Lay Providers Can Deliver Effective Cognitive Behavior Therapy for Older Adults With Generalized Anxiety Disorder: A Randomized Trial

Stanley, Melinda A.; Wilson, Nancy; Amspoker, Amber B.; Kraus-Schuman, Cynthia; Wagener, Paula; Calleo, Jessica; Cully, Jeffrey A.; Teng, Ellen J.; Rhoades, Howard M.; Williams, Susan P.; Masozera, Nicholas; Horsfield, Matthew; Kunik, Mark E.

doi:10.1002/da.22239

Cited by 87 publications

(88 citation statements)

References 77 publications

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“…It is worth noting that one such study included in this review found no significant difference in effectiveness between CBT provided by expert practitioners (post-doctoral fellows with formal training and experience) and CBT provided 'lay' practitioners (bachelor-level practitioners with no previous mental health training or experience (24)). Further studies investigating the relationship between qualification level and CBT's effectiveness in primary care are particularly needed because many graduate-level practitioners already provide CBT in primary care through initiatives such as IAPT.…”

Section: Clinical Implications and Future Researchmentioning

confidence: 90%

Effectiveness of Cognitive Behavioural Therapy for Anxiety and Depression in Primary Care: a Meta-analysis

Twomey

O’Reilly

Byrne

2015

European Psychiatry

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BackgroundCognitive behavioural therapy (CBT) is increasingly being delivered in primary care, in a variety of delivery formats such as guided self-help CBT, telephone-based CBT, computerized CBT and standard, one-to-one CBT. However, the vast majority of research has focused on CBT in specialized services, and no previous meta-analysis has examined CBT’s effectiveness across delivery formats in primary care.ObjectiveTo determine the effectiveness of multi-modal CBT (i.e. CBT across delivery formats) for symptoms of anxiety and depression, in primary care.MethodsA meta-analysis of CBT-focused RCTs, for symptoms of anxiety or depression, in primary care. The authors searched four databases. To be included, RCTs had to be set in primary care or have primary care participants. Results. Twenty-nine RCTs were included in three separate meta-analyses. Results showed multi-modal CBT was more effective than no primary care treatment (d =0.59), and primary care treatment-as-usual (TAU) (d = 0.48) for anxiety and depression symptoms. Moreover, multimodal CBT in addition to primary care TAU was shown to be more effective than primary care TAU for depression symptoms (no comparisons of this kind were available for anxiety) (d = 0.37).ConclusionsThe results from conducted meta-analyses indicate that multi-modal CBT is effective for anxiety and depression symptoms in primary care. Furthermore, based on CBT’s economic viability, increasing the provision of CBT in primary care seems justified. Future research should examine if varying levels of qualification among primary care CBT practitioners impacts on the effectiveness of CBT in this setting.

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Section: Clinical Implications and Future Researchmentioning

confidence: 90%

Effectiveness of Cognitive Behavioural Therapy for Anxiety and Depression in Primary Care: a Meta-analysis

Twomey

O’Reilly

Byrne

2015

European Psychiatry

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“…34 Effect sizes were based on completers-only data, as intention-to-treat outcome data was not available for all studies. As a number of trials had small samples, effect sizes were corrected using an adjustment, J , to convert effect sizes to Hedges' g. 35 For studies in which multiple treatment arms received CBT, data was collapsed to form one group where treatment was comparable, 36,37 and if not, data from the most relevant CBT group was extracted. 38 In studies in which multiple comparison groups did not receive CBT, data was extracted from the most active comparison condition.…”

Section: Between-group Effect Sizesmentioning

confidence: 99%

“…Two of the remaining 17 studies were excluded, 53,54 due to duplicate data from more appropriate eligible articles. 37,39 A final study was excluded because outcome data had been reported as an anxiety composite. 55 Fourteen…”

Section: Study Selectionmentioning

confidence: 99%

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Efficacy of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Older Adults: Systematic Review, Meta-Analysis, and Meta-Regression

