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1.
Psychiatr Serv ; : appips20230157, 2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38347813

RESUMO

Stressful events can exacerbate symptoms of psychiatric disorders among primary care patients, putting them at increased risk for suicide. In a pilot study that ran from August to December of 2020, researchers evaluated the acceptability and implementation of Managing Emotions in Disaster and Crisis (MEDIC), a self-help intervention designed to assist at-risk primary care patients. A total of 108 at-risk veterans completed baseline and 6-week assessments. Results were promising, with high patient acceptability and engagement along with improvement in all measures of mental illness symptoms from baseline to posttreatment. Self-help interventions like MEDIC may offer a low-burden way for primary care providers to support more patients.

2.
Subst Use Misuse ; 59(1): 90-96, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37791686

RESUMO

Background: Brief alcohol interventions (BAIs) are an evidence-based practice for addressing hazardous alcohol use in primary care settings. However, numerous barriers to implementation of BAIs in routine practice have been identified, including concerns about patient receptivity to BAIs. Despite this being a commonly identified barrier to BAI implementation, little BAI implementation research has focused on patient receptivity. Objectives: This study aimed to identify the treatment preferences of primary care patients who screened positive for hazardous alcohol use and to evaluate factors that may influence patients' receptivity to BAIs delivered in primary care. We conducted a mailed survey of primary care patients (N = 245) who screened positive for hazardous alcohol use on annual screening measures based on electronic medical record data. Patients completed measures assessing treatment preferences and a conjoint analysis questionnaire designed to evaluate the relative importance of three factors (focus of the BAI, tailoring of the BAI, and familiarity with the provider delivering the BAI) for patient receptivity. Results: Conjoint analysis results revealed that familiarity with provider (with patients preferring BAIs delivered by providers they have previously met) was the most important factor in predicting patients' receptivity to BAIs. Additionally, patients preferred to discuss alcohol use in the context of another concern (focus of the BAI) and preferred personalized information tailored based on their specific health concerns (tailoring of the BAI), although these factors were not statistically significant when accounting for familiarity with provider. Conclusions: Findings of the present study have potential to inform future research on implementation of BAIs.


Assuntos
Consumo de Bebidas Alcoólicas , Programas de Rastreamento , Humanos , Consumo de Bebidas Alcoólicas/prevenção & controle , Programas de Rastreamento/métodos , Registros Eletrônicos de Saúde , Atenção Primária à Saúde
3.
Fam Syst Health ; 41(3): 291-296, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37732973

RESUMO

The perceived disconnect between research and clinic contexts may thus result in frontline clinicians and administrators questioning the approachability and applicability of science to their day-to-day work with patients and families in integrated care. Science grinds along so painstakingly slowly that even within the research community, some thought leaders have called for a moratorium on RCTs in favor of approaches that will yield more immediate public health impact (Kessler & Glasgow, 2011). The aim of this editorial is to describe a both/and research approach called "hybrid studies" and to discuss achievable strategies for doing this kind of work on the front lines. Sure, you can get a multimillion-dollar grant and do a formal research study, but real people on the frontlines can do this type of work too! Hybrid studies have the capacity to answer the two essential questions in healthcare science concurrently and advance the progress of science translation (usable science). (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
Instalações de Saúde , Saúde Pública , Humanos , Bases de Dados Factuais
4.
Fam Syst Health ; 41(2): 135-139, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37338447

RESUMO

In this editorial, the authors explain the function and process of peer review, challenges they experienced in the wake of the COVID-19 pandemic, and strategies for ensuring that this fundamental process continues with integrity. In conclusion, the efforts of this editorial team to maintain a robust reviewer pool by inspiring, rewarding, training, and growing diversity cannot be the only efforts in this area. Those who "decline" jury duty may experience punitive consequences; however, there are no direct consequences for a qualified professional who declines to review, even routinely. Ultimately, the scientific community suffers, with a slower process that can then deteriorate. As a collective of professionals who value the contributions of science, we must all work to protect and grow participation in reviewing. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
COVID-19 , Revisão da Pesquisa por Pares , Humanos , Pandemias , COVID-19/epidemiologia
5.
Psychol Serv ; 20(3): 622-635, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35099230

