Telephone-Delivered Cognitive Behavioral Therapy and Telephone-Delivered Nondirective Supportive Therapy for Rural Older Adults With Generalized Anxiety Disorder

Abstract

IMPORTANCE Generalized anxiety disorder (GAD) is common in older adults; however, access to treatment may be limited, particularly in rural areas.OBJECTIVE To examine the effects of telephone-delivered cognitive behavioral therapy (CBT) compared with telephone-delivered nondirective supportive therapy (NST) in rural older adults with GAD. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial in the participants' homes of 141 adults aged 60 years and older with a principal or coprincipal diagnosis of GAD who were recruited between January 27, 2011, and October 22, 2013.INTERVENTIONS Telephone-delivered CBT consisted of as many as 11 sessions (9 were required) focused on recognition of anxiety symptoms, relaxation, cognitive restructuring, the use of coping statements, problem solving, worry control, behavioral activation, exposure therapy, and relapse prevention, with optional chapters on sleep and pain. Telephonedelivered NST consisted of 10 sessions focused on providing a supportive atmosphere in which participants could share and discuss their feelings and did not provide any direct suggestions for coping. MAIN OUTCOMES AND MEASURESPrimary outcomes included interviewer-rated anxiety severity (Hamilton Anxiety Rating Scale) and self-reported worry severity (Penn State Worry Questionnaire-Abbreviated) measured at baseline, 2 months' follow-up, and 4 months' follow-up. Mood-specific secondary outcomes included self-reported GAD symptoms (GAD Scale 7 Item) measured at baseline and 4 months' follow-up and depressive symptoms (Beck Depression Inventory) measured at baseline, 2 months' follow-up, and 4 months' follow-up. Among the 141 participants, 70 were randomized to receive CBT and 71 to receive NST.RESULTS At 4 months' follow-up, there was a significantly greater decline in worry severity among participants in the telephone-delivered CBT group (difference in improvement, −4.07; 95% CI, −6.26 to −1.87; P = .004) but no significant differences in general anxiety symptoms (difference in improvement, −1.52; 95% CI, −4.07 to 1.03; P = .24). At 4 months' follow-up, there was a significantly greater decline in GAD symptoms (difference in improvement, −2.36; 95% CI, −4.00 to −0.72; P = .005) and depressive symptoms (difference in improvement, −3.23; 95% CI, −5.97 to −0.50; P = .02) among participants in the telephone-delivered CBT group. CONCLUSIONS AND RELEVANCEIn this trial, telephone-delivered CBT was superior to telephone-delivered NST in reducing worry, GAD symptoms, and depressive symptoms in older adults with GAD.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01259596.

Long-Term Effects of Telephone-Delivered Psychotherapy for Late-Life GAD

“…13 The current findings demonstrate the superiority of CBT-T on reducing worry and general anxiety symptoms measured 12 months after the cessation of the intervention. The effect on depressive symptoms was borderline (p = 0.0376 versus a critical value of 0.0375) and the effect was not maintained on GAD symptoms, which was somewhat reduced (p = 0.088) by the 1-year follow-up assessment.…”

“…We demonstrated the superiority of CBT-T for reducing worry, GAD symptoms, and depressive symptoms 13 immediately upon completing treatment. The purpose of the current study is to determine if intervention effects were still present 1 year after completing treatment.…”

National Randomized Controlled Trial of Virtual House Calls for People with Parkinson's Disease: Interest and Barriers

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

“…18,[36][37][38][39][56][57][58][59][60][61][62][63][64] The total sample for the meta-analysis was N = 985 with an average age of 68.16 years (SD = 2.52).…”