Psychological interventions for anxiety in adult primary care patients: a review and recommendations for future research
Open accessAbstract
Anxiety symptoms are prevalent in primary care, yet treatment rates are low. The integration of behavioral health providers into primary care via the Primary Care Behavioral Health (PCBH) model offers a promising way to improve treatment options by adding a team member with the necessary skillset to deliver evidence-based psychological interventions for anxiety. We conducted a narrative review of psychological interventions for anxiety applied within adult primary care settings (k = 44) to update the literature and evaluate the fit of existing interventions with the PCBH model. The majority of studies were randomized controlled trials (RCTs; 70.5%). Most interventions utilized cognitive-behavioral therapy (68.2%) and were delivered individually, face-to-face (52.3%). Overall, 65.9% of interventions (58.6% of RCTs, 91.7% of pre-post) were effective in reducing anxiety symptoms, and 83.3% maintained the gains at follow-up. Although it is encouraging that most interventions significantly reduced anxiety, their longer formats (i.e., number and duration of sessions) and narrow symptom targets make translation into practice difficult. Methodological limitations of the research included homogenous samples, failure to report key procedural details, pre-post designs, and restrictive eligibility criteria. We offer recommendations to guide future research to improve the likelihood of successful translation of anxiety interventions into clinical practice.
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Behavioral health providers need brief behavioral anxiety interventions that are feasible within PCBH and can accommodate the full range of anxiety presentations in severity, disorder, and comorbidities.
“To ease implementation to maximize uptake in routine care (Cully et al. 2023), BHPs need brief behavioral anxiety interventions that are feasible within PCBH and can accommodate the full range of anxiety presentations in terms of symptom severity, disorder, and comorbidities (Seekles et al., 2013; Shepardson et al., 2018).”
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 Shepardson et al., 2018
The Conclusion calls for brief, PCBH-compatible interventions accommodating varied anxiety presentations, from subthreshold through mild and moderate severity, with or without comorbid depression. The citing sentence overextends this to the full range of severity and comorbidities: the Introduction says BHPs may refer patients with severe or long-standing symptoms to specialty care, and the Conclusion specifies depression rather than comorbidities generally. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAlthough numerous anxiety intervention protocols have been tested in IPC settings, the majority appear to have limited utility for IPC practice due to requiring more than six visits, using visit durations of 31-120 minutes, and/or having narrow focus targeting one specific anxiety diagnosis.
“Although numerous anxiety intervention protocols have been tested in IPC settings (see Shepardson et al., 2018 for a review), including CBT and Problem-Solving interventions, the majority appear to have limited utility for IPC practice due to requiring more than six visits, using visit durations of 31-120 minutes, and/or having narrow focus targeting one specific anxiety diagnosis.”
From Barriers to and Facilitators of Using Evidence-Based, Cognitive–Behavioral Anxiety Interventions in Integrated Primary Care Practice (2023) · cites this paper as Shepardson et al., 2018
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Experimental — accuracy not yet measuredMany anxiety interventions have been examined in primary care.
“While many anxiety interventions have been examined in primary care (Shepardson et al., 2018), most have a narrow focus (e.g., on a single disorder), cannot accommodate comorbid depression, and/or are not feasible due to high number or duration of sessions.”
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 Shepardson et al., 2018
Experimental — accuracy not yet measuredMost anxiety interventions examined in primary care are not feasible because of high number or duration of sessions.
“While many anxiety interventions have been examined in primary care (Shepardson et al., 2018), most have a narrow focus (e.g., on a single disorder), cannot accommodate comorbid depression, and/or are not feasible due to high number or duration of sessions.”
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 Shepardson et al., 2018
Most anxiety interventions examined in primary care cannot accommodate comorbid depression.
“While many anxiety interventions have been examined in primary care (Shepardson et al., 2018), most have a narrow focus (e.g., on a single disorder), cannot accommodate comorbid depression, and/or are not feasible due to high number or duration of sessions.”
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 Shepardson et al., 2018
Most anxiety interventions examined in primary care have a narrow focus, such as on a single disorder.
“While many anxiety interventions have been examined in primary care (Shepardson et al., 2018), most have a narrow focus (e.g., on a single disorder), cannot accommodate comorbid depression, and/or are not feasible due to high number or duration of sessions.”
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 Shepardson et al., 2018
Due to differences from the scope and format of treatment provided in specialty care, there may be unique factors relevant to IPC settings.
“Many of these barriers and facilitators may be relevant to IPC practice, but due to differences from the scope and format of treatment provided in specialty care (Shepardson et al., 2018; see Table 1), there may be unique factors relevant to IPC settings.”
From Barriers to and Facilitators of Using Evidence-Based, Cognitive–Behavioral Anxiety Interventions in Integrated Primary Care Practice (2023) · cites this paper as Shepardson et al., 2018
There is a dearth of anxiety treatment protocols feasible for IPC practice.
“The dearth of anxiety treatment protocols feasible for IPC practice (Shepardson et al., 2018) is concerning given how frequently anxiety is encountered in primary care.”
From Barriers to and Facilitators of Using Evidence-Based, Cognitive–Behavioral Anxiety Interventions in Integrated Primary Care Practice (2023) · cites this paper as Shepardson et al., 2018
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Self-citation
- Authors
- Shepardson, R. L., Buchholz, L. J., Weisberg, R. B., & Funderburk, J. S.
- Affiliations
- Syracuse VA Medical Center (US)
- Buffalo VA Medical Center (US)
- Boston University (US)
- University of Rochester Medicine (US)
- Corresponding author
- Shepardson, Robyn L.
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 54
- Pages
- 71-86
- ISSN
- 0887-6185 (ISSN-L)
- PMC
- PMC7909724
- OpenAlex
- W2781486643
- Cited by
- 44
- References
- 122
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 6 · 2023: 10 · 2022: 6 · 2021: 5 · 2020: 4 · 2019: 2 · 2018: 1 · 2017: 1
- FWCI
- 0.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Veterans Affairs (IK2 HX002107)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- anxiety disorders, psychological intervention, primary care, cognitive behavioral therapy, behavioral health integration, medication adherence, intervention dissemination, follow-up maintenance, methodological limitations
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Humans, Primary Health Care, Cognitive Behavioral Therapy
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