Context: The high comorbidity rate of generalized anxiety disorders (GADs) with other diagnoses-such as panic disorder, depression, alcohol abuse, posttraumatic stress disorder, insomnia, and obsessive compulsive disorder- make it one of the most common diagnoses found in primary care, with women predominantly affected. It is estimated that 5.4%-7.6% of primary care visits are associated with GAD and in addition to impairments in mental health there is additional impairment in pain, function, and activities of daily life, accelerating the need to reconsider the medical management of this disorder and move from the traditional medical model to a more holistic approach, focusing on self-care.
Objective: The study intended to investigate the effectiveness of a pilot program that used multiple complementary and alternative medicine (CAM) therapies, focusing on self-care behaviors for treatment of GAD.
Design: The study used a quasi-experimental, pretestposttest design to evaluate the benefits of the multitherapy program for one group of individuals with GAD.
Setting: The study occurred at a military treatment facility in the Pacific Northwest.
Participants: Participants were a convenience sample of volunteers seeking treatment at the military treatment facility. The study enrolled participants (N = 37) if they had a documented history of GAD or met screening criteria for GAD using the GAD-7.
Interventions: Participants received acupuncture treatments once/wk for 6 wks and engaged in yogic breathing exercises, self- and/or partner-assisted massage therapy using scented oils, episodic journaling, nutrition counseling, and exercise.
Outcome measures: The primary outcome of interest was the reduction in anxiety as measured by the anxiety subscale on the Depression Anxiety Stress Scale-21 (DASS-21), which assesses three negative affective states: (1) depression (DASS-D), (2) anxiety (DASS-A), and (3) stress (DASS-S). The research team also measured preand post-GAD-7 scores since it used them as a screening criterion for enrollment. In addition, the team assessed participants' levels of pain on a Likert scale.
Results: Of the originally enrolled participants, 68% completed the program (n = 25). The study found significant reductions in anxiety pre- and posttest using GAD-7 and identified overall and individual subscale reductions on the DASS-21. While not specifically targeted for treatment, secondary exploratory outcomes included reductions in use of anxiolytic medication and in the pain scale. The study considered the burden of use of multiple therapies upon participants; however, participation in the study's therapies was high.
Conclusion: The findings in this pilot study suggest multimodal interventions focusing on self-care behaviors may be feasible for patients seeking therapies that are adjunct or alternative to conventional treatments. The study also suggested that this type of patient will participate in multitherapy options, and it offers support for expanding the conceptualization of and treatment for GAD by integrating CAM into existing cognitive-behavioral models.