Individuals reporting chronic, nonmalignant pain for at least 6 months (N=114) were randomly assigned to 8 weekly group sessions of acceptance and commitment therapy (ACT) or cognitive-behavioral therapy (CBT) after a 4-6 week pretreatment period and were assessed after treatment and at 6-month follow-up. The protocols were designed for use in a primary care rather than specialty pain clinic setting. All participants remained stable on other pain and mood treatments over the course of the intervention. ACT participants improved on pain interference, depression, and pain-related anxiety; there were no significant differences in improvement between the treatment conditions on any outcome variables. Although there were no differences in attrition between the groups, ACT participants who completed treatment reported significantly higher levels of satisfaction than did CBT participants. These findings suggest that ACT is an effective and acceptable adjunct intervention for patients with chronic pain.

Some evidence suggests that acceptance-based approaches such as Acceptance and Commitment Therapy (ACT) may be well-suited to geriatric generalized anxiety disorder (GAD). The primary goal of this project was to determine whether ACT was feasible for this population. Seven older primary-care patients with GAD received 12 individual sessions of ACT; another 9 were treated with cognitive-behavioral therapy. No patients dropped out of ACT, and worry and depression improved. Findings suggest that ACT may warrant a large-scale investigation with anxious older adults.

Objective-To evaluate the efficacy of different types of behavioral treatments for geriatric anxiety [cognitive-behavioral therapy (CBT) alone, CBT with relaxation training (RT), and RT alone].Method-We compared effect sizes from 19 trials. Analyses were based on uncontrolled outcomes (comparing post-treatment and pre-treatment scores) and effects relative to control conditions on both anxiety and depressive symptoms.Results-Treatments for older adults with anxiety symptoms were, on average, more effective than active control conditions. Effect sizes were comparable to those reported elsewhere for CBT for anxiety in the general population or for pharmacotherapy in anxious older adults. CBT (alone or augmented with RT) does not appear to add anything beyond RT alone, although a direct comparison is challenging given differences in control conditions. Effects on depressive symptoms were smaller, with no differences among treatment types. Conclusion-Resultssuggest that behavioral treatments are effective for older adults with anxiety disorders and symptoms. Results must be interpreted with caution given the limitations of the literature, including differing sample characteristics and control conditions across studies. KeywordsPsychotherapy; Geriatric; Anxiety; Relaxation Training; Cognitive Behavioral Therapy Please address correspondence to: Julie Wetherell, Ph.D., UCSD Department of Psychiatry, 9500 Gilman Drive, Dept. 9116B, San Diego, CA 92093-9116, (858) 552-8585 ext. 2752, FAX: (858) jwetherell@ucsd.edu. 3 Note that Scogin et al. (47) contribute two RT samples ("progressive relaxation" and "imaginal progressive relaxation") and both Radley et al. (60) and Sallis et al. (58) describe "anxiety management training" which teaches methods of "dealing with" avoidance, "coping with" anxiety, "thinking processes," and "self-monitoring" that we did not deem as explicit CBT methods for the purposes of this review. NIH Public Access Author ManuscriptAm J Geriatr Psychiatry. Author manuscript; available in PMC 2010 February 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptThe prevalence of anxiety among older adults is high (1), surpassing the rates of depression and severe cognitive dysfunction (2). Almost twice as many mental health Medicare claims are filed for anxiety disorders (38%) as for affective disorders (21%; 3). Anxiety disorders are associated with decreased quality of life (4) and increased disability (5) in older adults. Persistent anxiety symptoms that do not meet criteria for an anxiety disorder are also associated with serious negative consequences such as sleep disturbance, interference with daily activities, and distress (6,7). Prospective as well as cross-sectional research in the elderly has demonstrated that anxiety symptoms are associated with medical illness such as coronary heart disease (8), self-reported mobility limitations (9), and higher levels of health care utilization, including more primary care visits and more time spent during each visit ...