Cognitive-behavioral therapy for anxiety in the elderly

Abstract

Anxiety is a significant problem among the elderly. Due to complexities in the medical management of elderly patients, researchers and clinicians have sought psychosocial alternatives to pharmacotherapy in order to treat anxiety in the elderly. Cognitive-behavioral therapy (CBT) in particular has been investigated as a promising treatment. Research conducted to date has established that CBT produces significant improvement in anxiety symptoms among the elderly. However, there is some concern that CBT does not benefit elderly anxiety patients as much as it does younger patients. Investigators are seeking methods of augmenting or supplementing CBT in order to develop more effective treatments for anxiety in the elderly.

A Deficit in Psychotherapeutic Care for Older People with Depression and Anxiety

“…CBT, considered the gold standard psychotherapy for anxiety disorders in adults of working age [20], appears less effective with older people [4,21]. The majority of studies evaluating CBT for anxiety disorders have been conducted in the US and many have recruited participants from university affiliated mental health centres and used recruitment via media announcements, and in some cases self-referral.…”

“…While the majority of participants in late life anxiety treatment trials show some improvement, participants do not necessarily achieve full responder status at the end of treatment, and in addition attrition rates are quite high across trials ranging from 25 to 39% [21]. Nonetheless, a meta-analysis of psychotherapeutic treatments for late life anxiety found that CBT was efficacious even when compared with active control conditions although the integrity of these controls was questioned [23].…”

“…Gorenstein and Papp [21] reviewed psychotherapy outcome (mainly CBT) in older people and calculated, using intention to treat analyses, that CBT for GAD is twice as effective with younger people compared to older people and attrition rates in GAD treatment trials are twice as high in older people compared to younger people. Perhaps reasons for this poorer treatment outcome for anxiety disorders in later life can be found in the complexity and continuity of anxiety problems among older people.…”

“…Thus, the conclusion is not that CBT does not work with older people but CBT is not yet fulfilling its potential for anxiety disorders with older people [21]. Perhaps, however, a greater degree of examination is required in terms of the magnitude of outcome and effect size for CBT with respect to different control procedures (e.g.…”

Anxiety: a hidden element in dementia

“…The person-centred technique of cognitive rehabilitation involves recognising and meeting the individual's needs and goals either by using personalised strategies for registering new information or by using memory aids. An alternative approach, according to Gorenstein & Papp (2007), is to add supportive group therapy alongside individual CBT. It should be noted that the evidence base for CBT with older adults is confounded by study limitations.…”