Publications (27) View all
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Article: A randomized controlled trial of telephone-delivered cognitive-behavioral therapy for late-life anxiety disorders.
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ABSTRACT: 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. Randomized controlled trial. Participants' homes. Sixty participants age 60 and older with a diagnosis of generalized anxiety disorder, panic disorder, or anxiety disorder not otherwise specified. CBT-T versus information-only comparison. Coprimary 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. 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 posttreatment assessment; however, only the reductions in worry were maintained by the 6-month follow-up assessment (ES = 0.80). 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.The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 08/2012; 20(8):707-16. · 3.35 Impact Factor -
Article: Feasibility and Acceptability of Bibliotherapy and Telephone Sessions for the Treatment of Late-life Anxiety Disorders.
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ABSTRACT: This article describes the development of Biblio and Telephone Therapy or BTT, a cognitive-behavioral treatment program for late-life anxiety disorders. Although studies have examined bibliotherapy for the treatment of late-life depression, none have studied it as a format for treating late-life anxiety. The application of this treatment to 4 older adults with Generalized Anxiety Disorder (GAD) and/or Panic Disorder (PD) is described and benefits, advantages and limitations are discussed.Clinical Gerontologist 01/2010; 33(1):62-68. · 0.73 Impact Factor -
Article: Obesity and onset of significant depressive symptoms: results from a prospective community-based cohort study of older men and women.
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ABSTRACT: Although several cross-sectional studies have linked obesity and depression, less is known about their longitudinal association and about the relative influence of obesity subtypes. We prospectively examined whether obesity (specifically, abdominal) increased the risk of onset of depression in a population-based sample of older persons. Participants were 2,547 nondepressed, well-functioning white and black persons, aged 70-79 years, enrolled in the Health, Aging, and Body Composition Study, an ongoing prospective community-based cohort study. Baseline measurements were conducted between April 1997 and June 1998. Overall obesity was assessed by body mass index (BMI) and percent body fat (measured by dual energy x-ray absorptiometry), whereas abdominal obesity measures included waist circumference, sagittal diameter, and visceral fat (measured by computer tomography). Onset of significant depressive symptoms was defined as a Center for Epidemiologic Studies Depression 10-item score > or = 10 at any annual follow-up over 5 years and/or new antidepressant medication use. Persistent depression was defined as depression at 2 consecutive follow-up visits. Over 5 years, significant depressive symptoms emerged in 23.7% of initially nondepressed persons. In men, both overall (BMI: hazard ratio [HR] per SD increase = 1.20; 95% CI, 1.03-1.40) and abdominal obesity (visceral fat: HR per SD increase = 1.19; 95% CI, 1.07-1.33) predicted onset of depressive symptoms after adjustment for sociodemographics. When BMI and visceral fat were adjusted for each other, only visceral fat was significantly associated with depression onset (HR = 1.18; 95% CI, 1.04-1.34). Stronger associations were found for persistent depressive symptoms. No associations were found in women. This study shows that obesity, in particular visceral fat, increases the risk of onset of significant depressive symptoms in men. These results suggest that specific mechanisms might relate visceral fat to the onset of depression.The Journal of Clinical Psychiatry 12/2009; 71(4):391-9. · 5.80 Impact Factor -
Article: A new home-based mental health program for older adults: description of the first 100 cases.
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ABSTRACT: The Geriatric Psychiatry Outreach (GO) Program began in 2005 and provides in-home psychiatric evaluation and treatment for older adults who have difficulty getting to an office-based setting. An initial assessment was conducted on the first 100 patients seen by the program and follow-up treatment was provided as clinically indicated. The mean age of patients seen was 79.7 (SD: 8.2), 74% were women, and the most common psychiatric diagnoses were depression (50%) and dementia (45%), with a mean of 1.4 (SD: 0.6) psychiatric diagnoses per patient. The patients had a mean of 4.8 (SD: 2.9) medical diagnoses and were on a mean of 6.8 (SD: 4.0) prescription and 2.2 (SD: 1.2) nonprescription medications. Patients received a mean of 4.2 (SD: 4.2) in-person visits and a mean of 30.2 (SD: 36.5) additional contacts related to their care, such as phone calls, e-mails, and faxes. Providing psychiatric services at home for older adults with mental illness is a much needed but rarely available service. Such patients typically have a complex combination of medical and psychiatric diagnoses and benefit from contacts in addition to the face-to-face visits.The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 12/2010; 18(12):1141-5. · 3.35 Impact Factor -
Article: Insomnia in older adults with generalized anxiety disorder.
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ABSTRACT: The purposes of this study are to determine the frequency and severity of insomnia symptoms and related complaints experienced by older adults with Generalized Anxiety Disorder (GAD) and compare them with older adults without GAD; compare insomnia symptoms among older adults with GAD with and without comorbid depression; determine if there are age differences in insomnia severity among people with GAD; and determine if there are differences in insomnia severity between older adults with GAD and older adults diagnosed with insomnia. Cross-sectional. Participants were recruited through primary care clinics, advertisements, and mass mailings. One hundred ten older adults; 31 with GAD, 25 with GAD and depression, 33 worried well, and 21 with no psychiatric diagnosis. Psychiatric diagnosis, sleep disturbance, and health. Participants with GAD with and without comorbid depression reported significantly greater sleep disturbance severity than participants with no psychiatric diagnosis and the worried well. There were no differences in sleep disturbances between older adults with GAD only and older adults with comorbid GAD and depression. The severity of sleep disturbance reported by older participants with GAD was greater than reports by young and middle-aged participants with GAD, and comparable with reports by older adults with a diagnosis of insomnia. Ninety percent of older adults with GAD report dissatisfaction with sleep and the majority report moderate to severe insomnia. These findings support the assessment of sleep disturbances within the context of late-life GAD.The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 07/2009; 17(6):465-72. · 3.35 Impact Factor
