BACKGROUND/RATIONALE:
Many Veteran primary care patients experience impairing anxiety symptoms, but treatment rates are low. Primary Care-Mental Health Integration (PC-MHI), in which mental health clinicians provide brief treatment in the primary care setting, can bridge the gap between demand for, and availability of, effective anxiety treatment. However, brief anxiety interventions suitable for use in the PC-MHI setting are needed to address a gap in VHA treatment options.

OBJECTIVE(S):
The overall objective is to develop, refine, and evaluate a brief anxiety intervention that will be acceptable to Veterans and feasible for PC-MHI providers. Aim 1: Examine PC-MHI providers' usual care practices for anxiety treatment and perceived feasibility of using evidence-based intervention techniques. Aim 2: Develop an adapted brief, Veteran-centered PC-MHI intervention for anxiety (with or without comorbid depression), then refine the treatment manual based on patient and provider feedback. Aim 3: Conduct a pilot RCT to evaluate feasibility, acceptability, implementation barriers and facilitators, and effectiveness (versus usual care).

METHODS:
Aim 1 is a qualitative study (N=18) sampling VHA PC-MHI providers. Aim 2 involves adapting existing evidence-based, cognitive-behavioral intervention techniques for delivery in a brief PC-MHI format that can accommodate various anxiety presentations and comorbid depressive symptoms. We will incorporate Aim 1 findings to reduce provider implementation challenges and pilot study findings on Veterans' treatment preferences to enhance patient engagement. We will obtain PC-MHI provider (N=4) feedback on feasibility of the intervention and then conduct a small open trial (N=5) to obtain Veteran feedback on acceptability, which together will inform further refinements to the treatment manual. Aim 3 will be a pilot hybrid type I effectiveness-implementation RCT (N=48) to evaluate feasibility, acceptability, intervention effectiveness in reducing anxiety symptom severity (vs. usual care), and implementation barriers and facilitators.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
This project aims to address a critical need for evidence-based anxiety interventions suitable for the PC-MHI setting for Veterans experiencing anxiety who prefer to be treated in primary care. Attending to Veterans' treatment preferences will enhance acceptability, and incorporating PC-MHI provider feedback regarding implementation challenges will improve feasibility of delivery.

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External Links for this Project

NIH Reporter

Grant Number: IK2HX002107-01A2
Link: https://reporter.nih.gov/project-details/9291597

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PUBLICATIONS:

Journal Articles

1. Shepardson RL, Minnick MR, Funderburk JS. Anxiety interventions delivered in primary care behavioral health routine clinical practice. Families, systems & health : the journal of collaborative family healthcare. 2020 Jun 1; 38(2):193-199. [view]
2. Shepardson RL, Buckheit KA, Funderburk JS. Anxiety treatment preferences among veteran primary care patients: Demographic, mental health, and treatment-related correlates. Families, systems & health : the journal of collaborative family healthcare. 2021 Dec 1; 39(4):563-575. [view]
3. Shepardson RL, Fletcher TL, Funderburk JS, Weisberg RB, Beehler GP, Maisto SA. Barriers to and facilitators of using evidence-based, cognitive-behavioral anxiety interventions in integrated primary care practice. Psychological Services. 2023 Nov 1; 20(4):709-722. [view]
4. Funderburk JS, Shepardson RL, Wray J, Acker J, Beehler GP, Possemato K, Wray LO, Maisto SA. Behavioral medicine interventions for adult primary care settings: A review. Families, systems & health : the journal of collaborative family healthcare. 2018 Sep 1; 36(3):368-399. [view]
5. Funderburk JS, Pigeon WR, Shepardson RL, Maisto SA. Brief behavioral activation intervention for depressive symptoms: Patient satisfaction, acceptability, engagement, and treatment response. Psychological Services. 2020 Nov 1; 17(4):443-451. [view]
6. Shepardson RL, Funderburk JS, Weisberg RB, Maisto SA. Brief, modular, transdiagnostic, cognitive-behavioral intervention for anxiety in veteran primary care: Development, provider feedback, and open trial. Psychological Services. 2023 Aug 1; 20(3):622-635. [view]
7. White EJ, Wray JM, Shepardson RL. Clinical considerations in designing brief exposure interventions for primary care behavioral health settings. Families, systems & health : the journal of collaborative family healthcare. 2020 Dec 1; 38(4):439-449. [view]
8. Possemato K, Johnson EM, Beehler GP, Shepardson RL, King P, Vair CL, Funderburk JS, Maisto SA, Wray LO. Patient outcomes associated with primary care behavioral health services: A systematic review. General hospital psychiatry. 2018 Jul 1; 53:1-11. [view]
9. Shepardson RL, Johnson EM, Possemato K, Arigo D, Funderburk JS. Perceived barriers and facilitators to implementation of peer support in Veterans Health Administration Primary Care-Mental Health Integration settings. Psychological Services. 2019 Aug 1; 16(3):433-444. [view]
10. Funderburk JS, Gass J, Shepardson RL, Mitzel LD, Buckheit KA. Practical Opportunities for Biopsychosocial Education Through Strategic Interprofessional Experiences in Integrated Primary Care. Frontiers in psychiatry. 2021 Sep 16; 12:693729. [view]
11. Funderburk JS, Gass JC, Wray JM, Shepardson RL. Prevalence and predictors of team-based care activities between primary care providers and embedded behavioral health providers: a national survey. Journal of Interprofessional Care. 2022 Jan 3; 37(1):58-65. [view]
12. Shepardson RL, Buchholz LJ, Weisberg RB, Funderburk JS. Psychological interventions for anxiety in adult primary care patients: A review and recommendations for future research. Journal of anxiety disorders. 2018 Mar 1; 54:71-86. [view]
13. Crasta D, Crane CA, Trabold N, Shepardson RL, Possemato K, Funderburk JS. Relationship Health and Intimate Partner Violence in Integrated Primary Care: Individual Characteristics and Preferences for Relationship Support across Risk Levels. International journal of environmental research and public health. 2022 Oct 27; 19(21). [view]
14. Shepardson RL, Mitzel LD, Trabold N, Crane CA, Crasta D, Funderburk JS. Sexual Dysfunction and Preferences for Discussing Sexual Health Concerns Among Veteran Primary Care Patients. Journal of the American Board of Family Medicine : JABFM. 2021 Mar 1; 34(2):357-367. [view]
15. Shepardson RL, Kosiba JD, Bernstein LI, Funderburk JS. Suicide risk among Veteran primary care patients with current anxiety symptoms. Family Practice. 2019 Jan 25; 36(1):91-95. [view]
16. Possemato K, Shepardson RL, Funderburk JS. The Role of Integrated Primary Care in Increasing Access to Effective Psychotherapies in the Veterans Health Administration. Focus (American Psychiatric Publishing). 2018 Oct 18; 16(4):384-392. [view]
17. Funderburk JS, Pigeon WR, Shepardson RL, Wade M, Acker J, Fivecoat H, Wray LO, Maisto SA. Treating depressive symptoms among veterans in primary care: A multi-site RCT of brief behavioral activation. Journal of affective disorders. 2021 Mar 15; 283:11-19. [view]
18. Mitzel LD, Funderburk JS, Buckheit KA, Gass JC, Shepardson RL, Edelman D. Virtual integrated primary care teams: Recommendations for team-based care. Families, systems & health : the journal of collaborative family healthcare. 2021 Dec 1; 39(4):638-643. [view]

DRA: Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Comparative Effectiveness, TRL - Applied/Translational
Keywords: none
MeSH Terms: none