A Randomized Controlled Trial of Telephone-Delivered Cognitive-Behavioral Therapy for Late-Life Anxiety Disorders

Abstract

Objectives Older adults face a number of barriers to receiving psychotherapy, such as a lack of transportation and access to providers. One way to overcome such barriers is to provide treatment by telephone. The purpose of this study was to examine the effects of cognitive behavioral therapy delivered by telephone (CBT-T) to older adults diagnosed with an anxiety disorder. Design Randomized controlled trial. Setting Participants' homes. Participants Sixty participants ≥ 60 years of age with a diagnosis of Generalized Anxiety Disorder, Panic Disorder, or Anxiety Disorder Not Otherwise Specified. Intervention CBT-T vs. information-only comparison. Measurements Co-primary outcomes included worry (Penn State Worry Questionnaire) and general anxiety (State Trait Anxiety Inventory). Secondary outcomes included clinician-rated anxiety (Hamilton Anxiety Rating Scale), anxiety sensitivity (Anxiety Sensitivity Index), depressive symptoms (Beck Depression Inventory), quality of life (SF-36), and sleep (Insomnia Severity Index). Assessments were completed prior to randomization, immediately upon completion of treatment, and 6 months after completing treatment. Results CBT-T was superior to information-only in reducing general anxiety (ES = 0.71), worry (ES = 0.61), anxiety sensitivity (ES = 0.85), and insomnia (ES = 0.82) at the post-treatment assessment; however, only the reductions in worry were maintained by the 6 month follow-up assessment (ES = 0.80). Conclusions These results suggest that CBT-T may be efficacious in reducing anxiety and worry in older adults, but additional sessions may be needed to maintain these effects.

Predictors of change in quality of life in older adults with generalized anxiety disorder

“…Cognitive behavioral therapy (CBT), an efficacious treatment for late-life GAD, also improves QOL (Brenes et al , 2012, Stanley et al , 2003, Wetherell et al , 2004). QOL has increasingly been a focus of treatment outcome research, as studies shift from a narrow focus on symptom reduction to broader evaluation of outcomes.…”

Effects of Telephone-Delivered Cognitive-Behavioral Therapy and Nondirective Supportive Therapy on Sleep, Health-Related Quality of Life, and Disability

“…In fact, few studies of older adults with GAD have reported on sleep as an outcome of psychotherapy treatment trials. Two studies that have included it found that CBT was superior to enhanced usual care for improving sleep (7–8). Insomnia in older adults has been associated with a number of negative health outcomes, including greater risk of falls (25), poorer physical functioning (26), and increased risk of developing depression (27).…”

“…Yet, few studies have reported on sleep as an outcome of psychotherapy trials, and those that do report conflicting outcomes. Brenes and colleagues (7) found that cognitive-behavioral therapy (CBT) for GAD was superior to enhanced usual care in reducing insomnia among older adults. Similarly, Bush and colleagues (8) found that CBT for late-life GAD was associated with greater improvements in the ability to fall asleep compared with enhanced usual care.…”

Cognitive–behavioral therapy for late-life anxiety: Similarities and differences between Veteran and community participants

“…Clinician-rated anxiety severity was rated using the Structured Interview Guide for the Hamilton Anxiety Scale (SIGH-A; Shear, et al, 2001). The SIGH-A is a 14-item measure with demonstrated sensitivity to change in clinical trials (Brenes et al, 2012). …”