Psychological interventions for anxiety in adult primary care patients: A review and recommendations for future research.
Psychological interventions for anxiety in adult primary care patients: A review and recommendations for future research.
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DOI：
10.1016/j.janxdis.2017.12.004
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发表时间：
2018-03
影响因子：
10.3
通讯作者：
Funderburk JS
中科院分区：
文献类型：
--
作者：
Shepardson RL;Buchholz LJ;Weisberg RB;Funderburk JS
焦虑症状在初级保健中普遍存在，但治疗率很低。通过初级保健行为健康（PCBH）模式将行为健康提供者整合到初级保健中，通过增加具有必要技能的团队成员来提供基于证据的焦虑心理干预，提供了一种有希望的方法来改善治疗方案。我们对成人初级保健环境（k = 44）中应用的焦虑心理干预进行了叙述性综述，以更新文献并评估现有干预措施与PCBH模型的拟合。大多数研究为随机对照试验（RCT; 70.5%）。大多数干预措施采用认知行为疗法（68.2%），并单独提供，面对面（52.3%）。总体而言，65.9%的干预措施（58.6%的随机对照试验，91.7%的术前术后干预）在减轻焦虑症状方面有效，77.8%的干预措施在随访时保持了收益。虽然令人鼓舞的是，大多数干预措施显着减少焦虑，他们的较长的格式（即，会话的数量和持续时间）和狭窄的症状目标使得难以转化为实践。研究方法的局限性包括同质样本，未能报告关键的程序细节，前后设计和限制性的资格标准。我们提供建议，以指导未来的研究，以提高成功的焦虑干预转化为临床实践的可能性。
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 77.8% 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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