Hall

Kellett

Berrios

et al. 2016

The American Journal of Geriatric Psychiatry

120

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Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/) eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) licence. This licence only allows you to download this work and share it with others as long as you credit the authors, but you can't change the article in any way or use it commercially. More information and the full terms of the licence here: https://creativecommons.org/licenses/ Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. and six-month follow-up, significant treatment effects favoring CBT were found in comparison to a waitlist or treatment-as-usual. When CBT was compared with active controls, a small non-significant treatment advantage was found for CBT at the end of treatment, with equivalence of outcomes at follow-up. Treatment effect size of CBT for GAD was significantly associated with attrition rates and depression outcomes. Conclusions: CBT is more helpful than having no treatment for GAD in later life. However, whether CBT shows long-term durability, or is superior to other commonly available treatments (such as supportive psychotherapy), remains to be tested. The relationship between treatment effects for GAD and depression following CBT warrants further research. Efficacy of CBT for GAD in

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“…Internet-delivered CBT, on the other hand, can be given to more patients as it requires less therapist involvement, is not time dependent, and is cheaper (115). Therapist guided Internet-delivered CBT is similar to face-to-face treatment with regard to treatment effects (115)(116)(117)(118)(119), despite different therapist backgrounds (120)(121)(122). Guided Internet-delivered CBT has been proven to be effective in the treatment of mild to moderate symptoms of depression and anxiety (104,123), and does not differ from face-to-face treatment.…”

Section: Cognitive Behavioural Therapymentioning

confidence: 99%

Improving care for patients with non-cardiac chest pain : Description of psychological distress and costs, and evaluation of an Internet-delivered intervention

Mourad¹

2015

Linköping University Medical Dissertations

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Introduction: More than half of all patients seeking care for chest pain do not have a cardiac cause for this pain. Despite recurrent episodes of chest pain, many patients are discharged without a clear explanation of the cause for their pain. A lack of explanation may result in a misinterpretation of the pain as being cardiac-related, causing worry and uncertainty, which in turn leads to substantial use of healthcare resources. Psychological distress has been associated with non-cardiac chest pain (NCCP), but there is limited research regarding the relationship between different psychological factors and their association with healthcare utilization. There is a need for interventions to support patients to manage their chest pain, decrease psychological distress, and reduce healthcare utilization and costs. Aim: The overall aim of this thesis was to improve care for patients with non-cardiac chest pain by describing related psychological distress, healthcare utilization and societal costs, and by evaluating an Internet-delivered cognitive behavioural intervention. Designs and methods: This thesis presents results from four quantitative studies. Studies I and II had a longitudinal descriptive and comparative design. The studies used the same initial cohort. Patients were consecutively approached within 2 weeks from the day of discharge from a general hospital in southeast Sweden. In study I, 267 patients participated (131 with NCCP, 66 with acute myocardial infarction (AMI), and 70 with angina pectoris (AP)). Out of these, 199 patients (99 with NCCP, 51 with AMI, 49 with AP) participated in study II. Participants were predominantly male (about 60 %) with a mean age of 67 years. Data was collected on depressive symptoms (Study I), healthcare utilization (Study I, II), and societal costs (Study II). Study III had a cross-sectional explorative and descriptive design. Data was collected consecutively on depressive symptoms, cardiac anxiety and fear of body sensations in 552 patients discharged with diagnoses of NCCP (51 % women, mean age 64 years) from four hospitals in southeast Sweden. Patients were approached within one month from the day of discharge. Study IV was a pilot randomized controlled study including nine men and six women with a median age of 66 years, who were randomly assigned to an intervention (n=7) or control group (n=8). The intervention consisted of a four-session guided Internet-delivered cognitive behavioural therapy (CBT) program containing psychoeducation, exposure to physical activity, and relaxation. The control group received usual care. Data was collected on chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms. Results: Depressive symptoms were prevalent in 20 % (Study IV) and 25 % (Study I, III) of the patients, and more than half of the patients still experienced depressive symptoms one year later (Study I). There were no significant differences in prevalence and severity of depressive symptoms between patients diagnosed with NCCP, AMI or AP. Living a...

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Lay Providers Can Deliver Effective Cognitive Behavior Therapy for Older Adults With Generalized Anxiety Disorder: A Randomized Trial

Abstract: Lay providers, working under the supervision of licensed providers, can deliver effective CBT.

Cited by 87 publications

References 77 publications

Effectiveness of Cognitive Behavioural Therapy for Anxiety and Depression in Primary Care: a Meta-analysis

Effectiveness of Cognitive Behavioural Therapy for Anxiety and Depression in Primary Care: a Meta-analysis

Efficacy of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Older Adults: Systematic Review, Meta-Analysis, and Meta-Regression

Improving care for patients with non-cardiac chest pain : Description of psychological distress and costs, and evaluation of an Internet-delivered intervention

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