RESUMO

Anxiety is undertreated in primary care, and most treatment provided is pharmacological rather than behavioral. Integrating behavioral health providers (BHPs) using the Primary Care Behavioral Health (PCBH) model can help address this treatment gap, but brief interventions suitable for use in PCBH practice are needed. We developed a modular, cognitive-behavioral anxiety intervention, Modular Anxiety Skills Training (MAST), that is evidence-based, transdiagnostic, feasible for PCBH, and patient-centered. MAST comprises up to six 30-min sessions emphasizing skills training. This article describes the rationale for and development of MAST as well as pilot work in the Veterans Health Administration (VA) to tailor and refine MAST for delivery to Veterans in VA primary care (MAST-V) to improve feasibility for VA BHPs and acceptability to Veterans. We used a convergent mixed-methods design with concurrent data collection. In phase one, we interviewed five BHPs to obtain feedback on the treatment manual. BHPs assessed MAST-V to be highly compatible with PCBH and provided suggestions to enhance feasibility. In phase two, we conducted an open trial in which six Veterans experiencing clinically significant anxiety received and provided feedback on all nine possible modules; we also assessed changes in mental health symptoms and functioning as well as treatment satisfaction and credibility. Veterans found MAST-V to be highly acceptable, and pre-post clinical outcomes were very promising with large effect sizes. Findings from this initial pilot provide preliminary support for the feasibility, acceptability, and efficacy of MAST-V and suggest further research with a randomized clinical trial is warranted. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
Veteranos , Humanos , Veteranos/psicologia , Retroalimentação , Ansiedade/terapia , Atenção Primária à Saúde , Cognição
6.
J Interprof Care ; 37(1): 58-65, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-34979874

RESUMO

Primary care (PC) settings increasingly use team-based care activities with embedded behavioral health providers (BHPs) to enhance patient care via group medical visits, conjoint appointments, team huddles, and warm handoffs. Aim 1 was to describe the variation of team-based care activities within integrated PC clinics. Aim 2 was to explore whether factors associated with the BHP (e.g., gender, training, and experience) and the PC setting (e.g., perceived teamwork) predict engagement in team-based activities. A national sample of eligible BHPs (n = 345; 14.2% response rate) completed an anonymous survey assessing the presence/intensity of team-based care activities. 90% of BHPs reported regularly engaging in team-based care activities with PC teams. Most engagement occurred when providing feedback to PC providers (90.4% at least daily) and during warm handoffs (90.4% at least once daily). Engagement in team-based care was predicted by the level of teamwork occurring within the PC clinic (ßs = .41-.47; ps < .001) and BHP characteristics, such as the number of years spent in PC (ßs = .24-.26, ps < .001). Although these data are promising, with many BHPs reportedly engaging in team-based activities with PC teams, there is significant variation. Researchers should continue to explore whether the engagement in these team-based care activities enhances patient care.


Assuntos
Prestação Integrada de Cuidados de Saúde , Atenção Primária à Saúde , Humanos , Prevalência , Relações Interprofissionais , Equipe de Assistência ao Paciente
7.
Psychol Serv ; 20(4): 709-722, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35951391

