Self-management support as an add-on to usual care for adults experiencing anxiety: A pragmatic randomized clinical trial

<h3>Context:</h3> 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. <h3>Objective:</h3> To examine the effectiveness of a virtual group self-management support intervention as an add-on to treatment as-usual (TAU). <h3>Study Design and Analysis:</h3> Pragmatic randomized controlled trial with a participatory research approach. <h3>Dataset:</h3> 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). <h3>Intervention:</h3> 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. <h3>Outcome Measures:</h3> 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. <h3>Results:</h3> 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. <h3>Conclusions:</h3> 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.