SAN DIEGO — Data increasingly support the use of individualized cognitive-behavioral therapy in primary care as a treatment for late-life generalized anxiety disorder, Melinda A. Stanley, Ph.D., said at the annual meeting of the American Association of Geriatric Psychiatry.
“A CBT approach is time-limited, directive, and collaborative, which makes it more palatable,” said Dr. Stanley, a psychologist of the department of psychiatry and behavioral sciences at Baylor College of Medicine, Houston. “We also have a fair amount of efficacy data now for younger adult populations with GAD that cognitive-behavioral therapy can be effective,” she said.
In a pilot study published in 2003, Dr. Stanley and her associates enrolled 12 elderly patients with generalized anxiety disorder (GAD) and a Mini-Mental State Examination score of 24 or greater in a randomized trial of individualized CBT treatment vs. “usual care” for late-life GAD.
Patients were recruited from primary care waiting rooms, physician referral, or self-referral.
The mean age of patients was 71 years; 83% were women and about 50% were Caucasian. Half of the study participants were using psychotropic medications.
The six patients who were in the CBT group received 8–10 sessions of CBT that included components of problem-solving training, sleep management skills, and increased attention to learning and memory difficulties (Am. J. Geriatr. Psychiatry 2003;11:92–6).
“We also are able to administer the intervention with more flexibility, primarily because we're administering it to individuals rather than to groups,” Dr. Stanley explained when describing the treatment approach, which continues to be studied.
“We can vary the number and scheduling of the sessions. We can do home visits if necessary, and we can change the emphasis on different treatment components as needed. For example, some patients come to us who don't have much in the way of [sleep] difficulty, so we don't spend much time teaching behavioral sleep skills.”
The treatment lasted for an average of 8 weeks.
Patients in the control group received usual care with telephone follow-up. “We called them biweekly to make sure no emergency services were needed and to try and reduce hospital admission,” she said.
Compared with controls, patients in the CBT group experienced statistically significant improvements in GAD severity, worry as measured by the Penn State Worry Questionnaire, and depression based on the Beck Depression Inventory.
There were no differences between the two groups in terms of the number of mental health referrals or visits, total number of medical visits, or number of new psychotropic medications.
On the basis of results of the pilot study, Dr. Stanley and her associates have launched a larger trial funded by the National Institute of Mental Health. The goal is to randomly assign 150 older primary care patients with GAD to receive either CBT or usual care with an evaluation of outcome made by an independent investigator.