiety disorders and, to a lesser extent, comorbid anxiety disorders that present in primary care.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In a 17-clinic primary care randomized controlled trial, CALM (computer-guided CBT and/or pharmacotherapy recommendations) was more effective than usual care for principal generalized anxiety disorder, panic disorder, and social anxiety disorder at selected follow-ups, but not for principal PTSD. Among comorbid anxiety disorders, only social anxiety disorder showed statistically significant CALM superiority.

Key findings

  • For principal GAD, CALM was superior to usual care at 6 months (−1.61; 95% CI = −2.42 to −0.79), 12 months (−2.34; 95% CI = −3.22 to −1.45), and 18 months (−2.37; 95% CI = −3.24 to −1.50).
  • For principal PD, CALM was superior at 6 months (−2.00; 95% CI = −3.55 to −0.44) and 12 months (−2.71; 95% CI = −4.29 to −1.14); for principal SAD, at 6 months (−7.05; 95% CI = −12.11 to −2.00).
  • For comorbid SAD, CALM was superior at 6 months (−4.26; 95% CI = −7.96 to −0.56), 12 months (−8.12; 95% CI = −11.84 to −4.40), and 18 months (−6.23; 95% CI = −9.90 to −2.55). Other comorbid disorders favored CALM but were not statistically significant.
  • Principal PTSD showed no significant differences at any follow-up, although effect sizes were similar in magnitude to other disorders: −0.29 at 6 months, −0.43 at 12 months, and −0.48 at 18 months.

Methods

  • Randomized controlled effectiveness trial comparing CALM intervention with usual care in 17 primary care clinics in 4 US cities; 1004 patients with principal DSM-IV GAD (n=549), PD (n=262), SAD (n=132), or PTSD (n=61), mean age 43.7 years (SD=13.7), 70.9% female.
  • CALM consisted of computer-guided CBT and/or pharmacotherapy recommendations delivered with collaborative care; assessments occurred at baseline, 6, 12, and 18 months using disorder-specific scales: GADSS, PDSS-SR, SPIN, and PCL-C.
  • Outcomes were modeled with repeated-measures analysis over four assessments, using restricted maximum likelihood under missing-at-random assumptions; analyses were intent-to-treat, with Hochberg correction for multiple comparisons.

Limitations

  • The paper states that independent diagnostic assessments were not made at each follow-up; disorder-specific symptom scales may have been differentially sensitive to change, complicating cross-disorder comparisons; and the design does not permit dismantling which CALM components produced effects.
  • The paper notes that usual care was active—27–34% reported receiving CBT with at least 3 elements and 36–42% reported appropriate anti-anxiety medication at an appropriate dose for at least 2 months—which likely attenuated between-group effect sizes.
  • Evident from the text: principal PTSD had a relatively small sample (n=61), and comorbid analyses used smaller cell sizes (GAD n=207; PD n=213; SAD n=273; PTSD n=120), limiting statistical power for some comparisons.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/archgenpsychiatry.2011.25

Cites

51 of 51 references verified0 citation errors · 0 not checkable

Statistics

3 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Verification

Claims the paper makes

28 Own result · 17 Own method · 17 Own interpretation · 13 Not checked yet · 2 No basis given

Verify all 34 references — free account

Show all 38 claims

  • It may state two separate claims as one. 30
  • Probably not a substantial claim. 13
39 of 39
  • The paper relies on this without support.

    Effective evidence-based psychosocial and pharmacological treatments for anxiety disorders are often unavailable or delivered suboptimally in practice.

    “Although effective evidence-based psychosocial (i.e., cognitive behavioral therapy, CBT) and pharmacological treatments for anxiety disorders exist, these treatments often are not available (i.e., CBT), or sub-optimally delivered (i.e., pharmacotherapy).”
  • The authors state this as an assumption.

    The repeated-measures analyses assume that missing outcome data are missing at random.

    “which produces valid estimates under the missing-at-random assumption.36”
  • The authors state this as an assumption.

    PTSD is more difficult than other anxiety disorders for inexperienced therapists.

    “since it is often generally assumed that PTSD is more difficult than other anxiety disorders for inexperienced therapists.”
  • The paper relies on this without support.

    Effectiveness trials typically yield lower effect sizes than efficacy trials because they tolerate more noise in recreating the real world.

    “Effectiveness trials typically yield lower effect sizes even with the very same treatment protocol because they tolerate more “noise” in attempting to recreate the “real world.””
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

1 of 1

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upF(3, 258) = 2.7reported n.s. · recomputed p = .046

    “F(3, 258)=2.7, ns.”

  • Consistentχ²(3) = 2.9reported n.s. · recomputed p = .407

    “X2 (3) = 2.9, ns”

  • ConsistentF(3, 258) = 0.62reported n.s. · recomputed p = .603

    “F(3,258)=.62, ns.”

3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Self-check results appear here once an independent check has confirmed them.

Citations

Cites

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Cited by

Sorted by citations

Items 101–134 of 134

Metadata

Authors
Craske, M. G., Stein, M. B., Sullivan, G., Sherbourne, C., Bystritsky, A., Rose, R. D., Lang, A. J., Welch, S., Campbell-Sills, L., Golinelli, D., & Roy-Byrne, P.
Affiliations
  • University of California, Los Angeles (US)
  • University of California San Diego (US)
  • University of Arkansas for Medical Sciences (US)
  • RAND Corporation (US)
  • University of Washington (US)
Venue
Archives of General Psychiatry
Published
2011-04-04
Volume
68
Issue
4
Pages
378
ISSN
0003-990X (ISSN-L)
OpenAlex
W2089496028
Cited by
132
References
50
Citations by year
2026: 2 · 2025: 3 · 2024: 4 · 2023: 7 · 2022: 4 · 2021: 9 · 2020: 7 · 2019: 8 · 2018: 7 · 2017: 11 · 2016: 7 · 2015: 12 · 2014: 13 · 2013: 17 · 2012: 18
FWCI
21.02
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (U01MH057835, K24MH065324, K24MH064122, R01MH057835, R01MH058915, K24MH64122, R01MH057858, U01MH070022, U01MH070018, U01MH057858, U01MH058915)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
anxiety disorders, primary care, cognitive behavioral therapy, generalized anxiety disorder, panic disorder, social anxiety disorder, post-traumatic stress disorder, comorbidities, usual care, treatment efficacy, primary care referral, access to mental health care, relapse
MeSH terms
Adult, Antidepressive Agents, Anxiety Disorders, Female, Humans, Male, Primary Health Care, Anti-Anxiety Agents, Cognitive Behavioral Therapy, Evidence-Based Medicine

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