ADEQUACY OF TREATMENT RECEIVED BY PRIMARY CARE PATIENTS WITH ANXIETY DISORDERS: Primary Care Anxiety Treatment Adequacy
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BACKGROUND: We examined the adequacy of pharmacotherapy and psychotherapy received by primary care patients with anxiety disorders over up to 5 years of follow-up. METHOD: Five hundred thirty-four primary care patients at 15 US sites, who screened positive for anxiety symptoms, were assessed for anxiety disorders. Those meeting anxiety disorder criteria were offered participation and interviewed again at six and 12 months postintake, and yearly thereafter for up to 5 years. We utilized existing definitions of appropriate pharmacotherapy and created definitions of potentially adequate psychotherapy/cognitive-behavioral therapy (CBT). RESULTS: At intake, of 534 primary care participants with anxiety disorders, 19% reported receiving appropriate pharmacotherapy and 14% potentially adequate CBT. Overall, 28% of participants reported receiving potentially adequate anxiety treatment, whether pharmacotherapy, psychotherapy, or both. Over up to five years of follow-up, appropriate pharmacotherapy was received by 60% and potentially adequate CBT by 36% of the sample. Examined together, 69% of participants received any potentially adequate treatment during the follow-up period. Over the course of follow-up, primary care patients with MDD, panic disorder with agoraphobia, and with medicaid/medicare were more likely to receive appropriate anxiety treatment. Ethnic minority members were less likely to receive potentially adequate care. CONCLUSIONS: Potentially adequate anxiety treatment was rarely received by primary care patients with anxiety disorders at intake. Encouragingly, rates improved over the course of the study. However, potentially adequate CBT remained much less utilized than pharmacotherapy and racial-ethnic minority members were less likely to received care, suggesting much room for improved dissemination of quality treatment.
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Pharmacological treatment is much more common than psychological treatment for anxiety in primary care.
“Only half of patients receive minimally adequate treatment, with pharmacological treatment much more common than psychological treatment (Weisberg et al., 2014)”
From Barriers to and Facilitators of Using Evidence-Based, Cognitive–Behavioral Anxiety Interventions in Integrated Primary Care Practice (2023) · cites this paper as Weisberg et al., 2014
The Discussion reports that 47% received potentially adequate care after one year, supporting “only half” as an approximation for that time point. It also reports higher rates of potentially adequate pharmacotherapy than psychotherapy over up to five years (60% versus 36%). The broader claim that pharmacological treatment itself was much more common is not established: the Results report psychotherapy of any kind for 60% during follow-up, versus appropriate antianxiety medication use for 70%. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOnly half of primary care patients with anxiety receive minimally adequate treatment.
“Only half of patients receive minimally adequate treatment, with pharmacological treatment much more common than psychological treatment (Weisberg et al., 2014)”
From Barriers to and Facilitators of Using Evidence-Based, Cognitive–Behavioral Anxiety Interventions in Integrated Primary Care Practice (2023) · cites this paper as Weisberg et al., 2014
The Discussion reports that 47% received potentially adequate care after one year, close to the claimed half, and that pharmacotherapy was more common than psychotherapy over follow-up (60% versus 36%). But the sentence omits the time frame: the paper reports 28% at intake and 69% over up to five years. It also describes treatment as potentially adequate, not definitively minimally adequate. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAnxiety is undertreated in primary care.
“Anxiety is undertreated in primary care, and treatment provided is most often pharmacological (Stein et al., 2011; Weisberg et al., 2014) despite most patients preferring behavioral treatment (McHugh et al., 2013).”
From Brief modular anxiety intervention for primary care: Hybrid I pilot randomized controlled trial of feasibility, acceptability, effectiveness, and implementation potential (2024) · cites this paper as Weisberg et al., 2014
Treatment provided in primary care is most often pharmacological.
“Anxiety is undertreated in primary care, and treatment provided is most often pharmacological (Stein et al., 2011; Weisberg et al., 2014) despite most patients preferring behavioral treatment (McHugh et al., 2013).”
From Brief modular anxiety intervention for primary care: Hybrid I pilot randomized controlled trial of feasibility, acceptability, effectiveness, and implementation potential (2024) · cites this paper as Weisberg et al., 2014
In the same study, only 36% received potentially adequate psychotherapy, defined as cognitive and/or behavioral therapy.
“whereas only 36% received 'potentially adequate psychotherapy,' defined as cognitive and/or behavioral therapy.”
From Barriers to and Facilitators of Using Evidence-Based, Cognitive–Behavioral Anxiety Interventions in Integrated Primary Care Practice (2023) · cites this paper as Weisberg et al., 2014
In a 5-year longitudinal study of 534 primary care patients with anxiety disorders, 60% received potentially adequate pharmacotherapy, defined as an appropriate anxiety medication at an appropriate dose for at least eight consecutive weeks.
“In a 5-year longitudinal study of 534 primary care patients with anxiety disorders (Weisberg et al., 2014), 60% received 'potentially adequate pharmacotherapy,' defined as an appropriate anxiety medication at an appropriate dose for at least eight consecutive weeks”
From Barriers to and Facilitators of Using Evidence-Based, Cognitive–Behavioral Anxiety Interventions in Integrated Primary Care Practice (2023) · cites this paper as Weisberg et al., 2014
Anxiety is under-treated in primary care.
“anxiety 1 is under-treated in this setting.”
From Barriers to and Facilitators of Using Evidence-Based, Cognitive–Behavioral Anxiety Interventions in Integrated Primary Care Practice (2023) · cites this paper as Weisberg et al., 2014
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- Authors
- Weisberg, R. B., Beard, C., Moitra, E., Dyck, I., & Keller, M. B.
- Affiliations
- Brown University (US)
- Corresponding author
- Weisberg, Risa B.
- Venue
- Depression and Anxiety
- Publisher
- Hindawi Limited
- Published
- 2013-11-04
- Volume
- 31
- Issue
- 5
- Pages
- 443-450
- ISSN
- 1091-4269 (ISSN-L)
- PMC
- PMC4157338
- OpenAlex
- W1557589161
- Cited by
- 57
- References
- 35
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 7 · 2022: 5 · 2021: 5 · 2020: 6 · 2019: 3 · 2018: 8 · 2017: 2 · 2016: 3 · 2015: 4 · 2014: 3
- FWCI
- 4.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Pfizer
- CeNeRx
- National Institute of Mental Health (R01MH051415)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- anxiety disorders, primary care, treatment adequacy, pharmacotherapy, cognitive behavioral therapy, psychotherapy utilization, racial and ethnic minorities, major depressive disorder, panic disorder with agoraphobia, access to mental health care
- MeSH terms
- Adult, Agoraphobia, Anxiety Disorders, Attitude of Health Personnel, Major Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Middle Aged, New England, Primary Health Care, Psychotherapy, Surveys and Questionnaires, Anti-Anxiety Agents, Comorbidity, Cognitive Behavioral Therapy, Patient Satisfaction
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