{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:16:11Z","timestamp":1785402971387,"version":"3.56.0"},"reference-count":45,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"unspecified","delay-in-days":71,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0033291726103365_sec1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Individuals with severe mental illnesses (SMIs) experience anxiety that impairs functioning and quality of life. This cluster randomized trial evaluated exposure-based cognitive behavioral therapy (ebCBT) integrated into assertive community treatment (ACT) teams to reduce anxiety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291726103365_sec2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Fifteen ACT teams were allocated to ebCBT + ACT (k = 8, n = 50) or ACT-only (k = 7, n = 43). The intervention followed four steps: situation identification, four-component analysis (behavior, cognition, emotion, physical symptoms), psychoeducation, and graded exposure. Staff received 50 h training and bimonthly supervision over 12 months. Co-primary outcomes were trait and social anxiety; secondary outcomes were psychiatric symptoms, functioning, quality of life, and recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291726103365_sec3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The ebCBT + ACT group showed significant improvements in State\u2013Trait Anxiety Inventory\u2013Trait scores at 12 months (AMD = \u22125.30, 95% CI = \u22128.71 to \u22121.90, p = 0.002, d = \u22120.64) and 18 months (AMD = \u22127.22, 95% CI = \u221212.1 to \u22122.34, p = 0.004, d = \u22120.60). Brief Fear of Negative Evaluation scores showed near-significant improvement at 18 months (AMD = \u22123.70, 95% CI = \u22127.44 to 0.04, p = 0.052, d = \u22120.40). Secondary outcomes, including global functioning, recovery, and quality of life, also improved. Cost-effectiveness analyses indicated favorable cost-effectiveness for anxiety outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291726103365_sec4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Embedding ebCBT within ACT services may reduce anxiety-related fear and avoidance and enhance recovery-related outcomes in individuals with SMI. These findings support the feasibility and clinical value of integrating structured psychological interventions into intensive community-based outreach services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s0033291726103365","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T07:01:25Z","timestamp":1773385285000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Exposure-based cognitive behavioral therapy delivered by assertive community treatment teams for severe mental illness with symptoms of anxiety: a cluster randomized controlled trial"],"prefix":"10.1017","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3386-9576","authenticated-orcid":false,"given":"Sayaka","family":"Sato","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04t0s7x83","id-type":"ROR","asserted-by":"publisher"}],"name":"National Institute of Mental 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