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Disorder-Specific Impact of Coordinated Anxiety Learning and Management Treatment for Anxiety Disorders in Primary Care
Open accessAbstract
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.
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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.
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28 Own result · 17 Own method · 17 Own interpretation · 13 Not checked yet · 2 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CALM was superior to Usual Care for principal GAD at 6-month (−1.61; 95% CI = −2.42 to −.79), 12-month (−2.34; 95% CI = −3.22 to −1.45) and 18-month (−2.37; 95% CI = −3.24 to −1.50), PD at 6-month (−2.00; 95% CI = −3.55 to −0.44) and 12-month (−2.71; 95% CI = −4.29 to −1.14), and SAD at 6-month (−7.05; 95% CI = −12.11 to −2.00) outcomes.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Results
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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- The authors state this as an assumption: The repeated-measures analyses assume that missing outcome data are missing at random.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CALM was superior to Usual Care for comorbid SAD at 6-month (−4.26; 95% CI = −7.96 to −0.56), 12-month (−8.12, 95% CI = −11.84 to −4.40) and 18- month (−6.23, 95% CI = −9.90 to −2.55) outcomes.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Results
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The repeated-measures analyses assume that missing outcome data are missing at random.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CALM was superior to Usual Care for principal GAD at 6-month (−1.61; 95% CI = −2.42 to −.79), 12-month (−2.34; 95% CI = −3.22 to −1.45) and 18-month (−2.37; 95% CI = −3.24 to −1.50), PD at 6-month (−2.00; 95% CI = −3.55 to −0.44) and 12-month (−2.71; 95% CI = −4.29 to −1.14), and SAD at 6-month (−7.05; 95% CI = −12.11 to −2.00) outcomes.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Results
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The repeated-measures analyses assume that missing outcome data are missing at random.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CALM was superior to Usual Care for principal GAD at 6-month (−1.61; 95% CI = −2.42 to −.79), 12-month (−2.34; 95% CI = −3.22 to −1.45) and 18-month (−2.37; 95% CI = −3.24 to −1.50), PD at 6-month (−2.00; 95% CI = −3.55 to −0.44) and 12-month (−2.71; 95% CI = −4.29 to −1.14), and SAD at 6-month (−7.05; 95% CI = −12.11 to −2.00) outcomes.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Results
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The repeated-measures analyses assume that missing outcome data are missing at random.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CALM was superior to Usual Care for principal GAD at 6-month (−1.61; 95% CI = −2.42 to −.79), 12-month (−2.34; 95% CI = −3.22 to −1.45) and 18-month (−2.37; 95% CI = −3.24 to −1.50), PD at 6-month (−2.00; 95% CI = −3.55 to −0.44) and 12-month (−2.71; 95% CI = −4.29 to −1.14), and SAD at 6-month (−7.05; 95% CI = −12.11 to −2.00) outcomes.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Results
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The repeated-measures analyses assume that missing outcome data are missing at random.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CALM was superior to Usual Care for comorbid SAD at 6-month (−4.26; 95% CI = −7.96 to −0.56), 12-month (−8.12, 95% CI = −11.84 to −4.40) and 18- month (−6.23, 95% CI = −9.90 to −2.55) outcomes.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Results
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The repeated-measures analyses assume that missing outcome data are missing at random.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CALM was superior to Usual Care for principal GAD at 6-month (−1.61; 95% CI = −2.42 to −.79), 12-month (−2.34; 95% CI = −3.22 to −1.45) and 18-month (−2.37; 95% CI = −3.24 to −1.50), PD at 6-month (−2.00; 95% CI = −3.55 to −0.44) and 12-month (−2.71; 95% CI = −4.29 to −1.14), and SAD at 6-month (−7.05; 95% CI = −12.11 to −2.00) outcomes.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Results
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The repeated-measures analyses assume that missing outcome data are missing at random.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CALM was superior to Usual Care for principal GAD at 6-month (−1.61; 95% CI = −2.42 to −.79), 12-month (−2.34; 95% CI = −3.22 to −1.45) and 18-month (−2.37; 95% CI = −3.24 to −1.50), PD at 6-month (−2.00; 95% CI = −3.55 to −0.44) and 12-month (−2.71; 95% CI = −4.29 to −1.14), and SAD at 6-month (−7.05; 95% CI = −12.11 to −2.00) outcomes.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Results
