Design of the Coordinated Anxiety Learning and Management (CALM) study: innovations in collaborative care for anxiety disorders.

BACKGROUND: Despite a marked increase in the number of persons seeking help for anxiety disorders, the care provided may not be evidence based, especially when delivered by nonspecialists. Since anxiety disorders are most often treated in primary care, quality improvement interventions, such as the Coordinated Anxiety Learning and Management (CALM) intervention, are needed in primary care.

RESEARCH DESIGN: This study is a randomized controlled trial of a collaborative care effectiveness intervention for anxiety disorders.

SUBJECTS: Approximately 1040 adult primary care patients with at least one of four anxiety disorders (generalized anxiety disorder, panic disorder, posttraumatic stress disorder or social anxiety disorder) will be recruited from four national sites.

INTERVENTION: Anxiety clinical specialists (ACSs) deliver education and behavioral activation to intervention patients and monitor their symptoms. Intervention patients choose cognitive-behavioral therapy, antianxiety medications or both in "stepped-care" treatment, which varies according to clinical needs. Control patients receive usual care from their primary care clinician. The innovations of CALM include the following: flexibility to treat any one of the four anxiety disorders, co-occurring depression, alcohol abuse or both; use of on-site clinicians to conduct initial assessments; and computer-assisted psychotherapy delivery.

EVALUATION: Anxiety symptoms, functioning, satisfaction with care and health care utilization are assessed at 6-month intervals for 18 months.

CONCLUSION: CALM was designed for clinical effectiveness and easy dissemination in a variety of primary care settings.