# Improving Anxiety Treatment Engagement and Effectiveness in Primary Care-Mental Health Integration: Multi-site Hybrid I RCT of a Brief Veteran-Centered Anxiety Intervention

> **NIH VA I01** · SYRACUSE VA  MEDICAL CENTER · 2021 · —

## Abstract

Background: Many Veterans experience impairing symptoms of anxiety and seek treatment in primary care,
yet anxiety is highly undertreated in this setting. Primary Care-Mental Health Integration (PCMHI), in which
mental health clinicians embedded in primary care provide brief treatment, affords an opportunity to address
this treatment gap. However, behavioral interventions that are compatible with the brief PCMHI treatment
format and able to accommodate a wide range of anxiety presentations are needed. Accordingly, Veterans
Anxiety Skills Training (VAST) was designed to be evidence-based, transdiagnostic, feasible for PCMHI, and
Veteran-centered. VAST comprises empirically-supported cognitive-behavioral therapy (CBT) techniques
adapted into a manualized modular intervention specifically designed for delivery in PCMHI. As VAST is being
piloted at a single site with study therapists, the next scientific step is a multi-site randomized controlled trial
(RCT) to evaluate its effectiveness using PCMHI providers in routine care. Significance/Impact: This study
addresses Veteran care priorities of mental health and suicide prevention, MISSION Act priorities of increasing
access to care and improving patient satisfaction with Veterans Health Administration (VHA) care, and Health
Services Research and Development (HSR&D) focus areas of quality, effectiveness, and efficiency as well as
implementation science research methods. Improving anxiety treatment in PCMHI will address a major gap in
VHA treatment options, given the high prevalence of anxiety in primary care, tendency for patients with anxiety
to seek treatment in primary care rather than specialty mental health settings, and absence of Evidence-Based
Psychotherapy (EBP) protocols addressing non-trauma related anxiety. Innovation: Modular (vs. standard)
intervention designs offer advantages in efficiency, patient and provider satisfaction, efficacy, effectiveness,
implementation, and sustainability. Other innovative aspects include the transdiagnostic approach and
examination of fidelity to inform future implementation. Specific Aims: The specific aims are to: (1) Compare
patient clinical outcomes for VAST vs. PCMHI usual care between baseline and 16 weeks (post) in a multi-site
RCT in which PCMHI providers deliver VAST, and examine whether treatment gains are more likely to be
maintained for VAST vs. PCMHI usual care at 28 weeks (follow-up); (2) For participants assigned to receive
VAST, explore patient-level predictors of (a) early (8 weeks) and (b) overall (16 weeks) treatment response;
and (3) Conduct a mixed-methods process evaluation of VAST implementation to examine rates of, barriers to,
and facilitators of achieving and sustaining high-fidelity intervention delivery. Methodology: In this multi-site,
hybrid type I effectiveness-implementation RCT, 178 adult Veterans with elevated anxiety symptoms will be
recruited from primary care at two VHA sites. PCMHI providers will be randomized to delive...

## Key facts

- **NIH application ID:** 10187035
- **Project number:** 1I01HX003206-01A1
- **Recipient organization:** SYRACUSE VA  MEDICAL CENTER
- **Principal Investigator:** ROBYN LEANNE SHEPARDSON
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-05-01 → 2025-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10187035

## Citation

> US National Institutes of Health, RePORTER application 10187035, Improving Anxiety Treatment Engagement and Effectiveness in Primary Care-Mental Health Integration: Multi-site Hybrid I RCT of a Brief Veteran-Centered Anxiety Intervention (1I01HX003206-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10187035. Licensed CC0.

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