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.

Background-Several theories have posited a common internalizing factor to help account for the relationship between mood and anxiety disorders. These disorders are often comorbid and strongly covary. Other theories and data suggest that personality traits may account, at least in part, for comorbidity between depression and anxiety. The present study examines the relationship between neuroticism and an internalizing dimension common to mood and anxiety disorders.

Objective Randomized comparisons of acceptance-based treatments with traditional cognitive behavioral therapy (CBT) for anxiety disorders are lacking. To address this research gap, we compared acceptance and commitment therapy (ACT) to CBT for heterogeneous anxiety disorders. Method One hundred twenty eight individuals (52% female, mean age = 38, 33% minority) with one or more DSM-IV anxiety disorders began treatment following randomization to 12 sessions of CBT or ACT; both treatments included behavioral exposure. Assessments at pre-treatment, post-treatment, 6-month, and 12-month follow-up measured anxiety specific (principal disorder Clinical Severity Ratings [CSR], Anxiety Sensitivity Index, Penn State Worry Questionnaire, Fear Questionnaire avoidance) and non-anxiety specific (Quality of Life Index [QOLI], Acceptance and Action Questionnaire-16 [AAQ]) outcomes. Treatment adherence and therapist competency ratings, treatment credibility, and co-occurring mood and anxiety disorders were investigated. Results CBT and ACT improved similarly across all outcomes from pre- to post-treatment. During follow-up, ACT showed steeper CSR improvements than CBT (p < .05, d = 1.33) and at 12-month follow-up, ACT showed lower CSRs than CBT among completers (p < .05, d = 1.05). At 12-month follow-up, ACT reported higher AAQ than CBT (p = .08, d = .42; Completers: p < .05, d = .59) whereas CBT reported higher QOLI than ACT (p < .05, d = .43). Attrition and comorbidity improvements were similar, although ACT utilized more non-study psychotherapy at 6-month follow-up. Therapist adherence and competency were good; treatment credibility was higher in CBT. Conclusions Overall improvement was similar between ACT and CBT, indicating that ACT is a highly viable treatment for anxiety disorders.

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.

Background Generalized anxiety disorder (GAD) and major depressive disorder (MDD) are highly comorbid. A possible explanation is that they share four symptoms according to the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition – Text Revision (DSM-IV-TR). The present study addressed the symptom overlap of people meeting DSM-IV-TR diagnostic criteria for GAD, MDD, or both to investigate whether comorbidity might be explained by overlapping diagnostic criteria. Methods Participants (N = 1,218) were enrolled in the Coordinated Anxiety Learning and Management (CALM) study (a randomized effectiveness clinical trial in primary care). Hypotheses were: 1) the comorbid GAD/MDD group would endorse the overlapping symptoms more than the non-overlapping symptoms, and 2) the comorbid GAD/MDD group would endorse the overlapping symptoms more than GAD only or MDD only groups, whereas differences would not occur for non-overlapping symptoms. Results The overlapping GAD/MDD symptoms were endorsed more by the comorbid group than the MDD group but not the GAD group when covarying for total symptom endorsement. Similarly, the comorbid group endorsed the overlapping symptoms more than the non-overlapping symptoms and did not endorse the non-overlapping symptoms more than the GAD or MDD groups when covarying for total symptom endorsement. Conclusions The results suggest that comorbidity of GAD and MDD is strongly influenced by diagnostic overlap. Results are discussed in terms of errors of diagnostic criteria, as well as models of shared psychopathology that account for diagnostic criteria overlap.