This program is for adults who have been diagnosed with panic disorder, generalized anxiety disorder, social anxiety disorder, or post-traumatic stress disorder (PTSD).

Coordinated Anxiety Learning and Management (CALM), a community-based program, is designed to decrease symptoms of anxiety and/or depression and improve the overall functioning of participants.

Results from one internal randomized controlled trial indicate that participants in the CALM group experienced significant decreases in global anxiety symptoms over 18 months compared to participants in usual care. The intervention appeared to have the most impact on generalized anxiety disorder with lesser effects on panic disorder and social anxiety disorder. There was no effect on PTSD.

CALM is a model of collaborative care in primary care settings where participants choose from computer-assisted cognitive behavioral therapy (CBT; CALM Tools for Living), anti-anxiety medication, or a combination of therapy and medication. A clinician delivers CALM Tools for Living sessions and helps participants understand and work though the content and practice skills. Sessions focus on the following:

• Self-monitoring;
• Psychoeducation;
• Developing a fear hierarchy;
• Breathing;
• Cognitive Restructuring;
• In-person and imagined exposure; and
• Relapse prevention.

Participants with co-occurring disorder choose the primary disorder as a target, and modules on psychoeducation, cognitive restructuring, and exposure include content that is tailored to a participant’s target disorder. Participants can change the intensity of their care by increasing therapy or medication, adding an additional mode, or switching to a different mode of care.

Clinicians can track participant’s information and outcomes and share information with psychiatrists and primary care providers through an online patient-tracking system.

The program was first delivered in 2006 at primary care clinics in Arkansas, California, and Washington. CALM has been modified for use with veterans and is delivered as VA CALM.

This program is implemented by a minimally trained clinician (e.g., social worker, registered nurse, master's- or doctoral-level psychologist), the participant's primary care provider, and a psychiatrist.  Clinicians are not required to be familiar with CBT, and they receive training on the computer-assisted CBT program and use of medication in anxiety treatment. Clinicians also receive weekly telephone supervision from a psychologist and psychiatrist for issues with CBT or medication management. Please use details in the Contact section for more information on training and costs.

Considerations for implementing this program include acquiring buy-in from participants, primary care providers, clinicians, and psychiatrists; ensuring clinicians receive training; locating a room that has a computer available in the primary care clinic where the clinician and participant can hold sessions; and ensuring the program is delivered with fidelity.

The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

If you are interested in implementing CALM, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Completion of CALM Tools for Living requires approximately 6- to 8-weekly, 1-hour sessions; however, program length varies for each participant, based on how they respond to treatment. Treatment will continue until participants show improvement by increasing their current modality (i.e., therapy or medication) or by adding a different modality.

Information on implementation costs was not located. Please use details in the Contact section to learn more.

To move CALM to the Effective category on the Clearinghouse Continuum of Evidence at least two studies should be performed. One of these studies must demonstrate sustained, positive outcomes, and the second study must be an external evaluation, conducted independently of the program developer, that also shows sustained, positive outcomes.

The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu

You may also contact Center for Technology and Behavioral Health Geisel School of Medicine at Dartmouth by mail 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH 03766, phone 1-603-646-7000, email info@c4tbh.org, or visit https://www.c4tbh.org/contact-us/

https://www.c4tbh.org/program-review/coordinated-anxiety-learning-management-calm/ and Sullivan et al. (2007).

Campbell‐Sills, L., Roy‐Byrne, P. P., Craske, M. G., Bystritsky, A., Sullivan, G., & Stein, M. B. (2016). Improving outcomes for patients with medication‐resistant anxiety: Effects of collaborative care with cognitive behavioral therapy. Depression and Anxiety, 33(12), 1099-1106. http://dx.doi.org/10.1002/da.22574

Craske, M. G., Stein, M. B., Sullivan, G., Sherbourne, C., Bystritsky, A., Rose, R. D., … Roy-Byrne, P. (2011). Disorder-specific impact of Coordinated Anxiety Learning and Management treatment for anxiety disorders in primary care. Archives of General Psychiatry, 68(4), 378-388. https://doi.org/10.1001/archgenpsychiatry.2011.25

Roy-Byrne, P., Craske, M. G., Sullivan, G., Rose, R. D., Edlund, M. J., Lang, A. J., … Stein, M. B. (2010). Delivery of evidence-based treatment for multiple anxiety disorders in primary care: A randomized controlled trial. JAMA: The Journal of the American Medical Association, 303(19), 1921-1928. https://doi.org/10.1001/jama.2010.608