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The repeated-measures analyses assume that missing outcome data are missing at random.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CALM was superior to Usual Care for comorbid SAD at 6-month (−4.26; 95% CI = −7.96 to −0.56), 12-month (−8.12, 95% CI = −11.84 to −4.40) and 18- month (−6.23, 95% CI = −9.90 to −2.55) outcomes.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Results
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The same pattern occurred for GAD remission rates, at 6 months (p<.01, NNT = 7.7; 95% CI = 5.1−15.4), 12 months (p<.001, NNT = 4.4; CI = 3.4−6.1), and 18 months (p<.001, NNT = 5.2; CI = 3.8−7.9).”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
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In the paper
“For PD, response rates were not significantly greater in ITV than UC”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
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In the paper
“Only for SAD were there significant differences, favoring ITV, at 6, 12 and 18 months (ESs = −.29 to −.55).”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
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In the paper
“For GAD, GADS scores were significantly lower in ITV than UC at 6 (Effect Size or ES=−.33), 12 (ES=−.51) and 18 (ES=−.64) months.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
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In the paper
“For PD, PDSS scores were significantly lower in ITV than UC at 6 (ES=−35) and 12 (ES=−.46) months.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
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In the paper
“For SAD, the response rates differed at 6 months (p<.05, NNT = 5.1; CI = 3.1–15.6)”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
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In the paper
“Finally, neither response nor remission rates to ITV vs. UC differed significantly for PTSD, although they were numerically comparable to rates for GAD at 6 and 12 months.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
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In the paper
“although remission rates were significantly greater in ITV than UC at 12 months (p<.03, NNT = 5.7; CI = 3.7–13.3).”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
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In the paper
“However, only in the case of SAD in CALM did the changes statistically exceed improvements in UC.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
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In the paper
“For GAD, response rates were significantly greater in ITV than UC at 6 months (p<.001, number needed to treat (NNT) = 5.8; 95% CI = 4.2–9.2), 12 months (p<.001, NNT = 4.6; CI = 3.5–6.5), and 18 months (p<.001, NNT = 4.7; CI = 3.6−6.9).”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
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In the paper
“For SAD, SPIN scores were significantly lower in ITV than UC at 6 (ES=−.53) months.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
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In the paper
“Measures of comorbid symptom severity typically improved over time.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
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In the paper
“although remission rates did not differ at any assessment.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
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In the paper
“Table 1 shows that most demographic characteristics were similar across ITV and UC within each principal anxiety disorder group.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Sample Selection, Attrition, and Description
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In the paper
“we created a model of CBT that addressed the four most common anxiety disorders in primary care settings (panic disorder with or without agoraphobia, generalized anxiety disorder, social anxiety disorder, and posttraumatic stress disorder;5 in one program.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Conclusions
What the sources say
- Not checked yetcites [5] Kroenke K Spitzer RL Williams JB Monahan PO Lowe B Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection Ann Intern Med 2007 146 317 325 17339617
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In the paper
“Over the one-year intervention, rates of CBT only (32–43%), medication/care management only (3–11%), and CBT plus medication (46–65%) were similar across the four principal anxiety disorder groups”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > CALM Participation
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None of the sources cited for this claim have been checked yet.
