Anxiety interventions delivered in primary care behavioral health routine clinical practice
Open accessAbstract
INTRODUCTION: Although anxiety is highly prevalent in primary care and a top reason for referral to primary care behavioral health (PCBH) services, there are limited data on which anxiety interventions are used in routine PCBH practice. The objective of this study was to identify interventions delivered when treating anxiety in PCBH practice. METHOD: We conducted an online survey of PCBH providers regarding their clinical practice with patients who present for treatment of anxiety symptoms. The final sample comprised 209 PCBH providers recruited from e-mail listservs of national professional organizations (59.3% psychologists, 23.4% social workers, 12.4% counselors, 4.8% other). Providers reported on use (yes/no) of 17 interventions in their most recent session with their most recent adult patient presenting with a primary concern of non-trauma-related anxiety. RESULTS: On average, patients were reported to be 42.2 (14.73) years old, White (73.7%), and male (56.5%) with anxiety symptoms of moderate severity (65.6%). Most reportedly had comorbid sleep difficulties (63.6%), depressive symptoms (58.4%), and/or stress/adjustment (56.0%). Providers reported delivering an average of 5.77 (2.05, range: 1-15) interventions, with psychoeducation (94.7%), relaxation training (64.1%), and supportive therapy (60.8%) being most common. Several highly efficacious evidence-based interventions for anxiety, including cognitive therapy (45.0%) and exposure (21.1%), were less common. DISCUSSION: While PCBH providers delivered numerous brief interventions for anxiety, cognitive therapy and exposure were underutilized. Furthermore, PCBH patients with anxiety symptoms were complex, with significant severity and comorbidity. These results suggest implications for research, clinical training, intervention design, and future implementation efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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The difference in outcomes is attributed to MAST-V's emphasis on teaching coping skills in session, whereas PCBH usual care most commonly comprised supportive therapy.
“Based on our theoretical approach, we attribute the difference to MAST-V’s emphasis on teaching coping skills in session, whereas consistent with prior research (Shepardson et al., 2020), treatment in PCBH usual care most commonly comprised supportive therapy.”
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., 2020
The paper’s Results report supportive therapy in 60.8% of surveyed PCBH sessions, making it one of the most common interventions. But psychoeducation (94.7%) and relaxation training (64.1%) were more common; the Discussion calls supportive therapy third most common. The cited study also did not examine the citing authors’ specific usual-care group. The explanation for the outcome difference is the citing authors’ own, not a finding attributed to this source. (LLM, conf=0.86)
Experimental — accuracy not yet measuredResearch suggests that the most effective anxiety intervention techniques, such as exposure and cognitive therapy, are much less common in IPC compared to psychoeducation, supportive therapy, and relaxation training.
“Further, research suggests that the most effective anxiety intervention techniques, such as exposure and cognitive therapy, are much less common in IPC compared to psychoeducation, supportive therapy, and relaxation training (Funderburk et al., 2011; Shepardson et al., 2020).”
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., 2020
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Funderburk, J. S., Pigeon, W. R., Shepardson, R. L., Wade, M., Acker, J., Fivecoat, H., Wray, L. O., & Maisto, S. A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.01.033 · Cited by 19 · see citing works
Self-citationShepardson, R. L., Fletcher, T. L., Funderburk, J. S., Weisberg, R. B., Beehler, G. P., & Maisto, S. A. (2023) · Psychological Services · doi:10.1037/ser0000696 · Cited by 13 · see citing works
Self-citationShepardson, R. L., Funderburk, J. S., Weisberg, R. B., & Maisto, S. A. (2022) · Psychological Services · doi:10.1037/ser0000622 · Cited by 6 · see citing works
Self-citationShepardson, R. L., Buckheit, K. A., & Funderburk, J. S. (2021) · Families Systems & Health · doi:10.1037/fsh0000628 · Cited by 4 · see citing works
Self-citationShepardson, R. L., Weisberg, R. B., Wade, M., Maisto, S. A., & Funderburk, J. S. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.05.107 · Cited by 3 · see citing works
Self-citationDigital Cognitive Behavioral Treatment for Generalized Anxiety Disorder
Parsons, E. M., Ball, T. M., Carl, J. R., Henry, A. L., Emsley, R., Miller, C. B., Wong, E. Y., Coombs, E., Collins, D., Long, L. J., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.48884 · Cited by 3 · see citing works
White, E. J., Wray, J. M., & Shepardson, R. L. (2020) · Families Systems & Health · doi:10.1037/fsh0000543 · Cited by 3 · see citing works
Self-citationAnxiety Management in Chronic Idiopathic Urticaria within Integrated Primary Care
Phillips, J. E., O’Brien, K., Fritz, V., & Incorvati, C. (2024) · Clinical Case Studies · doi:10.1177/15346501241278373
Shepardson, R. L., Johnson, E. M., Gass, J. C., Wade, M., & Funderburk, J. S. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122217
Self-citationvon Cederwald, A. F., Carlsson, V., Salomonsson, S., & Kaldo, V. (2026) · Research Square · doi:10.21203/rs.3.rs-10514842/v1
- Authors
- Shepardson, R. L., Minnick, M. R., & Funderburk, J. S.
- Affiliations
- Syracuse VA Medical Center (US)
- Venue
- Families, Systems, & Health
- Published
- 2020-06
- Volume
- 38
- Issue
- 2
- Pages
- 193-199
- ISSN
- 1091-7527 (ISSN-L)
- 1939-0602
- PMC
- PMC8314503
- OpenAlex
- W3033872337
- Cited by
- 10
- References
- 0
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2022: 2 · 2021: 2 · 2020: 1
- FWCI
- 1.21
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Families Systems & Health (publishedVersion, other-oa)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Syracuse VA Medical Center
- Collaborative Family Healthcare Association
- Department of Veterans Affairs (15-262)
- 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, primary care behavioral health, anxiety intervention, evidence-based interventions, cognitive therapy, exposure therapy, psychoeducation, relaxation training, supportive therapy, comorbidities, sleep disorders, depressive symptoms, brief psychotherapy
- MeSH terms
- Adult, Anxiety, Behavioral Medicine, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Primary Health Care, Cognitive Behavioral Therapy
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