Cognitive Behavior Therapy for Generalized Anxiety Disorder Among Older Adults in Primary Care

Stanley, Melinda A.; Wilson, Nancy; Novy, Diane M.; Rhoades, Howard M.; Wagener, Paula; Greisinger, Anthony; Cully, Jeffrey A.; Kunik, Mark E.

doi:10.1001/jama.2009.458

Cited by 240 publications

(179 citation statements)

References 44 publications

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“…18,[36][37][38][39][56][57][58][59][60][61][62][63][64] The total sample for the meta-analysis was N = 985 with an average age of 68.16 years (SD = 2.52).…”

Section: Study Selectionmentioning

confidence: 99%

Efficacy of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Older Adults: Systematic Review, Meta-Analysis, and Meta-Regression

Hall

Kellett

Berrios

et al. 2016

The American Journal of Geriatric Psychiatry

122

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Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/) eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) licence. This licence only allows you to download this work and share it with others as long as you credit the authors, but you can't change the article in any way or use it commercially. More information and the full terms of the licence here: https://creativecommons.org/licenses/ Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. and six-month follow-up, significant treatment effects favoring CBT were found in comparison to a waitlist or treatment-as-usual. When CBT was compared with active controls, a small non-significant treatment advantage was found for CBT at the end of treatment, with equivalence of outcomes at follow-up. Treatment effect size of CBT for GAD was significantly associated with attrition rates and depression outcomes. Conclusions: CBT is more helpful than having no treatment for GAD in later life. However, whether CBT shows long-term durability, or is superior to other commonly available treatments (such as supportive psychotherapy), remains to be tested. The relationship between treatment effects for GAD and depression following CBT warrants further research. Efficacy of CBT for GAD in

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“…18,[36][37][38][39][56][57][58][59][60][61][62][63][64] The total sample for the meta-analysis was N = 985 with an average age of 68.16 years (SD = 2.52).…”

Section: Study Selectionmentioning

confidence: 99%

Efficacy of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Older Adults: Systematic Review, Meta-Analysis, and Meta-Regression

Hall

Kellett

Berrios

et al. 2016

The American Journal of Geriatric Psychiatry

122

View full text Add to dashboard Cite

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“…[45][46][47][48] The effectiveness and acceptance of these psychological interventions for mental health problems in older people have been recently evidenced, even if not widely promoted in daily practice. [49][50][51] Collaborative care between GPs and psychiatrists could also encourage appropriate prescriptions. Another area that could probably be targeted is the difference between whether the medication could be stopped or whether there is clinical evidence that it should be stopped.…”

Section: Implications For Future Research and Clinical Practicementioning

confidence: 99%

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

Lasserre

Younès

Blanchon³

et al. 2010

Br J Gen Pract

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The use of psychotropic drugs has increased over recent years in France. GPs are the first prescribers, especially for older patients. AimTo analyse discrepancies between GPs' opinions and practice when prescribing psychotropic drugs to older patients. SettingPostal surveys sent to GPs all over mainland France. Design of studyCross-sectional postal study. MethodA questionnaire collected data on characteristics of GPs' practices, their opinions about psychotropic drug consumption in older people, and a full description of their last older patient receiving a psychotropic drug and seen last by the GP on that particular day. ResultsA total of 350 participating GPs saw 2498 patients aged ≥65 years. Among these patients, the prevalence of psychotropic use was 32.1% (803/2498) for anxiolytics/hypnotics, and 17.5% for antidepressants (438/2498). A total of 91% of GPs agreed that it was possible to reduce or stop psychotropic drugs for these patients. Characteristics of 339 patients taking psychotropic drug were reported: 85.8% (291/339) received at least one anxiolytic/hypnotic and 56.9% (193/339) received at least one antidepressant; there were prescribed for more than 1 year in 68.4% (199/291) and 43.5% (84/193) of the cases respectively. GPs stated that it was possible to reduce or stop anxiolytic/hypnotic drugs for only 27% (79/291) of these patients. Barriers to doing this were patients' refusal (79%), and the absence of any local offer of psychotherapy (73%) or alternative therapy (70%). ConclusionA mismatch exists between GPs' intent (91%) and practice (27%) regarding reduction of psychotropic prescription in individuals aged ≥65 years. The barriers encountered should be examined further to help physicians improve management of psychotropic prescription.

