Developing a Low-Intensity Primary Care Intervention for Anxiety Disorders

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DESCRIPTION (provided by applicant): Anxiety disorders are the most common class of mental health problem in the U.S. population and are highly prevalent in primary care. Although they are associated with great social, educational, and occupational impairment, and with increased health care costs, few people receive adequate treatment. There is a great need for low-intensity, scalable, non-pharmacological interventions. While not all patients may achieve remission after these first-step treatments, they are necessary to achieve the greatest reduction in suffering across the population at large. Cognitive Bias Modification (CBM), which uses simple computer tasks to directly target cognitive vulnerability to anxiety disorders, is an ideal candidate for a first-step, scalable intervention. CBM is computerized and requires minimal training or provider time. Ideally, CBM delivery would be linked to primary care, as this is the setting where the majority of anxious patients first present for care. Further, primary care-linked delivery will allow for primary care provider (PCP) monitoring of patient outcomes and provision of more intensive treatments as needed. The overarching goal of this study is thus to develop and refine CBM so that it is feasible and acceptable to deliver in the primary care setting. First, we will tailor CBM for primary care by developing the first transdiagnostic and personalized CBM. Entitled "Attention and Interpretation Modification (AIM)", this CBM will comprise both a computerized assessment to develop a personalized set of stimuli and a treatment, which corrects attention and interpretation biases. AIM will be delivered via 8, 30-minute computer sessions. To further facilitate future implementation, we will develop methods for primary care linked delivery of AIM, including an option to complete sessions at home while still being monitored by the PCP. Our development work will be informed by ongoing evaluation with an Advisory Panel (AP) of PCPs, practice leaders, nurses, and patients, and by our team's experience creating quick, easily interpretable PCP feedback systems via use of paraprofessional Patient Navigators. We will conduct an open trial of AIM (n = 18) to attain feasibility and acceptability data and experience to help us refine AIM and delivery methods. Next, we will conduct a pilot, double-blind randomized controlled trial (RCT; n=42). The pilot RCT will allow us to examine the feasibility and acceptability of AIM and of our research procedures for an eventual full-scale RCT. Further, both trials will allow us to pilot potential moderators including baseline attentional and interpretational bias and specific anxiety disorder diagnosis. In the future large-scale RCT, anxiety symptom severity will be the primary outcome and psychosocial functioning will be the secondary outcome. Achievement of these aims will prepare us to apply for a future R01 to conduct a large-scale, adequately powered, hybrid effectiveness-implementation RCT testing AIM, a primary care-linked, personalized CBM. This line of work will lead to the incorporation into primary care of readily scalable, translational, effective, non-pharmacological mental health treatment for patients with anxiety disorders.