RESUMO

Cognitive-behavioral treatment for anxiety disorders and symptoms remains underutilized in integrated primary care (IPC), in part because the many treatments developed for specialty care are not readily translated to this unique setting. The objective of this study was to identify barriers and facilitators to behavioral health providers (BHPs) delivering evidence-based cognitive--behavioral anxiety interventions within IPC practice. We conducted semistructured interviews with a national sample of 18 BHPs (50% psychologists, 33% social workers, 17% registered nurses) working in IPC in the Veterans Health Administration. We assessed barriers to and facilitators of using psychoeducation, exposure, cognitive therapy, relaxation training, mindfulness/meditation, Acceptance and Commitment Therapy-based interventions, and problem-solving therapy. Qualitative coding and conventional content analysis revealed barriers and facilitators at three levels: IPC, provider, and patient. Themes suggested key barriers of poor fit with the IPC model, BHP training deficits, and lack of patient buy-in, and key facilitators of good perceived fit of the intervention (e.g., scope, duration) with the IPC model, BHPs feeling well equipped, and utility for patients. BHPs select interventions based on fit for the individual patient. Some results were consistent with prior work from specialty care, but the IPC model itself introduces significant implementation challenges. BHPs would benefit from flexible intervention options and training on IPC treatment goals and how to deliver the essence of evidence-based interventions in small doses. Our findings will help to inform adaptation of behavioral anxiety interventions to better fit IPC practice and development of beneficial training and resources for BHPs to reduce implementation challenges. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
Terapia de Aceitação e Compromisso , Humanos , Transtornos de Ansiedade/terapia , Ansiedade/terapia , Atenção Primária à Saúde , Cognição
8.
Artigo em Inglês | MEDLINE | ID: mdl-36360867

RESUMO

This study explores differences in characteristics and relationship treatment preferences across different levels of intimate partner violence (IPV) among Veterans Affairs (VA) primary care patients. In Fall 2019, we sent a mail-in survey assessing relationship healthcare needs to N = 299 Veterans randomly sampled from 20 northeastern VA primary care clinics (oversampling female and younger Veterans). We compared those reporting past year use or experience of physical/sexual aggression, threats/coercion, or injury (Severe IPV; 21%), to those only reporting yelling and screaming (Verbal Conflict; 51%), and denying any IPV (No IPV; 28%). Participants across groups desired 2-6 sessions of face-to-face support for couples' health and communication. No IPV participants were older and had preferred treatment in primary care. The Verbal Conflict and Severe IPV groups were both flagged by IPV screens and had similar interest in couple treatment and relationship evaluation. The Severe IPV group had higher rates of harms (e.g., depression, alcohol use disorder, relationship dissatisfaction, fear of partner) and higher interest in addressing safety outside of VA. Exploratory analyses suggested differences based on use vs. experience of Severe IPV. Findings highlight ways integrated primary care teams can differentiate services to address dissatisfaction and conflict while facilitating referrals for Severe IPV.


Assuntos
Violência por Parceiro Íntimo , Veteranos , Humanos , Feminino , Agressão , Inquéritos e Questionários , Atenção Primária à Saúde
9.
J Am Coll Health ; : 1-8, 2022 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-35882060

RESUMO

Objective: To examine whether sexual assault prospectively predicts unhealthy weight management behaviors in college women. Method: Participants were female college students (N = 483) with monthly assessments across the first year, including the frequency and severity of sexual assault and unhealthy weight management behaviors. Results: Frequency of sexual assault prior to college predicted dieting, purging, and diet pill use, over the first year. Severity of those experiences predicted dieting and diet pill use. Frequency of sexual assault during the first semester predicted purging and diet pill use during the second semester. Severity predicted all three unhealthy weight management behaviors. Findings held consistently when controlling for socioeconomic status (SES), race/ethnicity, body mass index (BMI), and pre-college mood, anxiety, and eating disorders, as well as unhealthy weight management behaviors during the first semester in longitudinal analyses. Reverse models were non-significant. Conclusions: This research documents the detrimental effects of sexual assault on unhealthy weight management behaviors in college women, and highlights the importance of prevention and intervention.

