Cognitive-behavioral Therapy for Late-life Anxiety: Similarities and Differences Between Veteran and Community Participants

Overview

Journal J Anxiety Disord

Publisher Elsevier

Specialty Psychiatry

Date 2015 May 26

PMID 26005839

Citations 12

Authors

Terri L Barrera

Jeffrey A Cully

Amber B Amspoker

Nancy L Wilson

Cynthia Kraus-Schuman

Paula D Wagener

Jessica S Calleo

Ellen J Teng

Howard M Rhoades

Nicholas Masozera

Mark E Kunik

Melinda A Stanley

Affiliations

Soon will be listed here.

Abstract

Cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety; however, a growing body of research suggests that CBT effect sizes are smaller in Veteran samples. The aim of this study was to perform secondary data analyses of a randomized controlled trial of CBT for late-life generalized anxiety disorder compared with treatment as usual (TAU) in a Veteran (n = 101) and community-based (n = 122) sample. Veterans had lower income and less education than community participants, greater severity on baseline measures of anxiety and depression, poorer physical health, and higher rates of psychiatric comorbidity. Treatment effects were statistically significant in the community sample (all ps < 0.01), but not in Veterans (all ps > 0.05). Further analyses in Veterans revealed that poorer perceived social support significantly predicted poorer outcomes (all ps < 0.05). Our results underscore the complexity of treating Veterans with anxiety, and suggest that additional work is needed to improve the efficacy of CBT for Veterans, with particular attention to social support.

Citing Articles

Change in self-construal: a repertory grid technique study of women admitted to a Mother and Baby Unit.

Wozniak E, Hare D, Gregg L, Wittkowski A Front Psychiatry. 2024; 15:1424010.

PMID: 39619341 PMC: 11604810. DOI: 10.3389/fpsyt.2024.1424010.

Intolerance of uncertainty on distress and impairment: The mediating role of repetitive negative thinking.

Kelso K, Gros D J Psychopathol Behav Assess. 2024; 2024.

PMID: 39246301 PMC: 11378962. DOI: 10.1007/s10862-024-10157-w.

Cognitive behavioural therapy and third-wave approaches for anxiety and related disorders in older people.

Hendriks G, Janssen N, Robertson L, van Balkom A, van Zelst W, Wolfe S Cochrane Database Syst Rev. 2024; 7:CD007674.

PMID: 38973756 PMC: 11229394. DOI: 10.1002/14651858.CD007674.pub3.

A pilot open trial of video telehealth-delivered exposure and response prevention for obsessive-compulsive disorder in rural Veterans.

Fletcher T, Boykin D, Helm A, Dawson D, Ecker A, Freshour J Mil Psychol. 2024; 34(1):83-90.

PMID: 38536285 PMC: 10013345. DOI: 10.1080/08995605.2021.1970983.

Psychotherapy and depressive symptom trajectories among VA patients: Comparing dose-effect and good-enough level models.

Lee A, Sripada R, Hale A, Ganoczy D, Trivedi R, Arnow B J Consult Clin Psychol. 2021; 89(5):379-392.

PMID: 34124925 PMC: 9383046. DOI: 10.1037/ccp0000645.

References

Barrera T, Mott J, Hofstein R, Teng E . A meta-analytic review of exposure in group cognitive behavioral therapy for posttraumatic stress disorder. Clin Psychol Rev. 2012; 33(1):24-32. DOI: 10.1016/j.cpr.2012.09.005. View

Andreescu C, Belnap B, Rollman B, Houck P, Ciliberti C, Mazumdar S . Generalized anxiety disorder severity scale validation in older adults. Am J Geriatr Psychiatry. 2008; 16(10):813-8. PMC: 2803316. DOI: 10.1097/JGP.0b013e31817c6aab. View

Pfeiffer P, Heisler M, Piette J, Rogers M, Valenstein M . Efficacy of peer support interventions for depression: a meta-analysis. Gen Hosp Psychiatry. 2011; 33(1):29-36. PMC: 3052992. DOI: 10.1016/j.genhosppsych.2010.10.002. View

