Group psychoeducative cognitive-behaviour therapy for mixed anxiety and depression with older adults

Abstract

Objectives. There is a dearth of older adult literature regarding group treatment for comorbid anxiety and depression. This research evaluated the effectiveness of a low intensity group psychoeducational approach. Method.Patients attended six sessions of a manualised cognitive-behavioural group programme. Validated measures of anxiety, depression and psychological well-being were taken at assessment, termination and short-term follow-up and staff rated patients regarding their functioning at the same time points. Patients rated the alliance and their anxiety and depression at each group session. Outcomes were categorised according to whether patients had recovered, improved, deteriorated or been harmed. Effect sizes were compared to extant group interventions for anxiety and depression.Results. Eight groups were completed with 34 patients, with a drop-out rate of 17%.Staff and patient rated outcome measures showed significant improvements in assessment to termination and assessment to follow-up comparisons. Over one quarter (26.47 %) of patients met the recovery criteria at follow-up and no patients were harmed. Outcomes for anxiety were better than for depression and the alliance was stable over time.Conclusion. The intervention evaluated shows some clinical and organisational promise. The group approach needs to be further explored and tested in research with greater methodological control.Keywords: older adult, CBT, group, co-morbid anxiety/depression. RUNNING HEAD: Group CBT for mixed anxiety and depression in older adults Depression and anxiety co-occur at high rates in older adult populations; Beekman et al., (2000) found that 47.5% of those with major depressive disorder had co-morbid anxiety disorders and 26.1% of people with anxiety disorders had co-morbid major depressive disorders. Katona, Manela and Livingstone (1997) found high rates of co-morbid generalised anxiety disorder (GAD) in older adults diagnosed with depression and Flint (1999) noted that late-life GAD was typically associated with depression. Co-morbidity in older adults is twice more likely in women than men, with more severely depressed individuals more likely to suffer with severe anxiety and vice versa (Schoevers, Beekman, Deeg, Jonker & van Tilburg, 2003).Despite this well evidenced overlap between anxiety and depression in older people, there is a relative lack of research regarding one-to-one and group psychotherapy interventions. Whilst group cognitive behaviour therapy (CBT) is recommended by NICE for working age adults with anxiety and depression for example (NICE Guideline 90, 2009), there are no specific guidelines in relation to older adults due to lack of evidence. Only one study has evaluated group CBT treatment of mixed anxiety and depression (Schimmel-Spreeuw, Linssen & Heeren, 2000) with outpatient elderly depressed women. Statistically significant reductions in depression, anxiety and neuroticism were observed from pre to post pre to follow-up comparisons.A recent review of older adult group CBT specifically ...

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