Long-term effectiveness and prediction of treatment outcome in cognitive behavioral therapy and sertraline for late-life anxiety disorders
Open accessAbstract
BACKGROUND: Although anxiety disorders are prevalent in older adults, randomized controlled trials of treatment effectiveness for late-life anxiety are scarce and have focused primarily on the effectiveness of psychotherapeutic interventions. However, recent findings suggest that in some cases, pharmacological treatment may be more beneficial for late-life anxiety disorders. As yet, there have been no systematic studies investigating prognostic factors for the outcome of cognitive behavioral therapy (CBT) and pharmacotherapy for late-life anxiety. The objective of the present study was to study long-term treatment outcomes and to explore differential predictors for both short-term and long-term treatment outcomes of sertraline and CBT for late-life anxiety disorders. METHODS: Participants of a randomized controlled trial (RCT) comparing sertraline and CBT for the treatment of late-life anxiety were contacted one year after completing their treatment, so that predictors for both short-term and long-term treatment outcome could be established. RESULTS: Sertraline showed a greater reduction of symptoms than CBT on anxiety (Hamilton Anxiety Rating Scale; HARS) and worry (Worry Domain Questionnaire) ratings at one-year follow-up. The strongest predictor for short-term CBT outcome was poor perceived health, explaining 40% of the variance in post-treatment residual gain scores on the HARS. The strongest predictor for long-term CBT outcome was neuroticism, explaining 20% of the variance in residual gain scores at one-year follow-up. Analyses revealed no significant predictors for treatment outcome in sertraline participants. CONCLUSIONS: Our study suggests that long-term use of sertraline might be more beneficial for late-life anxiety than a 15-week CBT program. Poor perceived health and neuroticism are predictive of less improvement after CBT in anxious older adults. Implications of these findings are discussed.
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Co-morbid depressive symptoms have a negative impact on treatment outcome in anxious older adults when treated with CBT.
“Some evidence suggests that co-morbid depressive symptoms have a negative impact on treatment outcome in anxious older adults (when treated with CBT) [46].”
Gender was not a predictor of CBT outcomes in prior studies, including for social phobia, and it was neither a predictor nor a moderator of outcome in the previous study of a mixed anxiety disorder sample.
“Gender was not a predictor of CBT outcomes in prior studies, including for social phobia (Schuurmans et al., 2009; Watanabe et al., 2010), and it was neither a predictor nor a moderator of outcome in the previous study of a mixed anxiety disorder sample (Wolitzky-Taylor et al., 2012).”
From Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: Outcomes and moderators (2014) · cites this paper as Schuurmans et al., 2009
The Predictor variables of treatment outcome section (p. 6) lists the factors tested for CBT outcome but does not include gender. Gender appears in Data analysis (p. 7) only as a variable used to impute missing data. Although the sample included people with social phobia (The treatment study, p. 3), our copy does not establish whether gender predicted CBT outcomes for them or for the sample overall. (LLM, conf=0.77)
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- Authors
- Schuurmans, J., Comijs, H., Emmelkamp, P. M. G., Weijnen, I. J. C., van den Hout, M., & van Dyck, R.
- Affiliations
- Vrije Universiteit Amsterdam (NL)
- GGZ inGeest (NL)
- University of Amsterdam (NL)
- Corresponding author
- Schuurmans, Josien
- Venue
- International Psychogeriatrics
- Publisher
- Elsevier BV
- Published
- 2009-12
- Volume
- 21
- Issue
- 6
- Pages
- 1148-1159
- ISSN
- 1041-6102 (ISSN-L)
- OpenAlex
- W2168895879
- Cited by
- 48
- References
- 40
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 5 · 2020: 3 · 2019: 5 · 2018: 2 · 2017: 5 · 2016: 1 · 2015: 1 · 2014: 5 · 2013: 3 · 2012: 3
- FWCI
- 3.81
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Psychogeriatrics (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (acceptedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- cognitive behavioral therapy, sertraline, long-term treatment outcomes, prognostic factors, health perception, neuroticism, older adults, worry
- MeSH terms
- Aged, Aged, 80 and over, Anxiety Disorders, Attitude to Health, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neurotic Disorders, Personality Inventory, Prognosis, Psychometrics, Cognitive Behavioral Therapy, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Sertraline
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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