Psychological interventions for anxiety in adult primary care patients: A review and recommendations for future research

• Published in: Journal of anxiety disorders Vol. 54; pp. 71 - 86
• Main Authors: Shepardson, Robyn L., Buchholz, Laura J., Weisberg, Risa B., Funderburk, Jennifer S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.03.2018
• Subjects: Adult; Anxiety; Anxiety - psychology; Anxiety - therapy; Anxiety Disorders - psychology; Anxiety Disorders - therapy; Cognitive Behavioral Therapy; Humans; Intervention; Primary care; Primary care behavioral health; Primary Health Care; Review; Treatment; Intervention; Primary care behavioral health; Anxiety; Treatment; Review; Primary care
• ISSN: 0887-6185; 1873-7897; 1873-7897
• DOI: 10.1016/j.janxdis.2017.12.004

•We reviewed psychological interventions (k = 44) for anxiety in adult primary care.•We evaluated effectiveness and feasibility in Primary Care Behavioral Health (PCBH).•Approximately 2/3 of interventions were effective in reducing anxiety symptoms.•Yet most had narrow symptom targets and utilized too many and too lengthy sessions.•Interventions need to be widely applicable and feasible within real-world settings. 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.