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“…Tolin and colleagues (2007) (Steketee, Frost, Tolin, Rasmussen, & Brown, 2010;Tolin, Steketee, & Frost, 2007). Although the attrition rates reported above are not higher than those seen in other geriatric treatment studies for anxiety (e.g., Stanley et al, 2009;Wetherell & Gatz, 2001) and depression (Serfaty et al, 2009), we believe that increased use of informal therapeutic techniques, such as motivational interviewing and problem solving, can increase the retention of geriatric participants in treatment studies for HD.…”

Section: Va Author Manuscriptmentioning

confidence: 58%

“…Behavioral treatment outcome studies for older adults with generalized anxiety disorder (GAD) report attrition rates from ranging from 25.3% (Stanley et al, 2009) to 34.7% (Wetherell & Gatz, 2001) and geriatric depression rates as low as 18.1% (Serfaty et al, 2009). Among those individuals who were enrolled in this report, only four participants (6.35%) terminated treatment prematurely, suggesting that, once properly engaged, individuals suffering from HD strongly desire to remain in treatment.…”

Section: Attritionmentioning

confidence: 84%

“…Reasons for early termination reported in these studies included poor homework compliance (Steketee, Frost, Wincze, Greene, & Douglass, 2000;Tolin, Steketee, & Frost, 2007), frequent cancellations and scheduling conflicts (Tolin, Steketee, & Frost, 2007;Steketee, Frost, Tolin, Rasmussen, & Brown, 2010), transportation difficulties (Steketee, Frost, Tolin, Rasmussen, & Brown, 2010), and dissatisfaction with progress or treatment (Steketee, Frost, Tolin, Rasmussen, & Brown, 2010;Tolin, Steketee, & Frost, 2007). Although the attrition rates reported above are not higher than those seen in other geriatric treatment studies for anxiety (e.g., Stanley et al, 2009;Wetherell & Gatz, 2001) and depression (Serfaty et al, 2009), we believe that increased use of informal therapeutic techniques, such as motivational interviewing and problem solving, can increase the retention of geriatric participants in treatment studies for HD.…”

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confidence: 84%

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Treatment Recruitment and Retention of Geriatric Participants With Hoarding Disorder

Ayers

Dozier

Mayes

et al. 2015

Clinical Gerontologist

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This study describes the initial contact of 255 potential participants, recruitment of 63 participants, and retention of 57 participants from three geriatric Hoarding Disorder (HD) studies. Patients with HD were easily recruited from the community, primarily through the use of clinician referrals and posted flyers, as evidenced by steady patient flow despite lack of compensation for participation. Contrary to treatment outcomes of late life mood and anxiety disorders, geriatric HD patients are largely retained in clinical research treatment studies. Results demonstrate that older adults with HD can be engaged in treatment. Participants often needed the study staff to provide substantial support, including informal motivational interviewing and problem solving, in scheduling and attending the initial visit.Keywords hoarding disorder; older adults; recruitment and retention Address correspondence to Catherine R. Ayers, PhD, ABPP, Anxiety Disorders Clinic, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA 92161, USA. cayers@ucsd.edu. U.S. Department of Veterans AffairsPublic Access Author manuscript Clin Gerontol. Author manuscript; available in PMC 2018 January 29. VA Author ManuscriptVA Author Manuscript VA Author ManuscriptHoarding Disorder (HD) is characterized by an inability to discard possessions regardless of the objects' value due to a desire to keep the items as well as to avoid the distress accompanying the act of discarding. This prevents the use of active living spaces due to excessive clutter and causes clinically significant distress or functional impairment (American Psychiatric Association, 2013). Hoarding has been associated with an increased risk for fire or falling in the home as well as increased medical problems in older adults (Ayers, Iqbal, & Strickland, 2014;Dong, Simon, Mosqueda, & Evans, 2011;Kim, Steketee, & Frost, 2001). Further, geriatric HD patients exhibit lower global functioning and increased impairment in activities of daily living than non-HD peers (Ayers, Schiehser, Liu, & Wetherell, 2012). Epidemiological research has suggested that the prevalence of DSM-5 hoarding disorder is approximately 1.5% of the general population (Nordsletten et al., 2013), and there is some evidence to suggest that clinically significant compulsive hoarding may increase with age (Samuels et al., 2008). However, there has been no large-scale investigation of the prevalence of HD in older adults. The course of HD appears chronic for 73.0% of adult with compulsive hoarding symptoms and increasing for another 21.2% (Tolin, Meunier, Frost, & Steketee, 2010). When left untreated older adults with HD can experience moderate to severe symptomatology (Ayers, Saxena, Golshan, & Wetherell, 2010).Individuals with HD often resist treatment or seek intervention only as a result of family or community pressure (Frost, Steketee, & Williams, 2000). In a clinical case series examining mid-life and older adults with clinically significant hoarding symptoms, Christensen & Greist (200...

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Cognitive Behavior Therapy for Generalized Anxiety Disorder Among Older Adults in Primary Care

Cited by 240 publications

References 44 publications

Efficacy of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Older Adults: Systematic Review, Meta-Analysis, and Meta-Regression

Efficacy of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Older Adults: Systematic Review, Meta-Analysis, and Meta-Regression

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

Treatment Recruitment and Retention of Geriatric Participants With Hoarding Disorder

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