In the paper
“The overwhelming majority of individuals with an anxiety disorder meet diagnostic criteria for at least one other diagnosis, most commonly another anxiety and/or mood disorder, in community-based or population-based samples1,15 as well as in samples drawn from treatment settings.16”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Conclusions
What the sources say
- Not checked yetcites [1] Kessler RC Chiu WT Demler O Walters EE Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication Arch Gen Psychiatry 2005 62 6 617 627 15939839 PMC2847357
- Not checked yetcites [15] Jacobi F Wittchen H-U Holting C Hofler M Pfister H Muller N Lieb R Prevalence, co-morbidity and correlates of mental disorders in the general population: Results from the German Health Interview and Examination Survey (GHS) Psychol Med 2004 34 4 597 611 15099415
- Not checked yetcites [16] Brown TA Chorpita BF Barlow DH Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal J Abnorm Psychol 1998 107 2 179 192 9604548
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Each scale possesses good to excellent psychometric properties.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Methods > Measures
What the sources say
- Not checked yetcites [28] Houck PR Speigel DA Shear MK Rucci P Reliability of the self-report version of the Panic Disorder Severity Scale Depress Anxiety 2002 15 4 183 185 12112724
- Not checked yetcites [29] Andreescu C Belnap BH Rollman BL Houck P Ciliberti C Mazumdar S Shear MK Lenze EJ Generalized Anxiety Disorder Severity Scale validation in older adults Am J Geriat Psychiatry 2008 16 10 813 818 (2008) PMC2803316 18827227
- Not checked yetcites [30] Weiss BJ Calleo J Rhoades H Novy DM Kunik ME Lenze EJ Stanley MA The utility of the Generalized Anxiety Disorder Severity Scale (GADSS) with older adults in primary care Depress Anxiety 2009 26 1 E10 E15 18839400 PMC2709998
- Not checked yetcites [31] Shear K Belnap BH Mazumdar S Houck P Rollman BL Generalized anxiety disorder severity scale (GADSS): A preliminary validation study Depress Anxiety 2006 23 2 77 82 16411185
- Not checked yetcites [32] Connor KM Davidson JRT Churchill LE Sherwood A Foa E Weisler RH Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale Br J Psychiatry 2000 176 379 386 10827888
- Not checked yetcites [33] Weathers PL Furlong MJ Solorzano D Mail survey research in counseling psychology: Current practice and suggested guidelines J Couns Psychol 1993 40 2 238 244
- Not checked yetcites [34] Ruggiero KJ Del Ben K Scotti JR Rabalais AE Psychometric Properties of the PTSD Checklist--Civilian Version J Trauma Stress 2003 16 5 495 502 14584634
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In the paper
“as were the percentage of visits dedicated to CBT versus medication management (X2 (3) = 2.9, ns).”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > CALM Participation
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“By relying upon no-treatment control comparisons, prior studies of CBT17,18,20,21,22,26 were unable to attribute the effects on comorbidity specifically to CBT versus treatment in general.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
What the sources say
- Not checked yetcites [17] Borkovec TD Abel JL Newman H Effects of psychotherapy on comorbid conditions in generalized anxiety disorder J Consult Clin Psychol 1995 63 3 479 483 7608362
- Not checked yetcites [18] Brown TA Barlow DH Long-term outcome in cognitive-behavioral treatment of panic disorder: Clinical predictors and alternative strategies for assessment J Consult Clin Psychol 1995 63 5 754 765 7593868
- Not checked yetcites [20] Stanley MA Beck JG Glasco JD Treatment of generalized anxiety in older adults: A preliminary comparison of cognitive-behavioral and supportive approaches Behav Ther 1996 27 4 565 581
- Not checked yetcites [21] Tsao JCI Lewin MR Craske MG The effects of cognitive-behavior therapy for panic disorder on comorbid conditions J Anxiety Disord 1998 12 4 357 371 9699119
- Not checked yetcites [22] Tsao JCI Mystkowski JL Zucker BG Craske MG Effects of cognitive-behavioral therapy for panic disorder on comorbid conditions: Replication and extenstion Behav Ther 2002 33 4 493 509
- Not checked yetcites [26] Craske MG Rose RD Lang A Welch SS Campbell-Sills L Sullivan G Sherbourne C Bystritsky A Stein MB Roy-Byrne PP Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings Depress Anxiety 2009 26 3 235 242 19212970 PMC2906395
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Since most ITV participants completed their treatment by 6 months, the 12 and 18 month follow-up assessments largely assessed sustainability of treatment effects.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Furthermore, non-expert clinicians (ACSs) were equally successful in adhering to and competently applying CBT across the anxiety disorders when guided by our computerized program.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Furthermore, the design does not permit dismantling of the degree to which intervention effects were attributable to specific components of the CALM intervention, such as CBT and psychotropic medications.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Nonetheless, the effect sizes indicated that our evidence-based intervention tailored to primary care was more effective than UC for each principal anxiety disorder, at least out to 12 months after study entrance.