Long-term effectiveness and prediction of treatment outcome in cognitive behavioral therapy and sertraline for late-life anxiety disorders

• Published in: International psychogeriatrics 2009-12, Vol.21 (6), p.1148-1159
• Main Authors: Schuurmans, Josien, Comijs, Hannie, Emmelkamp, Paul M. G., Weijnen, Ingrid J. C., van den Hout, Marcel, van Dyck, Richard
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antidepressants; Anxiety; anxiety disorders; Anxiety Disorders - diagnosis; Anxiety Disorders - psychology; Anxiety Disorders - therapy; Attitude to Health; Behavior therapy. Cognitive therapy; Biological and medical sciences; Clinical trials; Cognitive Therapy; Comparative studies; Female; Follow-Up Studies; Geriatric psychology; Geriatrics; Humans; Male; Medical prognosis; Medical sciences; Middle Aged; Neuropharmacology; Neurotic Disorders - diagnosis; Neurotic Disorders - psychology; Older people; Personality Inventory - statistics & numerical data; Pharmacology. Drug treatments; Prognosis; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychopathology. Psychiatry; Psychopharmacology; randomized controlled trial; Serotonin Uptake Inhibitors - therapeutic use; sertraline; Sertraline - therapeutic use; Treatment Outcome; Treatments
• ISSN: 1041-6102; 1741-203X
• DOI: 10.1017/S1041610209990536

Background: Although anxiety disorders are prevalent in older adults, randomized controlled trials of treatment effectiveness for late-life anxiety are scarce and have focused primarily on the effectiveness of psychotherapeutic interventions. However, recent findings suggest that in some cases, pharmacological treatment may be more beneficial for late-life anxiety disorders. As yet, there have been no systematic studies investigating prognostic factors for the outcome of cognitive behavioral therapy (CBT) and pharmacotherapy for late-life anxiety. The objective of the present study was to study long-term treatment outcomes and to explore differential predictors for both short-term and long-term treatment outcomes of sertraline and CBT for late-life anxiety disorders. Methods: Participants of a randomized controlled trial (RCT) comparing sertraline and CBT for the treatment of late-life anxiety were contacted one year after completing their treatment, so that predictors for both short-term and long-term treatment outcome could be established. Results: Sertraline showed a greater reduction of symptoms than CBT on anxiety (Hamilton Anxiety Rating Scale; HARS) and worry (Worry Domain Questionnaire) ratings at one-year follow-up. The strongest predictor for short-term CBT outcome was poor perceived health, explaining 40% of the variance in post-treatment residual gain scores on the HARS. The strongest predictor for long-term CBT outcome was neuroticism, explaining 20% of the variance in residual gain scores at one-year follow-up. Analyses revealed no significant predictors for treatment outcome in sertraline participants. Conclusions: Our study suggests that long-term use of sertraline might be more beneficial for late-life anxiety than a 15-week CBT program. Poor perceived health and neuroticism are predictive of less improvement after CBT in anxious older adults. Implications of these findings are discussed.