10.
Fam Syst Health ; 40(2): 147-151, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35666893

RESUMO

Our annual coeditors' retreat is a time to step back from the words on the page and reflect on our values for this work. Our values set the course for goals and subsequent actions for the year. In our 3 days away from the office to focus on the journal, we have the quiet space to set intentions. Then, we set timelines, we send emails, we put things in motion. We came to this year's retreat prepared to consider a critical topic: equity, diversity, and inclusion (EDI). That Families, Systems, & Health (FSH) recruit, welcome, review, and publish science that is representative of the widest range of experience and perspective is a core value for us as coeditors. We feel we have a moral and ethical obligation as leaders, scientists, and humans, to pursue social justice and equitable health outcomes for all. Such efforts are needed to help rectify the longstanding history of systemic racism and discrimination against minoritized communities that continues even today. In the context of recent events including protests against racial injustices as well as health disparities experienced by people of color during the coronavirus disease 2019 (COVID-19) pandemic, the scientific community is realizing we can no longer remain bystanders. Our role as coeditors of a journal affords the opportunity to support equitable and inclusive practices representing a diverse array of individuals and communities throughout the peer review and publication process, which not only enhances equity but also improves science. In exploratory conversations with our leadership team (i.e., coeditors, associate editors, and department editors) and editorial board, we knew that all of us were of a mind in our values and aspirations to improve EDI in FSH. We write this editorial to transparently communicate in a way that provides context for recent and upcoming changes in journal processes designed to support EDI. We want to clearly state our intentions to work on improving EDI throughout all aspects of FSH. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
COVID-19 , Saúde da População , Hormônio Foliculoestimulante , Humanos , Liderança , Pandemias
11.
Fam Syst Health ; 40(1): 1-9, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35311323

RESUMO

In 2013, a bunch of us ran around collecting paper surveys off chairs after a plenary address at the Collaborative Family Healthcare Association's (CFHA) annual conference. From 150 responses, we found that less than a quarter would take the time to attend a workshop about research and evaluation. Fast forward 5 years: The organization showed robust attendance at research and evaluation training sessions, and interest in a preconference had risen to 77%. What prompted this shift? In response to survey findings, the Research and Evaluation Committee (REC), supported by the CFHA, engaged a data-informed and stakeholder-responsive approach to cultivating empiricism within the CFHA. The activities led by the REC demonstrate the need for creativity and leadership in this area and the CFHA's strong. organizational values around such efforts. As past and present leaders in the CFHA's REC initiatives, we write this editorial to make explicit the value of research to the organization and the value of the organization to the evidence base. In addition, we document some key institutional history in this area and, with input from the CFHA's current chief executive officer, Neftali Serrano, and REC chair, Will Lusenhop, forecast a vision for the future. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Atenção à Saúde , Intenção , Relações Familiares , Instalações de Saúde , Humanos , Liderança
12.
Fam Syst Health ; 39(4): 638-643, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34735210

RESUMO

INTRODUCTION: Integrated primary care teams are increasingly relying upon virtual care, including both telehealth and team members who are teleworking, due to the COVID-19 pandemic. This shift to virtual care can present challenges for the coordination and provision of team-based care in primary care. The current report uses extant literature on teams to provide recommendations to support integrated primary care teams, including behavioral health providers, in adapting to and sustaining virtual team-based care. METHOD: We used the Seven C's framework by Salas and colleagues (2015) to organize our findings and recommendations, focusing on coordination, cooperation, cognition, and communication. RESULTS: Integrated primary care teams may benefit from tending to both implicit and explicit forms of coordination and the use of debriefs to improve team coordination. Given the potential challenge of trust in a virtual team, documentation of care coordination and reexamination of how feedback is provided to primary care providers may benefit team cooperation. Sharing team goals and crosstraining on specific aspects of team processes, such as communicating essential information to behavioral health providers for a warm handoff, may improve the cognition of the team. Teams may also benefit by findings ways to incorporate informal communication into the workflow and using closed-loop communication to decrease missed communications. DISCUSSION: This report provides initial recommendations based on extant team literature to support integrated primary care teams in adapting to virtual care. Future work should build off this report by examining virtual integrated primary care teams and providing evidence-based recommendations to optimize virtual care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
COVID-19 , Pandemias , Comunicação , Humanos , Equipe de Assistência ao Paciente , Atenção Primária à Saúde , SARS-CoV-2
13.
Front Psychiatry ; 12: 693729, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34603099

RESUMO

Even with the expansion of primary care teams to include behavioral health and other providers from a range of disciplines, providers are regularly challenged to deliver care that adequately addresses the complex array of biopsychosocial factors underlying the patient's presenting concern. The limits of expertise, the ever-changing shifts in evidence-based practices, and the difficulties of interprofessional teamwork contribute to the challenge. In this article, we discuss the opportunity to leverage the interprofessional team-based care activities within integrated primary care settings as interactive educational opportunities to build competencies in biopsychosocial care among primary care team members. We argue that this approach to learning while providing direct patient care not only facilitates new provider knowledge and skills, but also provides a venue to enhance team processes that are key to delivering integrated biopsychosocial care to patients. We provide three case examples of how to utilize strategic planning within specific team-based care activities common in integrated primary care settings-shared medical appointments, conjoint appointments, and team huddles-to facilitate educational objectives.