Kessler R, Chiu W, Demler O, Merikangas K, Walters E . Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6):617-27. PMC: 2847357. DOI: 10.1001/archpsyc.62.6.617. View

Webb S, Diefenbach G, Wagener P, Novy D, Kunik M, Rhoades H . Comparison of self-report measures for identifying late-life generalized anxiety in primary care. J Geriatr Psychiatry Neurol. 2008; 21(4):223-31. PMC: 2597543. DOI: 10.1177/0891988708324936. View

Borkovec T, Costello E . Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol. 1993; 61(4):611-9. DOI: 10.1037//0022-006x.61.4.611. View

Spoont M, Sayer N, Nelson D, Nugent S . Does filing a post-traumatic stress disorder disability claim promote mental health care participation among veterans?. Mil Med. 2007; 172(6):572-5. DOI: 10.7205/milmed.172.6.572. View

Goodson J, Helstrom A, Halpern J, Ferenschak M, Gillihan S, Powers M . Treatment of posttraumatic stress disorder in U.S. combat veterans: a meta-analytic review. Psychol Rep. 2012; 109(2):573-99. DOI: 10.2466/02.09.15.16.PR0.109.5.573-599. View

Resnick B, Nahm E . Reliability and validity testing of the revised 12-item Short-Form Health Survey in older adults. J Nurs Meas. 2001; 9(2):151-61. View

10.

Therrien Z, Hunsley J . Assessment of anxiety in older adults: a systematic review of commonly used measures. Aging Ment Health. 2011; 16(1):1-16. DOI: 10.1080/13607863.2011.602960. View

11.

Barrera T, Mott J, Hundt N, Mignogna J, Yu H, Stanley M . Diagnostic specificity and mental health service utilization among veterans with newly diagnosed anxiety disorders. Gen Hosp Psychiatry. 2013; 36(2):192-8. DOI: 10.1016/j.genhosppsych.2013.10.013. View

12.

Jain S, McLean C, Rosen C . Is there a role for peer support delivered interventions in the treatment of veterans with post-traumatic stress disorder?. Mil Med. 2012; 177(5):481-3. DOI: 10.7205/milmed-d-11-00401. View

13.

Stanley M, Beck J, Novy D, Averill P, Swann A, Diefenbach G . Cognitive-behavioral treatment of late-life generalized anxiety disorder. J Consult Clin Psychol. 2003; 71(2):309-19. DOI: 10.1037/0022-006x.71.2.309. View

14.

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

15.

Ware Jr J, Kosinski M, Keller S . A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3):220-33. DOI: 10.1097/00005650-199603000-00003. View

16.

Mohr D, Carmody T, Erickson L, Jin L, Leader J . Telephone-administered cognitive behavioral therapy for veterans served by community-based outpatient clinics. J Consult Clin Psychol. 2011; 79(2):261-5. DOI: 10.1037/a0022395. View

17.

Brenes G, Miller M, Williamson J, McCall W, Knudson M, Stanley M . A randomized controlled trial of telephone-delivered cognitive-behavioral therapy for late-life anxiety disorders. Am J Geriatr Psychiatry. 2012; 20(8):707-16. PMC: 3407971. DOI: 10.1097/JGP.0b013e31822ccd3e. View

18.

Razykov I, Ziegelstein R, Whooley M, Thombs B . The PHQ-9 versus the PHQ-8--is item 9 useful for assessing suicide risk in coronary artery disease patients? Data from the Heart and Soul Study. J Psychosom Res. 2012; 73(3):163-8. DOI: 10.1016/j.jpsychores.2012.06.001. View

19.

Calleo J, Bush A, Cully J, Wilson N, Kraus-Schuman C, Rhoades H . Treating late-life generalized anxiety disorder in primary care: an effectiveness pilot study. J Nerv Ment Dis. 2013; 201(5):414-20. PMC: 3644354. DOI: 10.1097/NMD.0b013e31828e0fd6. View

20.

Pietrzak R, Cook J . Psychological resilience in older U.S. veterans: results from the national health and resilience in veterans study. Depress Anxiety. 2013; 30(5):432-43. DOI: 10.1002/da.22083. View