Cognitive Behavior Therapy for Generalized Anxiety Disorder Among Older Adults in Primary Care: A Randomized Clinical Trial

• Published in: JAMA : the journal of the American Medical Association 2009-04, Vol.301 (14), p.1460-1467
• Main Authors: Stanley, Melinda A, Wilson, Nancy L, Novy, Diane M, Rhoades, Howard M, Wagener, Paula D, Greisinger, Anthony J, Cully, Jeffrey A, Kunik, Mark E
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Aged; Anxiety; Anxiety Disorders - therapy; Anxiety disorders. Neuroses; Behavior modification; Behavior therapy. Cognitive therapy; Biological and medical sciences; Clinical trials; Cognitive Behavioral Therapy; Female; General aspects; Humans; Male; Medical sciences; Mental health; Middle Aged; Miscellaneous; Older people; Primary care; Primary Health Care; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Severity of Illness Index; Treatment Outcome; Treatments
• ISSN: 0098-7484; 1538-3598; 1538-3598
• DOI: 10.1001/jama.2009.458

CONTEXT Cognitive behavior therapy (CBT) can be effective for late-life generalized anxiety disorder (GAD), but only pilot studies have been conducted in primary care, where older adults most often seek treatment. OBJECTIVE To examine effects of CBT relative to enhanced usual care (EUC) in older adults with GAD in primary care. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial recruiting 134 older adults (mean age, 66.9 years) from March 2004 to August 2006 in 2 primary care settings. Treatment was provided for 3 months; assessments were conducted at baseline, posttreatment (3 months), and over 12 months of follow-up, with assessments at 6, 9, 12, and 15 months. INTERVENTION Cognitive behavior therapy (n = 70) conducted in the primary care clinics. Treatment included education and awareness, motivational interviewing, relaxation training, cognitive therapy, exposure, problem-solving skills training, and behavioral sleep management. Patients assigned to receive EUC (n = 64) received biweekly telephone calls to ensure patient safety and provide minimal support. MAIN OUTCOME MEASURES Primary outcomes included worry severity (Penn State Worry Questionnaire) and GAD severity (GAD Severity Scale). Secondary outcomes included anxiety ratings (Hamilton Anxiety Rating Scale, Beck Anxiety Inventory), coexistent depressive symptoms (Beck Depression Inventory II), and physical/mental health quality of life (12-Item Short Form Health Survey). RESULTS Cognitive behavior therapy compared with EUC significantly improved worry severity (45.6 [95% confidence interval {CI}, 43.4-47.8] vs 54.4 [95% CI, 51.4-57.3], respectively; P