14.
Fam Syst Health ; 39(4): 563-575, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34472956

RESUMO

INTRODUCTION: Anxiety symptoms are common, yet undertreated, among primary care patients. Accommodating patient treatment preferences improves engagement and retention. In contrast to depression, little is known about primary care patients' preferences for anxiety treatment. METHOD: Participants were 144 veterans experiencing anxiety symptoms but not receiving psychotherapy who were recruited from primary care. Preferences for 11 anxiety treatment attributes (method; location; type; format; provider; frequency, length, and number of appointments; psychotherapy orientation; symptom focus; and topic/skill) and demographic, mental health (e.g., anxiety symptom severity), and treatment-related (e.g., psychotherapy history) variables were assessed via mailed survey. We used chi-square goodness of fit tests to identify patient preferences for each attribute and multivariate multinomial logistic regression models to explore demographic, mental health, and treatment-related correlates of treatment preferences. RESULTS: Patient preferences were largely consistent with integrated primary care models, particularly Primary Care Behavioral Health, with a few exceptions. Patients preferred longer appointments (e.g., 45-60 minutes) and a longer duration of treatment (e.g., ≥13 appointments) than is typically offered in primary care. Several variables, particularly education level, perceived need for help, anxiety symptom severity, and attitudes toward psychotherapy, were repeatedly associated with preferences for various anxiety treatment attributes. DISCUSSION: Results from this study suggest that patients tend to have distinct preferences for anxiety treatment in primary care that are largely consistent with common integrated primary care models. Results also identify several variables that may be associated with specific preferences, which may help match patients to their preferred type of care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Veteranos , Ansiedade/terapia , Demografia , Humanos , Saúde Mental , Atenção Primária à Saúde
15.
J Am Board Fam Med ; 34(2): 357-367, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33833004

RESUMO

BACKGROUND: Sexual health is an important, yet often overlooked, aspect of overall health. Veterans may be particularly at risk for sexual dysfunction. The objectives of this study were to assess the prevalence and correlates of sexual dysfunction and examine preferences among veterans for discussing sexual problems. METHODS: In this cross-sectional study, we mailed 1500 surveys to a random sample of primary care patients from 3 Veterans Affairs medical centers; 313 were returned (21% response rate) and 248 had complete data. Veterans (M age = 49.4 years) were mostly White (86.7%), women (60.9%), and married (79.0%). The Arizona Sexual Experience Scale was used to screen for sexual dysfunction. RESULTS: Half of veterans, 62.3% of women and 32.0% of men, screened positive for sexual dysfunction. More than 60% of veterans agreed that the primary care team should provide information, proactively ask, and inquire on medical history forms about sexual problems; 59.3% were open to meeting with behavioral health providers. CONCLUSIONS: Primary care providers should ask veterans about sexual health, as sexual dysfunction was prevalent, especially among women and among men over age 65. Most veterans were receptive to being asked about sexual problems in primary care and preferred to be asked rather than bring it up.