Sullivan, G., Craske, M. G., Sherbourne, C., Edlund, M. J., Rose, R. D., Golinelli, D., ... Roy-Byrne, P. (2007). Design of the Coordinated Anxiety Learning and Management (CALM) study: Innovations in collaborative care for anxiety disorders. General Hospital Psychiatry, 29(5), 379-387. https://doi.org/10.1016/j.genhosppsych.2007.04.005

Abraham, T. H., Marchant-Miros, K., McCarther, M. B., Craske, M. G., Curran, G. M., Kearney, L. K., … Cucciare, M. A. (2018). Adapting Coordinated Anxiety Learning and Management for veterans affairs community-based outpatient clinics: Iterative approach. JMIR Mental Health, 5(8), e10277-e10277. https://doi.org/10.2196/10277

Cucciare, M. A., Marchant, K., Abraham, T., Ecker, A., Han, X., White, P., … Lindsay, J. (2021). A randomized controlled trial comparing a manual and computer version of CALM in VA community-based outpatient clinics. Journal of Affective Disorders Reports, 6. https://doi.org/10.1016/j.jadr.2021.100202

Wolitzky-Taylor, K., Krull, J., Rawson, R., Roy-Byrne, P., Ries, R., & Craske, M. G. (2018). Randomized clinical trial evaluating the preliminary effectiveness of an integrated anxiety disorder treatment in substance use disorder specialty clinics. Journal of Consulting and Clinical Psychology, 86(1), 81-88. https://doi.org/10.1037/ccp0000276

Jakubovski, E., & Bloch, M. H. (2016). Anxiety disorder-specific predictors of treatment outcome in the Coordinated Anxiety Learning and Management (CALM) trial. Psychiatric Quarterly, 87(3), 445-464. https://doi.org/10.1007/s11126-015-9399-6

Cucciare, M. A., Marchant, K., Lindsay, J., Craske, M. G., Ecker, A., Day, S., … Abraham, T. H. (2020). An evidence‐based model for disseminating‐implementing Coordinated Anxiety Learning and Management in Department of Veterans Affairs community‐based outpatient clinics. The Journal of Rural Health, 36(3), 371-380. https://doi.org/10.1111/jrh.12398

Ecker, A. H., Abraham, T. H., Martin, L. A., Marchant‐Miros, K., & Cucciare, M. A. (2021). Factors affecting adoption of Coordinated Anxiety Learning and Management (CALM) in veterans’ affairs community‐based outpatient clinics. The Journal of Rural Health, 37(2), 447-455. https://doi.org/10.1111/jrh.12528

Hunt, C., Campbell-Sills, L., Chavira, D., Craske, M., Sherbourne, C., Sullivan, G., … Bomyea, J. (2022). Prospective relations between anxiety sensitivity and transdiagnostic anxiety following cognitive-behavioral therapy: Evidence from the coordinated anxiety learning management trial. Behaviour Research and Therapy, 155, 104119-104119. https://doi.org/10.1016/j.brat.2022.104119

Joesch, J. M., Sherbourne, C. D., Sullivan, G., Stein, M. B., Craske, M. G., & Roy-Byrne, P. (2012). Incremental benefits and cost of Coordinated Anxiety Learning and Management for anxiety treatment in primary care. Psychological Medicine, 42(9), 1937-1948. https://doi.org/10.1017/S0033291711002893

Rose, R. D., Lang, A. J., Welch, S. S., Campbell-Sills, L., Chavira, D. A., Sullivan, G., ... Craske, M. G. (2011). Training primary care staff to deliver a computer-assisted cognitive–behavioral therapy program for anxiety disorders. General Hospital Psychiatry, 33(4), 336-342. https://doi.org/10.1016/j.genhosppsych.2011.04.011

Taylor, J. H., Jakubovski, E., & Bloch, M. H. (2015). Predictors of anxiety recurrence in the Coordinated Anxiety Learning and Management (CALM) trial. Journal of Psychiatric Research, 65, 154-165. https://doi.org/10.1016/j.jpsychires.2015.03.020

Williams, M. D., Sawchuk, C. N., Shippee, N. D., Somers, K. J., Berg, S. L., Mitchell, J. D., … Katzelnick, D. J. (2018). A quality improvement project aimed at adapting primary care to ensure the delivery of evidence-based psychotherapy for adult anxiety. BMJ Open Quality, 7(1). https://doi.org/10.1136/bmjoq-2017-000066