Alzheimer's, Dementia & Mental Health
Cognitive Behavior Therapy Helps Older Adults with
Anxiety Reduce Worry, Improve Mental Health
Generalized anxiety disorder (GAD) is common in
late life, with prevalence up to 7.3 percent in the community
April 7, 2009 - Older adults with generalized
anxiety disorder who received cognitive behavior therapy had greater
improvement on measures of worry, depression and mental health than
patients who received usual care, according to a study in the April 8
issue of the Journal of the American Medical Association (JAMA).
Generalized anxiety disorder (GAD) is common in
late life, with prevalence up to 7.3 percent in the community and 11.2
percent in primary care. Late-life anxiety predicts increased physical
disability, memory difficulties and decreased quality of life, according
to background information in the article.
Late-life anxiety is usually treated with
medication, but associated risks (e.g., falls, hip fractures, memory
problems) with some drugs and patient fears of adverse effects limit
their usefulness.
Two previous studies suggested benefits of
cognitive behavior therapy (CBT) in primary care for late-life GAD, but
the studies were small and the conclusions were limited. Older adults
most often seek treatment for GAD in primary care.
Melinda A. Stanley, Ph.D., of the Baylor College of
Medicine, Houston, and colleagues conducted the first randomized
clinical trial of CBT for late-life GAD in primary care to examine
whether CBT would improve outcomes relative to enhanced usual care
(EUC).
The trial included 134 older adults (average age,
67 years) in two primary care settings, with treatment provided for 3
months. Assessments were conducted at the beginning of the trial,
posttreatment (3 months), and over 12 months of follow-up, with
assessments at 6, 9, 12 and 15 months.
Patients were randomized to either
● CBT (70 participants), which included education and awareness,
relaxation training, cognitive therapy, problem-solving skills training
and behavioral sleep management; or
● EUC (64 participants), in which patients were telephoned biweekly
during the first 3 months of the study by the same therapists to provide
support and ensure patient safety. Therapists reminded patients to call
project staff if symptoms worsened.
Levels of anxiety, worry, depression and
physical/mental health quality of life were measured via various tests
or surveys.
The researchers found that CBT, compared with EUC,
significantly improved worry severity, depressive symptoms and general
mental health. In intention-to-treat analyses, response rates defined
according to worry severity were higher following CBT compared with EUC
at 3 months (40.0% vs. 21.9%).
"This study is the first to suggest that CBT can be
useful for managing worry and associated symptoms among older patients
in primary care," the authors write.
"This study paves the way for future research to
test sustainable models of care in more demographically heterogeneous
groups."
About Anxiety
Fear and anxiety are part of life. You may feel
anxious before you take a test or walk down a dark street. This kind of
anxiety is useful - it can make you more alert or careful. It usually
ends soon after you are out of the situation that caused it. But for
millions of people in the United States, the anxiety does not go away,
and gets worse over time. They may have chest pains or nightmares. They
may even be afraid to leave home. These people have anxiety disorders.
Types include
●
Panic disorder
●
Obsessive-compulsive disorder
●
Post-traumatic stress disorder
●
Phobias
● Generalized anxiety disorder (see below)
Treatment can involve medicines, therapy or both.
By National Institute of Mental Health
>>
More at MedlinePlus
About Generalized Anxiety Disorder
Most people experience anxiety at some point in
their lives and some nervousness in anticipation of a real situation.
However if a person cannot shake unwarranted worries, or if the feelings
are jarring to the point of avoiding everyday activities, he or she most
likely has an anxiety disorder.
Symptoms: Chronic, exaggerated worry, tension, and
irritability that appear to have no cause or are more intense than the
situation warrants. Physical signs, such as restlessness, trouble
falling or staying asleep, headaches, trembling, twitching, muscle
tension, or sweating, often accompany these psychological symptoms.
Formal diagnosis: When someone spends at least six
months worried excessively about everyday problems. However,
incapacitating or troublesome symptoms warranting treatment may exist
for shorter periods of time.
Treatment: Anxiety is among the most common, most
treatable mental disorders. Effective treatments include cognitive
behavioral therapy, relaxation techniques, and biofeedback to control
muscle tension. Medication, most commonly anti-anxiety drugs, such as
benzodiazepine and its derivatives, also may be required in some cases.
Some commonly prescribed anti-anxiety medications are diazepam, alprazolam, and lorazepam. The non-benzodiazepine anti-anxiety
medication buspirone can be helpful for some individuals.
>>
More at National Mental Health
Information Center
