Cognitive-behavioral therapy provided in the primary care setting is beneficial for older patients with generalized anxiety disorder, according to data from a randomized clinical trial.
Although cognitive-behavior therapy (CBT) has been found to be effective in younger patients with generalized anxiety disorder (GAD) or panic attack and in older people with depression, this framework has not been studied extensively in the primary care setting in older patients with GAD.
In what they described as the first randomized clinical trial of this approach, Melinda A. Stanley, Ph.D., of Baylor College of Medicine, Houston, and her associates assessed the treatment in 134 patients with a diagnosis of GAD aged 60 and older (JAMA 2009;301:1460–7).
A total of 70 study subjects (mean age, 67 years) were randomly assigned to receive up to 10 individual 1-hour sessions of CBT over the course of 12 weeks in a primary care clinic. The program included patient education, motivational interviewing, relaxation training, problem-solving skills training, exposure therapy, and sleep management.
Brief telephone “booster” sessions also were offered at 4, 7, 10, and 13 months.
The remaining 64 subjects received usual care for GAD, which included medication plus biweekly 15-minute phone calls over 3 months to provide support and safety for patients.
The study sample was not representative of older patients in primary care, because there was a preponderance of women and most of the subjects were well educated.
The CBT and phone calls were provided by three master's degree-level therapists with at least 2 years of CBT experience; one predoctoral intern with more than 3 years' experience with CBT, specifically for anxiety; and one post-BA-level therapist with 5 years' experience with CBT, specifically for late-life anxiety.
After 3 months, the patients who received CBT showed significantly greater improvement on the Penn State Worry Questionnaire, a 16-item self-report scale, compared with improvements gained by the usual care group. The CBT group also showed significantly greater improvement on the Beck Depression Inventory II and the mental health component of the Medical Outcomes Study, a measure of health-related quality of life.
The results showed that for those patients who received CBT, the severity of worrying and depressive symptoms decreased, while general mental health improved. These benefits persisted throughout the 12 months of follow-up, the investigators said.
However, results on the Generalized Anxiety Disorder Severity Scale and the Hamilton Anxiety Scale were not significantly different between the CBT group and the control group.
The rates at which patients began or discontinued taking antianxiety medications were no different between the two groups, nor were changes in medication dosages.
“This study paves the way for future research to test sustainable models of care in more demographically heterogenous groups. In future studies, it will be important to examine the impact of treatment delivered by clinicians without specialized CBT expertise,” Dr. Stanley and her associates wrote.
None of the authors reported any financial disclosures. The study was funded by grants from the National Institute of Mental Health and the Houston VA Health Services Research and Development Center of Excellence.