LA JOLLA, CALIF. – Clinicians looking to become proficient in delivering cognitive-behavioral therapy need look no further than firing up their computer.
A treatment called CALM Tools for Living uses a computer program designed to help clinicians who are not experts in cognitive-behavioral therapy deliver the intervention to patients with anxiety or mood disorders. "The program was designed to help novice clinicians, those who are not very experienced or very well trained in cognitive-behavioral therapy," Michelle G. Craske, Ph.D., director of the Anxiety Disorders Research Center at the University of California, Los Angeles (UCLA), explained at the annual conference of the Anxiety and Depression Association of America.
Dr. Michelle Craske
"Our goal was for this to be a tool that could identify and treat anxiety disorders in the primary care setting, but it’s something that would be applicable to a wide range of health and mental health settings," Dr. Craske said. "It’s not limited to primary care."
The brainchild of Dr. Craske in collaboration with her UCLA colleague Raphael D. Rose, Ph.D., CALM Tools for Living is available via a license from the University of Washington. The CALM program is built to treat the major anxiety disorders: social anxiety, post-traumatic stress disorder, generalized anxiety disorder, and panic disorder, as well as depression. The program is organized into modules that are combined over eight sessions that last 45-50 minutes each. Some of the modules are the same for anxiety disorders and depression, while others contain content tailored specifically to each disorder. There are sections for the clinicians and patients to fill out independently, as well as sections for both parties to fill out while sitting together in front of a computer screen.
"This is not a generic program that’s applied broadly in the same way to everyone," said Dr. Craske, who also is a professor of psychology and of psychiatry and biobehavioral sciences at UCLA. "Rather, it’s a program that takes principles and applies them to each individual’s presentation of anxiety or depression."
For example, the CALM Action Module reviews the issue of avoidance behavior, and how it contributes to anxiety and depression in the long run. Each individual’s identified patterns of avoidance are then used in their treatment plan. The CALM Get Moving Module explains the connection between anxious and/or depressive symptoms and activity levels. Patients then devise a plan to increase their activity, as well as include pleasurable activities.
One published study found that at 12 months, participants who were randomized to the CALM intervention had higher response and remission rates, as well as greater improvements in anxiety, depression, functional status, and quality of life, compared with those who were randomized to usual care (JAMA 2010;303:1921-8). "The beauty of this program is that it guides the therapist as well as the patient in a way that maintains fidelity to CBT," said Dr. Craske, who was one of the authors of that study. "There is room for flexibility, but at the same time it gives assurance that what we think are essential elements of CBT are actually delivered.
"In fact, the program gives you measures of that. So administrators and supervisors can see how much of each component was actually delivered to the patient."
Although studies of CALM to date have involved adults, Dr. Craske said she thinks adolescents will love the program because of their love for computers. She also envisions the CALM program expanding into care for patients with chronic pain.
For information about upcoming CALM training sessions, visit www.calmtoolsforliving.org.
Dr. Craske said she had no relevant financial conflicts to disclose.