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In summary, the CALM intervention had a greater positive effect on symptoms of principal anxiety disorders relative to UC in this primary care sample.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The GAD effects were confirmed when analyzing response and remission rates where ITV was significantly superior to UC at each time point.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“At the same time, these effects likely represent what would be achieved in real world practice, where therapeutic alternatives must realistically be compared with other therapeutic options patients might pursue.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: unclear — It is unclear whether it could be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, independent diagnostic assessments were not made at each follow-up.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Also, the effect sizes of differences between ITV and UC (e.g., .24 to .55) indicated that comorbidity decreased more in ITV than UC at 6 and 12 months.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 30
- Probably not a substantial claim. 13
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Effect sizes favored CALM, but were not statistically significant for other comorbid disorders.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: The repeated-measures analyses assume that missing outcome data are missing at random.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and PTSD (ESs = −.18 to −.33).”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For PTSD, PCLC scores were not significantly different between ITV and UC at any follow-up assessment, although ESs were of similar magnitude to those of the other disorders: −.29 (6 months), −.43 (12 months) and −.48 (18 months).”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Effect sizes did not differ significantly across the four groups at any of the follow-up assessments, with one exception; the effect size for GAD was significantly larger than for PD at the 18 month assessment, p < .01.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although ESs always favored ITV, scores on the disorder specific measures did not differ significantly between ITV and UC at any follow-up assessment for GAD (ESs=−.18 to −.24)”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“PD (ESs = −.21 to −.33)”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Outcomes
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“GAD was the most common principal anxiety disorder (55%), followed by PD (26%), then SAD (13%) and PTSD (6%).”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The sample was ethnically diverse, medically ill, and highly comorbid in terms of anxiety disorders and major depressive disorder.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Computer-assisted programs have been used in training in CBT,9,10 and in self-directed CBT,11 but they have not before been used for ongoing assistance of the mental health provider in the delivery of CBT.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Conclusions
What the sources say
- Not checked yetcites [9] Carroll KM Rounsaville BJ A vision of the next generation of behavioral therapies research in the addictions Addiction 2007 102 6 850 862 17523974 PMC2148498
- Not checked yetcites [10] Gega L Norman IJ Marks IM Computer-aided vs. tutor-delivered teaching of exposure therapy for phobia/panic: Randomized controlled trial with pre-registration nursing students Int J Nurs Stud 2007 44 3 397 405 16631177
- Not checked yetcites [11] Spek V Cuijpers P Nyklicek I Riper H Keyzer J Pop V Internet-based congnitive behaviour therapy for symptoms of depression and anxiety: A meta-analysis Psychol Med 2007 37 3 319 328 17112400
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CALM (CBT and psychotropic recommendations) is more effective than Usual Care for principal anxiety disorders, and to a lesser extent, comorbid anxiety disorders that present in primary care.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Conclusions
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: The repeated-measures analyses assume that missing outcome data are missing at random.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The average number of CBT visits (6.7–8.2) and medication visits (2.1–2.9), and the percentage who completed all visits by 3 months (35–52%) and by 6 months (85–92%), were similar across the four groups.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > CALM Participation
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“For cross-sectional analyses (such as percentage of responders at the 3 follow-up times), we used attrition weights to correctly account for those Ps that missed one or more follow-up assessments.38”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Methods > Statistical Analysis
What the sources say
- Not checked yetcites [38] Brick JM Kalton G Handling Missing Data in Survey Research Stat Methods Med Res 1996 5 3 215 238 8931194
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Study retention was high. Specifically, non-response rates (“no contact” and “cumulative refusals”) ranged from 9.8–14.9 across all four principal anxiety disorders at 6 months, 17.4–22.5 at 12 months and 15.9–24.0 at 18 months.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Sample Selection, Attrition, and Description