Assuntos
Saúde Sexual , Veteranos , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde , Inquéritos e Questionários , Estados Unidos/epidemiologia , United States Department of Veterans Affairs
16.
J Affect Disord ; 283: 11-19, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33516082

RESUMO

BACKGROUND: Behavioral activation is ideal for embedded behavioral health providers (BHPs) working in primary care settings treating patients reporting a range of depressive symptoms. The current study tested whether a brief version of Behavioral Activation (two 30-minute appointments, 2 boosters) designed for primary care (BA-PC) was more effective than primary care behavioral health treatment-as-usual (TAU) in reducing depressive symptoms and improving quality of life and functioning. METHODS: Parallel-arm, multi-site randomized controlled trial. 140 Veterans were randomized to BA-PC or TAU and completed assessments at baseline, 6 weeks, 12 weeks, and 24 weeks. RESULTS: Reductions in depressive symptoms were observed in both groups between baseline and 3-weeks prior to any treatment, with continued reductions among those in the BA-PC condition through 12-weeks. However, there was no significant condition X time interaction at 12-weeks. Quality of life and mental health functioning were significantly improved for those in the BA-PC condition, compared to TAU, at 12 weeks. LIMITATIONS: Generalizability to a broader population may be limited as this sample consisted of veterans. Although engagement in TAU matched other prior work, it was lower than engagement in BA-PC, which also may compromise results. CONCLUSIONS: Although this study found that both TAU and BA-PC participants showed a decline in depressive symptoms, improvements in functioning and quality of life within those assigned to BA-PC, strong treatment retention and feasibility of BA-PC, and significant reductions in depressive symptoms among those with more severe baseline depressive symptoms are encouraging and support continued research on BA-PC. This trial was registered in clinicaltrials.gov as Improving Mood in Veterans in Primary Care (NCT02276807).


Assuntos
Depressão , Veteranos , Depressão/terapia , Humanos , Atenção Primária à Saúde , Qualidade de Vida , Resultado do Tratamento
17.
J Interpers Violence ; 36(13-14): 6440-6465, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-30565482

RESUMO

A precollege history of sexual victimization predicts revictimization during college, making it important to understand the mechanisms underlying the victimization-to-revictimization pathway. The study aimed to test whether heavy episodic drinking and personal and peer hookup norms mediate revictimization for two types of unwanted sexual contact: sexual coercion (attempted and/or completed sexual assault by the use of verbal coercion) and sexual assault (attempted and/or completed sexual assault by the use of force, threats, or incapacitation). At college entry, 483 first-year college women completed self-report measures of their precollege experiences, including history of sexual victimization and health behaviors (i.e., alcohol use, personal and peer hookup norms). At the end of the first and second semesters, they also completed measures assessing incident sexual victimization. Nearly one half of women (48%) reported an experience of attempted or completed sexual coercion or assault prior to entering college; 33% endorsed sexual coercion and 15% endorsed sexual assault in their first year of college. Structural equation models demonstrated that heavy episodic drinking and personal and peer hookup norms partially mediated revictimization for sexual assault, but not for sexual coercion. Sexual coercion was the most common tactic leading to unwanted sexual contact in this sample. Alcohol use and personal and peer hookup norms mediated revictimization by force, threats, or incapacitation. In contrast, the hypothesized mediators did not explain the revictimization pathway for verbally coerced assaults. Given the prevalence of sexual coercion, research needs to identify risk factors for verbal coercion to guide prevention efforts.


Assuntos
Vítimas de Crime , Delitos Sexuais , Coerção , Feminino , Humanos , Comportamento Sexual , Universidades
18.
Fam Syst Health ; 38(4): 439-449, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33119371

RESUMO

INTRODUCTION: Prevalence rates of anxiety disorders and symptoms in primary care (PC) settings are very high. Behavioral health consultants in primary care behavioral health (PCBH) settings enable increased access to evidence-based anxiety treatment. Despite strong extant support for exposure-based therapy for anxiety disorders, the use of exposure to treat anxiety in PC settings is low. Although barriers to exposure therapy (ET) may be exacerbated in PC settings, many anxiety presentations in PC warrant an exposure-based approach to treatment. Thus, exploration of feasibility and efficacy of ET in PC represents a critical area for advancing evidence-based treatment of anxiety symptoms. METHODS: The current article addresses this gap through the presentation of two case examples of ET conducted in PCBH. Theoretical and practical information regarding the implementation of exposure using a brief (≤ 30 min), time-limited (4-6 visit) approached are presented. RESULTS: Results from the case examples demonstrate feasibility of conducting exposure in a brief format consistent with a PCBH approach. Additionally, patient outcomes presented suggest that ET conducted in PCBH reduces anxiety symptoms and may facilitate referral to specialty care settings. DISCUSSION: Exposure may offer promise in improving the quality of anxiety treatment in PC. Future work documenting both effectiveness and implementation outcomes of exposure in PC in clinical work and research trials is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia Implosiva/métodos , Terapia Cognitivo-Comportamental/tendências , Humanos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências
19.
Fam Syst Health ; 38(2): 193-199, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32525354

