Cognitive Errors, Symptom Severity, and Response to Cognitive Behavior Therapy in Older Adults With Generalized Anxiety Disorder

Caudle, Donald D.; Senior, Ashley; Wetherell, Julie Loebach; Rhoades, Howard M.; Beck, J. Gayle; Kunik, Mark E.; Snow, A. Lynn; Wilson, Nancy; Stanley, Melinda A.

doi:10.1097/jgp.0b013e31803c550d

Cited by 59 publications

(37 citation statements)

References 39 publications

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“…107 With regard to cognitive impairment, baseline errors in the MiniMental State Examination (MMSE) orientation subscale appear to be associated with reduced response to CBT for GAD. 108 It may be that the goals and techniques of the treatment need to be modified in these patient groups. There have to date been no trials of CBT for anxiety symptoms and disorders specifically in the context of dementia, but a report of two case-studies suggest that a modified approach involving caregivers may be effective.…”

Section: Non-pharmacologicalmentioning

confidence: 99%

Anxiety disorders in older people

Lindesay

Stewart

Bisla

2012

Rev. Clin. Gerontol.

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SummaryThis article reviews the research into anxiety disorders in adults aged 65 years and older that has been published over the past ten years. The topics covered include: the construct of anxiety and its disorders in this age group; epidemiology, including prevalence, incidence, course, outlook, and risk factors; assessment scales; co-morbidity and differential diagnosis (depression, dementia, physical illness); and management, both pharmacological and non-pharmacological. There has been a significant improvement in our understanding of these disorders in older adults over this period, but evidence to support their treatment and prevention is still quite sparse.

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Section: Non-pharmacologicalmentioning

confidence: 99%

Anxiety disorders in older people

Lindesay

Stewart

Bisla

2012

Rev. Clin. Gerontol.

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“…Cognitive limitations in some older adults may produce difficulty in understanding or completing therapy tasks such as cognitive restructuring. Two prior studies have found that cognitive/executive functioning difficulties are associated with poorer response to CBT among older adults (Caudle et al, 2007; Mohlman, 2013). Less research has examined other potential factors that may predict outcome, but one study indicated that greater GAD severity, completion of more homework, and presence of a comorbid psychiatric diagnosis were associated with better CBT outcome among older adults (Wetherell et al, 2005).…”

Section: Introductionmentioning

confidence: 97%

Predictors of CBT outcome in older adults with GAD

Hundt

Amspoker

Kraus-Schuman

et al. 2014

Journal of Anxiety Disorders

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The current study is a secondary analysis of data from a randomized controlled trial of CBT for late-life GAD (Stanley et al., 2014) which provided an opportunity to examine predictors of outcome among those who received CBT. Participants were 150 older adults who were randomized to receive 10 sessions of CBT. Completer analyses found that homework completion, number of sessions attended, lower worry severity, lower depression severity, and recruitment site predicted 6-month worry outcome on the PSWQ-A, whereas homework completion, credibility of the therapy, lower anxiety severity, and site predicted better 6-month anxiety outcome on the STAI-T. In intent-to-treat multivariate analyses, however, only initial worry and anxiety severity, site, and number of sessions completed predicted treatment outcome. These results are largely consistent with predictors of outcome in younger adults and suggest that lower initial symptom severity and variables consistent with greater engagement in treatment predict outcome.

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“…Late-life GAD is associated with decreased quality of life (4, 5) , cognitive impairment (6, 7), and increased health care utilization (4). The onset of GAD in the elderly may reflect both the exposure to age-specific stressors and age-specific brain structural changes (e.g., neuronal degeneration and cerebro-vascular disease)(8).…”

Section: Introductionmentioning

confidence: 99%

Emotion Reactivity and Cerebrovascular Burden in Late-Life GAD: A Neuroimaging Study

Karim

Tudorascu

Aizenstein

et al. 2016

The American Journal of Geriatric Psychiatry

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Objectives Generalized Anxiety Disorder (GAD) is one of the most prevalent mental disorders in the elderly, but its functional neuroanatomy is not well understood. Given the role of emotion dysregulation in GAD, we sought to describe the neural bases of emotion regulation in late-life GAD by analyzing the functional connectivity (FC) in the Salience Network and the Executive Control Network during worry induction and worry reappraisal. Design, setting and participants Twenty-eight elderly GAD and thirty-one non-anxious comparison participants were included. Twelve elderly GAD completed a 12-week pharmacotherapy trial. We used an in-scanner worry script that alternates blocks of worry induction and reappraisal. We assessed network FC, employing the following seeds: anterior insula (AI), dorso-lateral prefrontal cortex (dlPFC), the bed nucleus of stria terminalis (BNST), the paraventricular nucleus (PVN). Results GAD participants exhibited greater FC during worry induction between the left AI and the right orbito-frontal cortex (OFC), and between the BNST and the subgenual cingulate. During worry reappraisal, the non-anxious participants had greater FC between the left dlPFC and the medial PFC, as well as between the left AI and the medial PFC, while elderly GAD had greater FC between the PVN and the amygdala. Following twelve weeks of pharmacotherapy, GAD participants had greater connectivity between the dlPFC and several prefrontal regions during worry reappraisal. Conclusion FC during worry induction and reappraisal points toward abnormalities in both worry generation and worry reappraisal. Following successful pharmacologic treatment, we observed greater connectivity in the prefrontal nodes of the Executive Control Network during reappraisal of worry.

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Cognitive Errors, Symptom Severity, and Response to Cognitive Behavior Therapy in Older Adults With Generalized Anxiety Disorder

Cited by 59 publications

References 39 publications

Anxiety disorders in older people

Anxiety disorders in older people

Predictors of CBT outcome in older adults with GAD

Emotion Reactivity and Cerebrovascular Burden in Late-Life GAD: A Neuroimaging Study

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