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“All P values were 2-tailed and are adjusted within outcome measures using Hochberg’s39 correction method to account for multiple comparisons.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Methods > Statistical Analysis
What the sources say
- Not checked yetcites [39] Hochberg Y A sharper Bonferroni procedure for multiple tests of significance Biometnika 1988 75 4 800 802
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“based on the Mini International Neuropsychiatric Interview (MINI)25 administered by the ACS after formal training and diagnostic reliability testing”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Methods > Participants
What the sources say
- Not checked yetcites [25] Sheehan DV Lecrubier Y Sheehan KH Amorim P Janavs J Weiller E Hergueta T Baker R Dunbar GC The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10 J Clin Psychiatry 1998 59 22 33 9881538
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“There was some imbalance (at p<.10) in education, ethnicity, number of comorbid anxiety disorders and GAD for PD only, which were used as covariates in the analyses.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > Sample Selection, Attrition, and Description
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Block size was masked to all clinical site study members.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Methods > Randomization
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“After baseline assessment, Ps were randomized, using stratified (by clinic and presence of co-morbid major depression) permuted block randomization, to ITV or UC by an automated program at RAND.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Methods > Randomization
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Average ACS adherence to the CALM CBT protocol was 5.0 (+/− 1.3) (on a 7-point scale) with no differences across the four principal anxiety disorder groups, F(3,258)=.62, ns.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > CBT Integrity
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The assessment battery was administered at baseline, 6, 12, and 18 months via a centralized phone survey by the RAND survey research group, blinded to group assignment.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Methods > Measures
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This is an efficient way for conducting an intent-to-treat analysis since it includes all Ps with a baseline assessment: 94 Ps (9.4%) completed baseline only; 63 (6%) completed baseline and one follow-up; 112 (11.1%) completed baseline and two follow-ups; and 735 (73%) completed baseline and all three follow-up”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Methods > Statistical Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Blind assessments occurred at 6, 12, and 18 months after baseline.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Methods > Design
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“For the CALM CBT program, digital recordings of each ACS session at each site (n=259) were randomly selected for adherence/competency monitoring using a set of 1–7 point Likert-scales (higher scores represents better performance), completed by 2 PhD level independent raters who initially demonstrated inter-rater reliability.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Methods > Measures
What the sources say
- Not checked yetcites [4] Stein MB Roy-Byrne PP Craske MG Bystritsky A Sullivan G Pyne JM Wayne K Sherbourne C Functional Impact and Health Utility of Anxiety Disorders in Primary Care Outpatients Medical Care 2005 43 12 1164 1170 16299426
boostedn = 259- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Since previous research has indicated that adequate CBT treatment of a principal anxiety disorder simultaneously improves rates of comorbid disorders,17,18,19,20,21,22 we hypothesized that the CALM intervention would benefit comorbid disorders as well.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Abstract > Conclusions
What the sources say
- Not checked yetcites [17] Borkovec TD Abel JL Newman H Effects of psychotherapy on comorbid conditions in generalized anxiety disorder J Consult Clin Psychol 1995 63 3 479 483 7608362
- Not checked yetcites [18] Brown TA Barlow DH Long-term outcome in cognitive-behavioral treatment of panic disorder: Clinical predictors and alternative strategies for assessment J Consult Clin Psychol 1995 63 5 754 765 7593868
- Not checked yetcites [19] Craske MG Farchione TJ Allen LB Barrios V Stoyanova M Rose R Cognitive behavioral therapy for panic disorder and comorbidity: More of the same or less of more? Behav Res Ther 2007 45 6 1095 1109 17069753
- Not checked yetcites [20] Stanley MA Beck JG Glasco JD Treatment of generalized anxiety in older adults: A preliminary comparison of cognitive-behavioral and supportive approaches Behav Ther 1996 27 4 565 581
- Not checked yetcites [21] Tsao JCI Lewin MR Craske MG The effects of cognitive-behavior therapy for panic disorder on comorbid conditions J Anxiety Disord 1998 12 4 357 371 9699119
- Not checked yetcites [22] Tsao JCI Mystkowski JL Zucker BG Craske MG Effects of cognitive-behavioral therapy for panic disorder on comorbid conditions: Replication and extenstion Behav Ther 2002 33 4 493 509
