May 1st, 2010

New scale created to measure anxiety

There is no shortage of self-report questionnaires to measure anxiety, but Mark Zimmerman, M.D. and his colleagues at Rhode Island Hospital and Alpert Medical School of Brown University have developed a new one – the Clinically Useful Anxiety Outcome Scale (CUXOS).

What distinguishes CUXOS, Zimmerman states, is its “goal to be user-friendly, reliable, and valid.” His study of CUXOS, which was published in the Journal of Clinical Psychiatry, found it to take on average less than two minutes to fill out and just 15 seconds to score. The study also showed CUXOS to be reliable, valid and sensitive to change in patients with anxiety. Other scales can be expensive, too long, or complicated to score, but not CUXOS, Zimmerman says. “Hopefully it will lend itself towards routine use in clinical practice.”

He envisions CUXOS being used in every patient visit – not just the last – “since we don’t always know when that will be.” By using it during every session, clinicians won’t overlook symptoms, he adds, and may even pick up on behaviors or feelings that had not been recognized as symptoms. And self-report scales can be particularly useful because they are not susceptible to clinician over-estimation of patient improvement, which may occur when there is an incentive to show success.

Clinicians are already overburdened with paperwork and Zimmerman sees CUXOS as user-friendly enough that it will be easy to regularly incorporate into a clinician’s practice. In his study, it’s noted that only 11 percent of clinicians routinely use standardized measures to assess outcomes when treating anxiety or depression.

For instance, says Zimmerman, at a follow-up visit, a clinician may ask how a patient is feeling and the patient may respond that he’s feeling better. “But if we don’t evaluate residual symptoms, we may overlook them and increase the risk of relapse.” CUXOS would also be useful, he says, to evaluate the effects of treatment. Additionally, he points out, insurance companies and funding agencies have been talking about soon wanting specific outcomes to be measured; CUXOS would provide the means.

CUXOS is also different from other self-report scales because it is not disorder-specific. And, it’s free. There is also an Internet-based CUXOS system, which Zimmerman says would be even easier to score, and which could graph the results over time.

Zimmerman, director of Rhode Island Hospital’s Outpatient Psychiatry and an associate professor of psychiatry and human behavior at Alpert Medical School, developed and studied the scale through the Rhode Island Methods to Improve Diagnostic Assessment and Services Project (MIDAS), for which he is principal investigator. In the study, nearly 1,000 psychiatric outpatients completed CUXOS. It is the second in a series of scales to be developed by MIDAS. The first was CUDOS, a measure for depression.

By Elinor Nelson

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