The Posttraumatic Stress Disorder Checklist is a commonly used measure, with military (PCL-M), civilian (PCL-C), and specific trauma (PCL-S) versions. This synthesis of the psychometric properties of all three versions found the PCL to be a well-validated measure. The PCL shows good temporal stability, internal consistency, test-retest reliability, and convergent validity. The majority of structural validity studies support four factor models. Little is available on discriminant validity and sensitivity to change. Strengths, limitations, and future research directions are discussed. Understanding the PCL's psychometric properties, strengths (e.g., items map on to DSM-IV diagnostic criteria), and limitations (e.g., may overestimate PTSD prevalence) will help clinicians and researchers make educated decisions regarding the appropriate use of this measure in their particular setting.

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MPROVING THE QUALITY OF MENtal health care requires continued efforts to move evidence-based treatments of proven efficacy into real-world practice settings with wide variability in patient characteristics and clinician skill. 1 The effectiveness of one approach, collaborative care, is well established for primary care depression, 2-5 but has been infrequently studied for anxiety disorders, 6,7 despite their common occurrence in primary care. 8 The multiplicity of anxiety disorders and the fact that anxious patients are less likely to seek 9 and harder to engage 10 in treatment may be contributing factors. Furthermore, whereas effective treatment for both anxiety and depressive disorders relies in part on pharmacotherapy, psychosocial treatments such as cognitive behavioral therapy (CBT) are important for pa-tients who are anxious. Not only do these patients strongly prefer psychological treatment over medications, 10,11 but also CBT may have ad-Author Affiliations are listed at the end of this article.

Individuals reporting chronic, nonmalignant pain for at least 6 months (N=114) were randomly assigned to 8 weekly group sessions of acceptance and commitment therapy (ACT) or cognitive-behavioral therapy (CBT) after a 4-6 week pretreatment period and were assessed after treatment and at 6-month follow-up. The protocols were designed for use in a primary care rather than specialty pain clinic setting. All participants remained stable on other pain and mood treatments over the course of the intervention. ACT participants improved on pain interference, depression, and pain-related anxiety; there were no significant differences in improvement between the treatment conditions on any outcome variables. Although there were no differences in attrition between the groups, ACT participants who completed treatment reported significantly higher levels of satisfaction than did CBT participants. These findings suggest that ACT is an effective and acceptable adjunct intervention for patients with chronic pain.

Overall, this investigation suggests that the OASIS is a valid instrument for measurement of anxiety severity and impairment in clinical samples. Its brevity and applicability to a wide range of anxiety disorders enhance its utility as a screening and assessment tool.

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Objective The objective of this study was to evaluate two abbreviated versions of the PTSD Checklist (PCL), a self-report measure of posttraumatic stress disorder (PTSD) symptoms, as an index of change related to treatment. Method Data for this study were from 181 primary care patients diagnosed with PTSD who enrolled in a large randomized trial. These individuals received a collaborative care intervention (CBT and/or medication) or usual care and were followed 6 and 12 months later to assess their symptoms and functioning. The sensitivity of the PCL versions (i.e., full, 2-item, 6-item), correlations between the PCL versions and other measures, and use of each as indicators of reliable and clinically significant change were evaluated. Results All versions had high sensitivity (.92-.99). Correlations among the three versions were high, but the 6-item version corresponded more closely to the full version. Both shortened versions were adequate indicators of reliable and clinically significant change. Conclusion Whereas prior research has shown the 2-item or 6-item versions of the PCL to be good PTSD screening instruments for primary care settings, the 6-item version appears to be the better alternative for tracking treatment-related change.

PTSD affects a substantial number of women in medical settings and is associated with significant distress and impairment. There are effective methods of treating trauma-related distress, but a minority seek such care. Thus, primary care is an important setting in which to identify individuals with PTSD. We sent questionnaires, including the PTSD Checklist--Civilian Version (PCL-C), to 419 female veterans who were seen in our primary care clinic in 1998; 56% (N = 221) returned the measures. A random subset (n = 49) was interviewed to establish psychiatric diagnoses. The results provide qualified support for the use of the PCL-C total score with a lowered cutoff score as a screening measure for PTSD in female veterans in primary care.