RESUMO

INTRODUCTION: Although anxiety is highly prevalent in primary care and a top reason for referral to primary care behavioral health (PCBH) services, there are limited data on which anxiety interventions are used in routine PCBH practice. The objective of this study was to identify interventions delivered when treating anxiety in PCBH practice. METHOD: We conducted an online survey of PCBH providers regarding their clinical practice with patients who present for treatment of anxiety symptoms. The final sample comprised 209 PCBH providers recruited from e-mail listservs of national professional organizations (59.3% psychologists, 23.4% social workers, 12.4% counselors, 4.8% other). Providers reported on use (yes/no) of 17 interventions in their most recent session with their most recent adult patient presenting with a primary concern of non-trauma-related anxiety. RESULTS: On average, patients were reported to be 42.2 (14.73) years old, White (73.7%), and male (56.5%) with anxiety symptoms of moderate severity (65.6%). Most reportedly had comorbid sleep difficulties (63.6%), depressive symptoms (58.4%), and/or stress/adjustment (56.0%). Providers reported delivering an average of 5.77 (2.05, range: 1-15) interventions, with psychoeducation (94.7%), relaxation training (64.1%), and supportive therapy (60.8%) being most common. Several highly efficacious evidence-based interventions for anxiety, including cognitive therapy (45.0%) and exposure (21.1%), were less common. DISCUSSION: While PCBH providers delivered numerous brief interventions for anxiety, cognitive therapy and exposure were underutilized. Furthermore, PCBH patients with anxiety symptoms were complex, with significant severity and comorbidity. These results suggest implications for research, clinical training, intervention design, and future implementation efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Ansiedade/terapia , Medicina do Comportamento/métodos , Atenção Primária à Saúde/métodos , Adulto , Ansiedade/psicologia , Terapia Cognitivo-Comportamental , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Psychol Serv ; 17(4): 443-451, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30714752

RESUMO

Depressive symptoms are the most common reason for referral to integrated behavioral health providers in primary care. Although evidence-based brief psychotherapies for depression in primary care exist, treatment duration is a significant barrier to implementation. In this open trial, we examined the patient experience of receiving a brief behavioral activation intervention designed for use in primary care (BA-PC), which comprised 2 30-min appointments and 2 boosters spaced 2-3 weeks apart across 12 weeks, and its impact on depression symptoms. Participants were 22 patients recruited from primary care who reported at least moderate depressive symptoms (score ≥ 10 on the Patient Health Questionnaire-9 [PHQ-9]). Patient experiences were examined through assessing patient engagement, satisfaction, acceptability, and treatment response. Fidelity of intervention delivery in delivering the BA-PC within a 12-week period was also assessed. Participants reported a high level of satisfaction with and acceptability of the BA-PC intervention, materials, and format. Within-subject t tests revealed a significant reduction in depressive symptoms from baseline at the 12-week assessment, based on PHQ-9 total score, t(21) = 3.80, p = .001. Evidence of fidelity included 81% of patients completing the 2 BA-PC appointments, average appointment lengths of approximately 30 min, and high content fidelity within each appointment. These preliminary findings suggest that overall experience of a brief BA-PC intervention was positive, with high patient satisfaction, patient acceptability, and treatment fidelity as well as positive patient treatment response. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental , Depressão/terapia , Transtorno Depressivo/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Participação do Paciente , Satisfação do Paciente , Psicoterapia Breve , Idoso , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde , Psicoterapia Breve/estatística & dados numéricos , Veteranos
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