Barriers to and facilitators of using evidence-based,
                        cognitive–behavioral anxiety interventions in integrated primary care
                        practice.

Shepardson, Robyn L.; Fletcher, Terri L.; Funderburk, Jennifer S.; Weisberg, Risa B.; Beehler, Gregory P.; Maisto, Stephen A.

doi:10.1037/ser0000696

Cited by 4 publications

(2 citation statements)

References 50 publications

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“…After reviewing the literature on primary care-based anxiety interventions (Shepardson et al, 2018), we identified intervention techniques that are not only effective in reducing anxiety, but also compatible with PCBH practice. In addition, we incorporated research on Veterans' anxiety treatment preferences (Shepardson & Funderburk, 2016), BHP usual care practices in behavioral anxiety treatment (Shepardson, Minnick, & Funderburk, 2020), and barriers and facilitators to using empirically supported behavioral anxiety interventions in PCBH practice (Shepardson, Fletcher, et al, 2020). The first author drafted detailed outlines for the therapist manual and patient handouts then obtained feedback from the second author, an expert in PCBH, and third author, an expert in PCBH and CBT for anxiety, both of whom have expertise in intervention development.…”

Section: Intervention Developmentmentioning

confidence: 99%

Brief, modular, transdiagnostic, cognitive-behavioral intervention for anxiety in veteran primary care: Development, provider feedback, and open trial.

Shepardson¹,

Funderburk²,

Weisberg³

et al. 2023

Psychological Services

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Anxiety is undertreated in primary care, and most treatment provided is pharmacological rather than behavioral. Integrating behavioral health providers (BHPs) using the Primary Care Behavioral Health (PCBH) model can help address this treatment gap, but brief interventions suitable for use in PCBH practice are needed. We developed a modular, cognitive-behavioral anxiety intervention, Modular Anxiety Skills Training (MAST), that is evidence-based, transdiagnostic, feasible for PCBH, and patient-centered. MAST comprises up to six 30-min sessions emphasizing skills training. This article describes the rationale for and development of MAST as well as pilot work in the Veterans Health Administration (VA) to tailor and refine MAST for delivery to Veterans in VA primary care (MAST-V) to improve feasibility for VA BHPs and acceptability to Veterans. We used a convergent mixed-methods design with concurrent data collection. In phase one, we interviewed five BHPs to obtain feedback on the treatment manual. BHPs assessed MAST-V to be highly compatible with PCBH and provided suggestions to enhance feasibility. In phase two, we conducted an open trial in which six Veterans experiencing clinically significant anxiety received and provided feedback on all nine possible modules; we also assessed changes in mental health symptoms and functioning as well as treatment satisfaction and credibility. Veterans found MAST-V to be highly acceptable, and pre-post clinical outcomes were very promising with large effect sizes. Findings from this initial pilot provide preliminary support for the feasibility, acceptability, and efficacy of MAST-V and suggest further research with a randomized clinical trial is warranted. SHEPARDSON, FUNDERBURK, WEISBERG, AND MAISTO

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Section: Intervention Developmentmentioning

confidence: 99%

Brief, modular, transdiagnostic, cognitive-behavioral intervention for anxiety in veteran primary care: Development, provider feedback, and open trial.

Shepardson¹,

Funderburk²,

Weisberg³

et al. 2023

Psychological Services

Self Cite

View full text Add to dashboard Cite

show abstract

“…In addition, people with PTSD present in primary care (PC) and specialty mental health (Calhoun et al, 2002; Schnurr et al, 2013) and a few who first present with PTSD in PC go on to receive care in specialty mental health clinics (Bohnert et al, 2016; Rodriguez et al, 2003). A recent study of barriers and facilitators to the use of evidence-based mental health care in primary care practice concluded that flexible and brief models of proven interventions developed for the PC setting, combined with flexible training that fits the PC model, are needed to ensure PC patient access to effective interventions (Shepardson et al, 2022). In recognition of the need for mental health care to start in primary care, the VA established the primary care mental health integration (PCMHI) program that includes embedded mental health providers in primary care who provide brief interventions for mental and behavioral health (Pomerantz, 2017).…”

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confidence: 99%

Treatment of posttraumatic stress disorder with prolonged exposure for primary care (PE-PC): Effectiveness and patient and therapist factors related to symptom change and retention.

Rauch¹,

Venners²,

Ragin³

et al. 2023

Psychological Services

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Prolonged exposure (PE) is a first-line treatment for posttraumatic stress disorder (PTSD) available in specialty mental health. PE for primary care (PE-PC) is a brief version of PE adapted for primary care mental health integration, composed of four—eight, 30-min sessions. Using retrospective data of PE-PC training cases from 155 Veterans Health Administration (VHA) providers in 99 VHA clinics who participated in a 4- to 6-month PE-PC training and consultation program, we examined patients’ PTSD and depression severity across sessions via mixed effects multilevel linear modeling. Additionally, hierarchical logistic regression analysis was conducted to assess predictors of treatment dropout. Among 737 veterans, medium-to-large reductions in PTSD (intent-to-treat, Cohen’s d = 0.63; completers, Cohen’s d = 0.79) and small-to-medium reductions in depression (intent-to-treat, Cohen’s d = 0.40; completers, Cohen’s d = 0.51) were observed. The modal number of PE-PC sessions was five (SD = 1.98). Providers previously trained in both PE and cognitive processing therapy (CPT) were more likely than providers who were not trained in either PE or CPT to have veterans complete PE-PC (OR = 1.54). Veterans with military sexual trauma were less likely to complete PE-PC than veterans with combat trauma (OR = 0.42). Asian American and Pacific Islander veterans were more likely than White veterans to complete treatment (OR = 2.93). Older veterans were more likely than younger veterans to complete treatment (OR = 1.11).

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Brief modular anxiety intervention for primary care: Hybrid I pilot randomized controlled trial of feasibility, acceptability, effectiveness, and implementation potential

Shepardson,

Weisberg,

Wade

et al. 2024

Journal of Affective Disorders

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Barriers to and facilitators of using evidence-based, cognitive–behavioral anxiety interventions in integrated primary care practice.

Cited by 4 publications

References 50 publications

Brief, modular, transdiagnostic, cognitive-behavioral intervention for anxiety in veteran primary care: Development, provider feedback, and open trial.

Brief, modular, transdiagnostic, cognitive-behavioral intervention for anxiety in veteran primary care: Development, provider feedback, and open trial.

Treatment of posttraumatic stress disorder with prolonged exposure for primary care (PE-PC): Effectiveness and patient and therapist factors related to symptom change and retention.

Brief modular anxiety intervention for primary care: Hybrid I pilot randomized controlled trial of feasibility, acceptability, effectiveness, and implementation potential

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