Emily M. Johnson, Julie C. Gass, Eibhlin Regan, Melanie Rainbow, Jennifer S. Funderburk

As we work to ascertain "what works clinically?" in integrated care, qualitative data from patients can inform our understanding of which aspects of treatment are helpful to patients. Prior research suggests that support factors (common factors such as empathic provider), learning factors (e.g., psychoeducation), and action factors (learning coping skills such as cognitive restructuring) are valued by patients in Primary Care Behavioral Health (PCBH; Allen et al., 2025; Koehler et al., 2020). The goals of this secondary data analysis were to describe which aspects of anxiety treatment patients found most helpful and examine whether responses differed by type of treatment (structured intervention vs. unstructured counseling). We hypothesized that patients in the structured intervention would be more likely to identify action factors as most helpful and patients in unstructured counseling would be more likely to identify support factors as most helpful. Data are from 127 patients who attended ≥1 treatment session and completed the 16-week post-treatment assessment in a randomized clinical trial. 66 patients received Modular Anxiety Skills Training, a structured cognitive-behavioral therapy (CBT) intervention, and 61 received PCBH usual care, which primarily comprised supportive counseling. We coded responses to an open-ended question: “Thinking back on the treatment sessions you completed with the behavioral health provider since you started this study, what was most helpful to you?” using a mix of deductive (for domains: support, learning, or action factors [Lambert, 2013]) and inductive (for categories within domains) coding. 49% of patients identified action factors as the most helpful aspect of anxiety treatment compared to 39% for support factors, 28% learning factors, and 18% other. For action factors, relaxation techniques and general coping tools were the most common categories. For support and learning factors, having someone to talk to/listen and self-awareness, respectively, were by far the most common categories. As hypothesized, patients in the structured intervention (58%) were more likely than those in unstructured counseling (39%) to identify action factors as most helpful, p=.04, whereas those in unstructured counseling (49%) were more likely than those in the structured intervention (29%) to identify support factors as most helpful (p=.02). Eliciting patient perspectives is integral to understand what patients find helpful in treatment. Results suggest that within more structured treatment, such as CBT interventions, patients are more likely to perceive coping skill provision as the most helpful aspect of treatment. However, consistent with prior research, we found that patients receiving either type of anxiety treatment valued both support and action factors. This presentation will be of interest to both clinicians and researchers in PCBH as we discuss the importance of blending common factors and skills training to optimize the impact of treatment.

Discuss how qualitative research can help us to better understand patient perspectives on treatment

Describe the difference between support, learning, and action factors

List multiple aspects of PCBH treatment that are valued by patients with anxiety