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Nonexpert treatment shown to be more effective than primary care in soothing widespread anxiety

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anxiety treatment flexible cognitive behavior therapy computer-assistedNEW YORK—One-size-fits-all treatments are particularly rare in the mental health world, where each patient’s ailments can seem unique.

But a team of researchers seems to have found a therapeutic model to treat anxiety disorders as wide-ranging as post-traumatic stress disorder (PTSD), social phobia and panic disorder. Lead study author Dr. Peter Roy-Byrne, of the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine, presented the findings May 18 at a press briefing in New York convened by JAMA The Journal of the American Medical Association.

When taken together, anxiety disorders affect about 18 percent of the population (which is more than twice the rate of depression). Some three fourths of people with mental disorders are managed in primary care (which Roy-Byrne called "the de facto mental health system"), but getting those patients—especially those with anxiety disorders—to see mental health specialists is much harder than getting them to see a radiologist, Roy-Byrne noted.

He and his team devised a flexible, collaborative care system that lightened loads for both doctors and psychiatrists (or psychologists) while making it easier for patients to get the help they needed. By enlisting the skills of nurses or masters-level clinicians with some training in anxiety management and an online patient progress tracking system, the treatment plan could adapt to patients without sending them to an expensive psychiatrist or psychologist, which has been shown to be especially difficult in anxiety patients (and could also allow specialists more time to address patients who most need their care). And a controlled trial, published May 19 in JAMA, showed promising results.

The researchers randomized 1,004 patients with at least one anxiety disorder (with and without major depression) to either their treatment model (which offered a choice of drug-based therapy as prescribed by overseeing doctors, computer-assisted cognitive behavioral therapy or a combination of both) or standard care (any treatment by their primary physician, recommended counselor or medication).

Patients receiving medication in the experimental group were advised about type and dosage as well as given additional guidance about healthy lifestyle habits, such as sleep hygiene and behavioral tips. Those getting cognitive behavioral therapy met with a nurse or masters-level clinician to work through a computer-guided program, which provided questions, examples and videos to guide the sessions as well as tailor and reinforce concepts. Primary care physicians and psychiatrists or psychologists oversaw the progress of patients and administrators via an online tracking system that charted attendance, performance and wellbeing so that they could follow-up or intervene if necessary.

The trial itself was open to patients’ changing needs, so if patients entered the trial on ineffective levels of medication but didn’t want to switch, the docs allowed them to stay on their preferred regimen. And if an experimental-group patient was not improving on a current path (of cognitive behavior therapy or pharmacological treatment), doctors could immediately see that and recommend alternative courses of action.

After a series of blinded follow-ups with patients (at six, 12 and 18 months after the start of the trial), the researchers found that with just six to eight sessions, patients in the treatment group were "averaging really negligible symptoms," he said. Fifty-one percent of people in the flexible, monitored treatment group were in remission at 18 months, compared to 36 percent of the usual care group.

The results "showed how we could use technology" to treat a broad range of anxiety disorders, Roy-Byrne noted on Tuesday. And because the treatment model was effective for a broad range of disorders, it could help the many people who have more than one ailment, "which is the rule rather than the exception," he added.

By using clinician-administered, evidence-based strategy, he said, "you can get a lot of people better fast." And the social implications of the model were not lost on Roy-Byrne. He noted that the days of the well-to-do and well-insured seeking in-depth psychiatric help for every minor mental health issue might be numbered. "How can you more responsibly distribute the expertise?" he asked. With an evidence-based treatment protocol, he concluded, the psychiatric and psychological big guns could be reserved for those who really needed them.

Image courtesy of iStockphoto/AlexRaths

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  1. 1. Mr. Sol Biderman 1:46 pm 05/21/2010

    Sending them to a priest, pastor , iman or rabbi might work even better.-Mr. Sol Biderman

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  2. 2. Mr. Sol Biderman 1:49 pm 05/21/2010

    Contacting an iman, rabbi, priest, pastor, yoga teacher or a trainer to reach alpha brain wave levels might help just as much or even more. -Mr. Sol Biderman

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  3. 3. ButMadNNW 2:32 pm 05/21/2010

    Not for people who aren’t religious, or if the religious leader isn’t properly trained in how to counsel people.

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  4. 4. Carneades Thales Strato of Ga. 2:51 pm 05/21/2010

    Unless the rabbi is humanistic, she’d be of no use.
    Brain waves make for our religious experiences rather than what the comedian-theologian John Hick prattles about in his new book. He is begging the question of an external intent. Fr.Griggs ever notes," Logic is the bane of theists."

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  5. 5. Carneades Thales Strato of Ga. 3:01 pm 05/21/2010

    Relilgion -God- is of no more use than a rabbit’s foot and means no more than a square circle or Lord Bertrand Arthur William Russell’s celestial tea pot. One can substitute somethng else larger than oneself for this placebo!
    Study my friends, Susan Blackmore’s " Dying to Live" and Paul Kurtz’s ‘ The Transcendental Temptation."

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  6. 6. Carneades Thales Strato of Ga. 3:03 pm 05/21/2010

    Relilgion -God- is of no more use than a rabbit’s foot and means no more than a square circle or Lord Bertrand Arthur William Russell’s celestial tea pot. One can substitute somethng else larger than oneself for this placebo!
    Study my friends, Susan Blackmore’s " Dying to Live" and Paul Kurtz’s ‘ The Transcendental Temptation."

    Link to this
  7. 7. Bops 10:52 pm 05/21/2010

    Now that Spice and some of the common religious incenses are being found to containing some mild hallucinogens.
    It’s funny that these same people, seem to think it’s a sin to take a drug that helps with depression or pain.

    Even the alternative medicine practices where the sense of smell is used to affect mood….I wonder why? (a little 018 maybe?) No problem adding it to candles. Church, Candles and getting Toasted…think about it honestly.

    The laundry isle…smells so over powering it makes me sick.
    Why are people buying so much of that nasty stuff?
    Nothing, some of the marketing PRO’S would do, (like a get rich quick scam) would surprise me. Those dryer sheets get hot…smell odd. Just something I noticed…it just doesn’t seem right. Notice any odd smells that you want to smell all the time…

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  8. 8. LaneyB 11:42 am 05/25/2010

    So which method worked the best? Medication or conversation?

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  9. 9. dongki13 2:49 pm 05/25/2010

    I see two causes of anxiety attacks: an emotional response to a particular event causing a "sympathetic-type" response, or a neurological "dysfunction" caused by some form of "irritation" to the nervous system. This neurological dysfunction can be a physical barrier (tumor, misaligned C1), or chemical (over or under production),

    All these tests that we do only shows us what kind of response a patient is having, not the cause of the attack.

    Chemical dependency is great to help maintain the symptoms, but the side-effects are great.

    Get to the root of the cause: get some counseling for your emotional trauma, or remove the cause of neurological dysfunction.

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  10. 10. Asstrodomus 2:57 am 06/3/2010

    Two words: Magic Mushrooms.

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  11. 11. Tron 11:00 pm 06/5/2010

    great article – dual diagnosis is rampid with drug addicts, it is amazing what time and precise direction can accomplish.

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