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Cited by 247Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and AssessmentsPsychotherapy Techniques and Applications

Cognitive Behavior Therapy for Generalized Anxiety Disorder Among Older Adults in Primary Care: A Randomized Clinical Trial

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Stanley, Melinda A., Wilson, Nancy L., Novy, Diane M., Rhoades, Howard M., Wagener, Paula D., Greisinger, Anthony J., Cully, Jeffrey A., Kunik, Mark E.·2009·JAMA
DOI 10.1001/jama.2009.458PMC PMC3328789
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Abstract

CONTEXT: Cognitive behavior therapy (CBT) can be effective for late-life generalized anxiety disorder (GAD), but only pilot studies have been conducted in primary care, where older adults most often seek treatment. OBJECTIVE: To examine effects of CBT relative to enhanced usual care (EUC) in older adults with GAD in primary care. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial recruiting 134 older adults (mean age, 66.9 years) from March 2004 to August 2006 in 2 primary care settings. Treatment was provided for 3 months; assessments were conducted at baseline, posttreatment (3 months), and over 12 months of follow-up, with assessments at 6, 9, 12, and 15 months. INTERVENTION: Cognitive behavior therapy (n = 70) conducted in the primary care clinics. Treatment included education and awareness, motivational interviewing, relaxation training, cognitive therapy, exposure, problem-solving skills training, and behavioral sleep management. Patients assigned to receive EUC (n = 64) received biweekly telephone calls to ensure patient safety and provide minimal support. MAIN OUTCOME MEASURES: Primary outcomes included worry severity (Penn State Worry Questionnaire) and GAD severity (GAD Severity Scale). Secondary outcomes included anxiety ratings (Hamilton Anxiety Rating Scale, Beck Anxiety Inventory), coexistent depressive symptoms (Beck Depression Inventory II), and physical/mental health quality of life (12-Item Short Form Health Survey). RESULTS: Cognitive behavior therapy compared with EUC significantly improved worry severity (45.6 [95% confidence interval {CI}, 43.4-47.8] vs 54.4 [95% CI, 51.4-57.3], respectively; P < .001), depressive symptoms (10.2 [95% CI, 8.5-11.9] vs 12.8 [95% CI, 10.5-15.1], P = .02), and general mental health (49.6 [95% CI, 47.4-51.8] vs 45.3 [95% CI, 42.6-47.9], P = .008). There was no difference in GAD severity in patients receiving CBT vs those receiving EUC (8.6 [95% CI, 7.7-9.5] vs 9.9 [95% CI, 8.7-11.1], P = .19). In intention-to-treat analyses, response rates defined according to worry severity were higher following CBT compared with EUC at 3 months (40.0% [28/70] vs 21.9% [14/64], P = .02). CONCLUSIONS: Compared with EUC, CBT resulted in greater improvement in worry severity, depressive symptoms, and general mental health for older patients with GAD in primary care. However, a measure of GAD severity did not indicate greater improvement with CBT. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00308724.

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  • The PSWQ-A can identify GAD in older primary care patients and can detect treatment-related change.

    “The PSWQ-A is useful for identifying GAD in older primary care patients (Webb et al., 2008), is capable of demonstrating change following treatment (Stanley et al., 2009; Shrestha et al., 2012)”

    From Cognitive-behavioral therapy for late-life anxiety: Similarities and differences between Veteran and community participants (2015) · cites this paper as Stanley et al., 2009

    Stanley et al. support the treatment-change portion in part: the Results (Post-treatment Outcomes) report significantly greater improvement after CBT on a worry questionnaire. But the Methods (Measures and Data Collection) specify that this was the 16-item PSWQ, not the PSWQ-A, so the paper does not establish that the abbreviated version detects treatment-related change. The identification claim is attributed to Webb et al., not Stanley et al. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Many CBT anxiety interventions are tailored to specific subpopulations, such as older adults with generalized anxiety disorder or adults with cardiac or pulmonary disease.

    “For instance, cognitive-behavioral therapy (CBT) anxiety interventions have performed well in primary care, but many are too time-intensive at 8-12 sessions and/or tailored to specific subpopulations, such as older adults with generalized anxiety disorder (Stanley et al., 2009; Wetherell et al., 2009) or adults with cardiac or pulmonary disease (Cully et al., 2017).”

    From Brief modular anxiety intervention for primary care: Hybrid I pilot randomized controlled trial of feasibility, acceptability, effectiveness, and implementation potential (2024) · cites this paper as Stanley et al., 2009

  • Patients receiving MAST-V showed clinically significant improvements in anxiety symptoms and functioning, as well as other comorbid symptoms.

    “As in prior RCTs of CBT-based anxiety interventions (Cully et al., 2017; Stanley et al., 2009), patients receiving MAST-V showed clinically significant improvements in anxiety symptoms and functioning, as well as other comorbid symptoms.”

    From Brief modular anxiety intervention for primary care: Hybrid I pilot randomized controlled trial of feasibility, acceptability, effectiveness, and implementation potential (2024) · cites this paper as Stanley et al., 2009

  • Cognitive function, psychiatric comorbidity and symptom severity were selected as covariates as they have been associated with poor treatment response in older people with GAD.

    “Cognitive function, psychiatric comorbidity and symptom severity were selected as covariates as they have been associated with poor treatment response in older people with GAD.1,22,77”

    From Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: The FACTOID feasibility study (2021) · cites this paper as [22]

    The Methods (Patient Population and Data Analysis; page unavailable) describe cognitive screening, psychiatric diagnoses, and baseline severity, but do not link those factors to poor treatment response. The Comment says that potential moderators of CBT response need further study. Searches for cognitive function, psychiatric comorbidity, symptom severity, and predictors of response found no passage establishing the claimed associations. (LLM, conf=0.76)

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Authors
Stanley, M. A., Wilson, N. L., Novy, D. M., Rhoades, H. M., Wagener, P. D., Greisinger, A. J., Cully, J. A., & Kunik, M. E.
Affiliations
  • Baylor College of Medicine (US)
  • The University of Texas MD Anderson Cancer Center (US)
  • The University of Texas Health Science Center at Houston (US)
  • Kelsey Research Foundation (US)
  • Michael E. DeBakey VA Medical Center (US)
Corresponding author
Stanley, Melinda A.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2009-04-08
Volume
301
Issue
14
Pages
1460
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2009.458
PMC
PMC3328789
OpenAlex
W2011332574
Cited by
247
References
47
Citations by year
2026: 4 · 2025: 2 · 2024: 11 · 2023: 6 · 2022: 10 · 2021: 11 · 2020: 15 · 2019: 12 · 2018: 16 · 2017: 17 · 2016: 14 · 2015: 15 · 2014: 21 · 2013: 19 · 2012: 15
FWCI
31.32
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01-MH53932, R01MH053932)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
cognitive behavioral therapy, generalized anxiety disorder, older adults, primary care, late-life anxiety, depressive symptoms, general mental health, quality of life, enhanced usual care, telephone follow-up, motivational interviewing, relaxation training, sleep management, exposure therapy, problem-solving training, cognitive therapy, relapse prevention, relapse prevention training
MeSH terms
Aged, Anxiety Disorders, Female, Humans, Male, Middle Aged, Primary Health Care, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome

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