4 - (IOP 9) Patient Selection of Different CBT Skill Modules Within a Modular Cognitive-behavioral Anxiety Intervention for Integrated Primary Care

Enhancing care access and engagement are important strategies to help bridge the mental health treatment divide. Offering mental health treatment through integrated primary care (IPC) increases our reach among those with low rates of treatment-seeking, such as military Veterans. Modular interventions, in which the type and order of treatment components may vary, allows for greater personalization to improve engagement. Modular Anxiety Skills Training (MAST) is a brief, transdiagnostic, modular cognitive-behavioral therapy (CBT) anxiety intervention designed for IPC settings. While MAST begins and ends with standard sessions (initial: assessment and anxiety psychoeducation, final: relapse prevention), patients collaborate with clinicians to select their choice of core skills module (exposure, relaxation, or cognitive coping), followed by up to 3 additional modules from any of the remaining core modules or four optional modules (mindfulness, low mood, sleep, or stress) for a total of up to 6 sessions. Given the novelty of modular treatment in IPC, the purpose of this descriptive analysis was to explore the utilization of the different CBT skills modules among primary care patients experiencing anxiety symptoms. Data are from a multisite hybrid I randomized controlled trial conducted 2021-2025 comparing MAST to Primary Care Behavioral Health usual care in 2 VA healthcare systems. Participants were 86 adult Veterans (22% female, 17% racial/ethnic minority, age M=52 [17] years) who were recruited from primary care and randomized to the MAST condition, of whom 74 (86%) attended ≥1 treatment session. At baseline, participants reported moderate symptom severity on the Generalized Anxiety Disorder-7, M=10.7 (4.4). Excluding 5 booster sessions and 8 anomalous sessions (e.g., predominantly risk assessment, major interruption), there were a total of 357 treatment sessions for an average of 4.8 (1.6) sessions per patient among those engaging in any treatment. About a third of the sessions (n=126, 35%), were the standard initial and final sessions: 74 patients completed Understand Anxiety and 52 completed Maintain Your Progress. A chi-square goodness-of-fit test showed that utilization of the three core modules (n=139; 39%) was not equally distributed, Χ2 (2, N=139)=8.91, p=.01, with both the Identify Anxious Thinking (n=57) and Relax Your Body (n=52) modules being selected more than the Face Your Fears (n=30) module. There were 92 optional module sessions (26%): 30 patients completed Live in the Here and Now, 24 Manage Your Stress, 21 Improve Your Mood, and 17 Improve Your Sleep. We found that Veteran primary care patients with anxiety utilized the full array of available modules, with cognitive coping and relaxation most commonly selected, likely due to their status as core modules and their relevance for most patients with anxiety. While exposure was the least commonly selected core module, it was completed by 41% of those engaging in treatment and was selected as frequently as the most popular optional module. Future research should examine the direct impact of different CBT skills modules on patient engagement and clinical outcomes in larger samples of Veteran and other patient populations using longitudinal designs.