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“The effect sizes for differences between ITV and UC were low to moderate. However, they are in the range of effect sizes for differences between CBT and other active treatments (such as psychodynamic, interpersonal and supportive therapies) for anxiety disorders (d=.43) 41.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
What the sources say
- Not checked yetcites [41] Tolin DF Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review Clinical Psych Review 2010 (in press) 20547435
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The disorder-specific symptom scales may have been differentially sensitive to change, thus rendering comparisons across disorders problematic.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Also, effect sizes indicated that our intervention was superior to usual care for comorbid anxiety symptoms, although the only comorbid anxiety to statistically benefit from our intervention over and above usual care was SAD.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“27–34% of the UC reported receiving CBT with at least 3 elements, and 36–42% reported any appropriate anti-anxiety medication at an appropriate dose for at least 2 months.14”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
What the sources say
- Not checked yetcites [14] Roy-Byrne P Craske MG Sullivan G Rose RD Edlund MJ Lang AJ Bystritsky A Welch SS Chavira DA Golinelli D Campbell-Sills L Sherbourne CD Stein MB Delivery of Evidence-Based Treatment for Multiple Anxiety Disoders in Primary Care JAMA 2010 303 19 1921 1928 20483968 PMC2928714
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The results with GAD were the strongest both statistically and in terms of effect sizes, which is particularly important since GAD is among the most commonly presenting anxiety disorders in primary care.5,42”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
What the sources say
- Not checked yetcites [5] Kroenke K Spitzer RL Williams JB Monahan PO Lowe B Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection Ann Intern Med 2007 146 317 325 17339617
- Not checked yetcites [42] Weisberg RB Overview of generalized anxiety disorder: epidemiology, presentation, and course J Clin Psychiatry 2009 70 suppl 2 4 9 19371500
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Also, statistical significance between ITV and UC for GAD, PTSD and PD symptoms may have been mitigated by sample size, and/or an overall improvement in comorbid symptoms due to either nonspecific treatment effects shared between ITV and UC or the passage of time alone.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In terms of principal anxiety disorder outcomes, ITV was statistically superior to UC across 6 months for GAD, PD and SAD, at 12 months for GAD and PD, and at 18 months for GAD.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This is the first study to evaluate differences in intervention effects relative to UC on comorbid disorder outcomes in a generalizable sample and using dimensional measures of comorbidity.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The effect sizes indicated that our intervention was superior to usual care at one or more time points in the treatment of each principal anxiety disorder, although effects were not statistically significant for PTSD.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Retention in the study and participation in the CALM intervention were relatively similar across the four anxiety disorders.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For PTSD, the results were nonsignificant at each follow-up time point. However, the statistical significance for PTSD comparisons was mitigated by the relatively small sample size, as the effect sizes for PTSD were actually equivalent to the effect sizes for the other principal anxiety disorders, including GAD.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The active nature of UC in this study likely contributed to the low to moderate between-group effect sizes, the pattern of mostly continued improvement in the UC group over time, and the lack of differences between ITV and UC for PD and SAD groups at the 18 month time point.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Similarly, average ACS competency was 5.3 (+/− 1.4) (on a 7-point scale), with no differences across the four principal anxiety disorder groups, F(3, 258)=2.7, ns.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > CBT Integrity
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“That they were equally capable with PTSD compared to the other disorders highlights the value of the computer-guided program, since it is often generally assumed that PTSD is more difficult than other anxiety disorders for inexperienced therapists.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: PTSD is more difficult than other anxiety disorders for inexperienced therapists.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, the CALM intervention tended to have a greater positive effect on all comorbid symptoms, but the effects were only statistically significant for comorbid social anxiety symptoms.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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.””
