Self-management support as an add-on to usual care for adults experiencing anxiety: A pragmatic randomized clinical trial
Bibliographic record
Abstract
Context: Anxiety disorders are common and disabling, and they are characterized by fluctuating symptom levels throughout the lifecourse. Self-management support (SMS) is a complementary intervention to evidence-based treatments that promotes self-efficacy and empowerment. While SMS is well established for chronic physical conditions, evidence is lacking to support the implementation of structured SMS programs for common mental disorders, and particularly anxiety. Objective: To examine the effectiveness of a virtual group self-management support intervention as an add-on to treatment as-usual (TAU). Study Design and Analysis: Pragmatic randomized controlled trial with a participatory research approach. Dataset: We recruited 414 adults aged 18 and over with anxiety symptoms according to self-reported assessment scales. Participants were randomly assigned to the SMS + TAU condition (n = 207) or the TAU only condition (n = 207). Intervention: We implemented a SMS program for anxiety developed by the Relief organization in Québec (Canada), a guided 10-week 2.5-h group virtual workshop with 15 participants supported by two trained facilitators. The program comprises a broad range of mental health intervention strategies and wellness-focused approaches in a nondirective toolkit aimed at building self-management skills. Outcome Measures: The primary outcome measure is the patient-reported Beck Anxiety Inventory. Secondary outcome measures include self-reported instruments for quality of life, anxiety and depressive symptoms, recovery, and service utilization. Results: Since 2022, we have recruited the sample and completed the 14 SMS workshops for the intervention group. The control condition will access a delayed intervention after a 12-month period. Intention-to-treat analysis were conducted, and a linear mixed regression model was used to account for between- and within-subject variations. At post-treatment, self-reported anxiety symptoms indicate that the SMS intervention had superior effects over TAU alone. The intervention also led to significant improvements in self-management and personal recovery. Conclusions: The addition of SMS to usual care was superior to usual care alone to reduce anxiety symptoms and foster recovery in adults experiencing anxiety. Findings suggest that SMS should be routinely offered in the community in a recovery-oriented approach.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.011 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.006 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.019 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".