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Cognitive Behavior Therapy helps Older
Adults with Anxiety reduce worry
Newswise — Older adults with
generalized anxiety disorder who received
cognitive behavior therapy had greater
improvement on measures of worry, depression
and mental health than patients who received
usual care, according to a study in the
April 8 issue of JAMA.
Generalized anxiety disorder
(GAD) is common in late life, with
prevalence up to 7.3 percent in the
community and 11.2 percent in primary care.
Late-life anxiety predicts
increased physical disability, memory
difficulties and decreased quality of life,
according to background information in the
article.
Late-life anxiety is
usually treated with medication, but
associated risks (e.g., falls, hip
fractures, memory problems) with some drugs
and patient fears of adverse effects limit
their usefulness.
Two previous studies
suggested benefits of cognitive behavior
therapy (CBT) in primary care for late-life
GAD, but the studies were small and the
conclusions were limited. Older adults most
often seek treatment for GAD in primary
care.
Melinda A. Stanley, Ph.D., of
the Baylor College of Medicine, Houston, and
colleagues conducted the first randomized
clinical trial of CBT for late-life GAD in
primary care to examine whether CBT would
improve outcomes relative to enhanced usual
care (EUC).
The trial included 134 older
adults (average age, 67 years) in two
primary care settings, with treatment
provided for 3 months.
Assessments were conducted at
the beginning of the trial, posttreatment (3
months), and over 12 months of follow-up,
with assessments at 6, 9, 12 and 15 months.
Patients were randomized to
either CBT (n = 70), which included
education and awareness, relaxation
training, cognitive therapy, problem-solving
skills training and behavioral sleep
management; or EUC (n = 64), in which
patients were telephoned biweekly during the
first 3 months of the study by the same
therapists to provide support and ensure
patient safety.
Therapists reminded patients
to call project staff if symptoms worsened.
Levels of anxiety, worry,
depression and physical/mental health
quality of life were measured via various
tests or surveys.
The researchers found
that CBT, compared with EUC, significantly
improved worry severity, depressive symptoms
and general mental health.
In intention-to-treat
analyses, response rates defined according
to worry severity were higher following CBT
compared with EUC at 3 months (40.0 percent
vs. 21.9 percent).
“This study is the first to
suggest that CBT can be useful for managing
worry and associated symptoms among older
patients in primary care,” the authors
write.
“This study paves the way for
future research to test sustainable models
of care in more demographically
heterogeneous groups.”
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