Meta-Analysis Comparing Different Behavioral Treatments for Late-Life Anxiety

Abstract

Objective-To evaluate the efficacy of different types of behavioral treatments for geriatric anxiety [cognitive-behavioral therapy (CBT) alone, CBT with relaxation training (RT), and RT alone].Method-We compared effect sizes from 19 trials. Analyses were based on uncontrolled outcomes (comparing post-treatment and pre-treatment scores) and effects relative to control conditions on both anxiety and depressive symptoms.Results-Treatments for older adults with anxiety symptoms were, on average, more effective than active control conditions. Effect sizes were comparable to those reported elsewhere for CBT for anxiety in the general population or for pharmacotherapy in anxious older adults. CBT (alone or augmented with RT) does not appear to add anything beyond RT alone, although a direct comparison is challenging given differences in control conditions. Effects on depressive symptoms were smaller, with no differences among treatment types. Conclusion-Resultssuggest that behavioral treatments are effective for older adults with anxiety disorders and symptoms. Results must be interpreted with caution given the limitations of the literature, including differing sample characteristics and control conditions across studies. KeywordsPsychotherapy; Geriatric; Anxiety; Relaxation Training; Cognitive Behavioral Therapy Please address correspondence to: Julie Wetherell, Ph.D., UCSD Department of Psychiatry, 9500 Gilman Drive, Dept. 9116B, San Diego, CA 92093-9116, (858) 552-8585 ext. 2752, FAX: (858) jwetherell@ucsd.edu. 3 Note that Scogin et al. (47) contribute two RT samples ("progressive relaxation" and "imaginal progressive relaxation") and both Radley et al. (60) and Sallis et al. (58) describe "anxiety management training" which teaches methods of "dealing with" avoidance, "coping with" anxiety, "thinking processes," and "self-monitoring" that we did not deem as explicit CBT methods for the purposes of this review. NIH Public Access Author ManuscriptAm J Geriatr Psychiatry. Author manuscript; available in PMC 2010 February 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptThe prevalence of anxiety among older adults is high (1), surpassing the rates of depression and severe cognitive dysfunction (2). Almost twice as many mental health Medicare claims are filed for anxiety disorders (38%) as for affective disorders (21%; 3). Anxiety disorders are associated with decreased quality of life (4) and increased disability (5) in older adults. Persistent anxiety symptoms that do not meet criteria for an anxiety disorder are also associated with serious negative consequences such as sleep disturbance, interference with daily activities, and distress (6,7). Prospective as well as cross-sectional research in the elderly has demonstrated that anxiety symptoms are associated with medical illness such as coronary heart disease (8), self-reported mobility limitations (9), and higher levels of health care utilization, including more primary care visits and more time spent during each visit ...

Brief internet-delivered cognitive behavioral therapy for anxiety in older adults: A feasibility trial

“…Results of another meta-analysis also found support for both CBT and relaxation training (RT) for older adults with anxiety, but that CBT does not appear to add anything beyond RT alone (Thorp et al, 2009). The authors acknowledged, however, that a direct comparison between treatments is difficult due to differences in control conditions (Thorp et al, 2009). Importantly, despite these issues, rates of treatment seeking in this age group are also low, even for those with multiple psychiatric co-morbidities (Australian Bureau of Statistics [ABS], 2007).…”

“…However, many questions remain about the use of CBT with older adults and concrete conclusions about effectiveness are currently limited by methodological limitations, such as high dropout rates and small sample sizes (Wilkinson, 2009). Results of another meta-analysis also found support for both CBT and relaxation training (RT) for older adults with anxiety, but that CBT does not appear to add anything beyond RT alone (Thorp et al, 2009). The authors acknowledged, however, that a direct comparison between treatments is difficult due to differences in control conditions (Thorp et al, 2009).…”

Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology

“…When compared with investigations in individuals aged between 18-65 years, there have been relatively few randomised controlled studies of the potential benefits and risks of psychological or pharmacological treatment for anxiety disorders in older people [IV] (Oude Voshaar, 2013), and little is known about the relative effectiveness and acceptability of differing treatments, or about the value of long-term treatment [I (M)] (Goncalves and Byrne, 2012;Gould et al, 2012;Pinquart and Duberstein, 2007;Thorp et al, 2009). Clearance of many drugs is slower in the elderly, so lower doses may be required than in younger patients.…”

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

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