Cognitive-Behavioral Therapy for Management of Anxiety and Medication Taper in Older Adults

Department of Psychiatry, Columbia University, New York, NY 10032, USA.
American Journal of Geriatric Psychiatry (Impact Factor: 4.24). 11/2005; 13(10):901-9. DOI: 10.1176/appi.ajgp.13.10.901
Source: PubMed


The authors hypothesized that patients with late-life anxiety undergoing cognitive-behavioral therapy plus medical management for medication taper (CBT-MM) would realize greater reduction in medication use and greater improvement in psychological symptoms than a control group undergoing medical management alone (MM).
Forty-two patients (age >60) who wanted to reduce anxiolytic medication were allocated to the two groups (CBT-MM versus MM), using a randomization plus difference-minimization procedure (to equate for medication use).
CBT-MM completers significantly reduced medication use, but not at a greater rate than MM completers. At the same time, CBT-MM completers experienced significantly greater alleviation of psychological symptoms than did MM completers. Some, but not all, treatment gains were maintained at 6-month follow-up. Intention-to-treat analyses using the mixed-effects model showed similar, but weaker, treatment effects than completer analyses.
Cognitive-behavioral therapy can alleviate psychological symptoms in elderly patients with anxiety even as patients reduce anxiolytic medication.

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    • "EBT data are limited or nonexistent for late-life anxiety disorders other than GAD, such as phobias, panic disorder, obsessive– compulsive disorder, and posttraumatic stress disorder. Although three studies in the present review included patients with panic disorder (Barrowclough et al., 2001; Gorenstein et al., 2005; Schuurmans et al., 2006), disorder-specific outcome data were not provided. We found only case reports and one study using a within-subjects design to examine treatment of late-life panic disorder (e.g., King & Barrowclough, 1991; Rathus & Sanderson, 1996; Swales, Solfvin, & Sheikh, 1996). "
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    ABSTRACT: This project identified evidence-based psychotherapy treatments for anxiety disorders in older adults. The authors conducted a review of the geriatric anxiety treatment outcome literature by using specific coding criteria and identified 17 studies that met criteria for evidence-based treatments (EBTs). These studies reflected samples of adults with generalized anxiety disorder (GAD) or samples with mixed anxiety disorders or symptoms. Evidence was found for efficacy for 4 types of EBTs. Relaxation training, cognitive-behavioral therapy (CBT), and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders. CBT for late-life GAD has garnered the most consistent support, and relaxation training represents an efficacious, relatively low-cost intervention. The authors provide a review of the strengths and limitations of this research literature, including a discussion of common assessment instruments. Continued investigation of EBTs is needed in clinical geriatric anxiety samples, given the small number of available studies. Future research should examine other therapy models and investigate the effects of psychotherapy on other anxiety disorders, such as phobias and posttraumatic stress disorder in older adults.
    Psychology and Aging 04/2007; 22(1):8-17. DOI:10.1037/0882-7974.22.1.8 · 2.73 Impact Factor
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    • "One major limitation of this study was the failure to report results separately by diagnosis, at least for the panic disorder patients. Another recently completed study investigated the efficacy of CBT plus medication management (MM) versus MM alone in 42 older adults who wished to discontinue their use of anxiolytic medication [46]. At enrollment , patients had been taking medications, including benzodiazepines (62%), meprobamate (12%), antidepressants (17%), opiates (5%), valerian (2%), and diphenhydramine (2%), for at least 8 weeks. "
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    ABSTRACT: Available data point to the potential value of pharmacologic and cognitive-behavioral interventions for the treatment of late-life anxiety disorders, with modest improvement and response rates in most cases. Further efficacy work is needed to investigate the impact of improved psychosocial approaches that allow for more idiosyncratic attention to the needs of older patients and outcomes following a broader range of pharmacologic treatments. Attention in this work needs to be given to long-term outcomes and generalizability of findings to broader and more representative samples of older patients. Additional effectiveness work also is needed to address the value of various treatment options in the settings where older adults typically receive care (eg, primary care, community-based programs) and to the methods for optimal dissemination of evidence-based interventions.
    Psychiatric Clinics of North America 01/2006; 28(4):871-96, ix. DOI:10.1016/j.psc.2005.09.006 · 2.13 Impact Factor
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    • "In a follow-up study, Stanley et al. (in press) found evidence for the efficacy of CBT over minimal contact control, with gains maintained over a 1-year follow-up period. Another recently completed study of GAD patients with anxiolytic dependence (Gorenstein et al., 2002) found that CBT plus medication management was more effective than medication management alone in reducing scores on several subscales of a measure of general psychopathology, with equivalent efficacy in reducing dependence on anxiolytic medications. However, there were no Group ϫ Time interactions, indicative of differential efficacy, on specific measures of worry, state or trait anxiety, or depression. "
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    ABSTRACT: Older adults with generalized anxiety disorder (GAD; N = 75; M age = 67.1 years) were randomly assigned to cognitive-behavioral therapy (CBT), a discussion group (DG) organized around worry-provoking topics, or a waiting period. Participants in both active conditions improved relative to the waiting list. Although CBT participants improved on more measures than DG participants, the authors found only I significant difference immediately after treatment and no differences at 6-month follow-up. Effect sizes were smaller than in younger samples, but CBT showed large effects and DG showed medium-sized effects Overall, results indicate that brief treatment of late-life GAD is beneficial, but they provide only limited support for the superiority of CBT to a credible comparison intervention.
    Journal of Consulting and Clinical Psychology 03/2003; 71(1):31-40. DOI:10.1037/0022-006X.71.1.31 · 4.85 Impact Factor
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