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?
The cited source doesn’t support the claim as written.
In the citing paper
“The CBT strategies that form the core of Coping Cat have been subjected to years of extensive research through clinical trials [183, 184], have been shown to be highly efficacious in addressing symptoms of a range of anxiety disorders, and are widely available at low cost.”
From A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders (2021) · cites this paper as [183]
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Our CBT protocol included the same basic treatment elements across all of the disorders (e.g., psychoeducation, cognitive restructuring, exposure – see Methods) but tailored the content of these elements to each specific disorder, an approach we have successfully tested in previous studies (e.g., Craske et al., 2011).”
From Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders (2012) · cites this paper as Craske et al., 2011
The cited source says what the claim attributes to it.
In the citing paper
“Cognitive behavioral therapy (CBT) is an empirically supported treatment for social phobia.”
From Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: Outcomes and moderators (2014) · cites this paper as Craske et al., 2011
In the citing paper
“Note, consistent with statistical methods of primary outcome publications,31,40 multi-level modeling was not conducted to account for potential clustering effects within site and clinic, given that estimates would not be stable with our small numbers of sites and clinics.”
Statistics that don’t add up
Each reported p-value recomputed from its test statistic and degrees of freedom.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“F(3, 258)=2.7, ns.”
§ Disorder specific impact of CALM treatment for anxiety disorders in primary care > Results > CBT Integrity
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.”
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
Statistical power analysis for the behavioral sciences
Cohen, J. (1990) · Computers Environment and Urban Systems · doi:10.1016/0198-9715(90)90050-4 · Cited by 65,417
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910
Statistical Power Analysis for the Behavioral Sciences (2nd ed.).
Lachenbruch, P. A., & Cohen, J. (1989) · Journal of the American Statistical Association · doi:10.2307/2290095 · Cited by 37,421
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139
Statistical Analysis With Missing Data
Lahiff, M., Little, R. J. A., & Rubin, D. B. (1989) · Journal of the American Statistical Association · doi:10.2307/2289883 · Cited by 17,385
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.617 · Cited by 12,052
Littell, R. C. (1996) · Medical Entomology and Zoology · Cited by 10,345
(1998) · PubMed · Cited by 10,216
The mini international neuropsychiatric interview
Lecrubier, Y., Sheehan, D. V., Hergueta, T., & Weiller, E. (1998) · European Psychiatry · doi:10.1016/s0924-9338(99)80239-9 · Cited by 5,899
A sharper Bonferroni procedure for multiple tests of significance
HOCHBERG, Y. (1988) · Biometrika · doi:10.1093/biomet/75.4.800 · Cited by 4,829
Cited by
Sorted by citations
Collaborative care for depression and anxiety problems
Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., Dickens, C., & Coventry, P. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006525.pub2 · Cited by 1,126
Rytwinski, N. K., Scur, M. D., Feeny, N. C., & Youngstrom, E. A. (2013) · Journal of Traumatic Stress · doi:10.1002/jts.21814 · Cited by 672
Craske, M. G., Stein, M. B., Eley, T. C., Milad, M. R., Holmes, A., Rapee, R. M., & Wittchen, H.-U. (2017) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2017.24 · Cited by 652
Stein, M. B., & Sareen, J. (2015) · New England Journal of Medicine · doi:10.1056/nejmcp1502514 · Cited by 314
Self-citationArch, J. J., Eifert, G. H., Davies, C., Vilardaga, J. C. P., Rose, R. D., & Craske, M. G. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0028310 · Cited by 443
Self-citation
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
- Publisher
- American Medical Association (AMA)
- Published
- 2011-04-04
- Volume
- 68
- Issue
- 4
- Pages
- 378
- ISSN
- 0003-990X (ISSN-L)
- PMC
- PMC3074172
- OpenAlex
- W2089496028
- Semantic Scholar
- 31e5ab66c6c62562531c15cd730b828e86acf3de
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-08, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-08 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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