4 - (SYM 72) Outcomes of a Brief, Nonspecialist-delivered Behavioral Intervention for Anxiety

Background: Anxiety is the most common adult mental health condition and confers significant personal and public health burden. Cognitive behavioral therapies (CBT) offer an acceptable and effective first-line treatment; however, shortages of mental health providers render such treatment largely unavailable or inaccessible. Provider task sharing is one approach to improve service access, in which brief interventions are delivered by nonspecialist providers (i.e., those with no prior training as a mental health professional). Here we present the feasibility and preliminary effectiveness outcomes of a single-arm trial of a brief behavioral intervention for mild-to-moderate anxiety designed for nonspecialist delivery.

Method: We recruited adults with clinically significant symptoms of anxiety to participate in a brief, structured treatment protocol over 6-8 weekly individual sessions. The intervention was previously developed using an iterative, community- and clinician-engaged process. Bachelor-level nonspecialists were trained and supervised to serve as interventionists (“coaches”). Sessions were designed to be approximately 30 min and emphasized cognitive behavioral strategies of either situational exposure or worry exposure. Feasibility and acceptability outcomes included recruitment, retention, coach fidelity to intervention, and working alliance. Primary clinical outcome was anxiety severity (Hamilton Anxiety Rating Scale; HAM-A).

Results: Six non-specialist “coaches” (83% women; 50% persons of color) delivered the intervention to a total of 21 enrolled participants (Mage=29, range 19-60 years; 81% women, 57% persons of color). The majority (n=17; 81%) of enrolled participants were retained, and working alliance was generally rated as high across sessions, although lower scores were observed in those who dropped. External rating of intervention fidelity was universally high. Decrease in HAM-A scores between baseline and post-treatment was clinically (Hedge’s g >1.0) and statistically significant (p< .001), and post-treatment anxiety severity was mild (HAM-A M=8.25, SD=5.01). Exploratory treatment mechanisms including anxiety sensitivity, cognitive avoidance, and experiential avoidance will be discussed.


Discussion: Preliminary findings support feasibility and acceptability of this treatment protocol and delivery model to improve anxiety symptoms. Further testing in a larger randomized trial is warranted.