Modular psychotherapy for anxiety in older primary care patients
Open accessAbstract
Objective To develop and test a modular psychotherapy protocol in older primary care patients with anxiety disorders.Design Randomized, controlled pilot study.Setting University-based geriatric medicine clinics.Participants Thirty-one elderly primary care patients with generalized anxiety disorder or anxiety disorder not otherwise specified.Intervention Modular form of psychotherapy compared with enhanced community treatment.Measurements Self-reported, interviewer-rated, and qualitative assessments of anxiety, worry, depression, and mental health-related quality of life.Results Both groups showed substantial improvements in anxiety symptoms, worry, depressive symptoms, and mental health-related quality of life. Most individuals in the enhanced community treatment condition reported receiving medications or some other form of professional treatment for anxiety. Across both conditions, individuals who reported major life events or stressors and those who used involvement in activities as a coping strategy made smaller gains than those who did not.Conclusions Results suggest that modular psychotherapy and other treatments can be effective for anxiety in older primary care patients. Results further suggest that life events and coping through increased activity may play a role in the maintenance of anxiety in older adults.
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Standard CBT manuals for GAD in older people typically include sessions on problem-solving and sleep hygiene in recognition that some older people with GAD may have poor problem-solving skills or poor sleeping habits.
“Standard CBT manuals for GAD in older people typically include sessions on problem-solving and sleep hygiene in recognition of the fact that some older people with GAD may have poor problem-solving skills, or poor sleeping habits.21,24,80”
From Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: The FACTOID feasibility study (2021) · cites this paper as [24]
Methods > Procedures describes sleep-hygiene guidelines and problem-solving skills training in this study’s modular protocol for older patients with GAD or ADNOS. It does not establish that standard CBT manuals typically include both, or state that they do so because some older people with GAD have poor problem-solving skills or sleeping habits. Page numbers are unavailable in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredA 12-week waiting period was used to control for natural recovery.
“A 12-week waiting period between randomization and the start of treatment was designed to control for potential natural recovery, which our team observed in a previous investigation (Wetherell et al., 2009).”
From Acceptance and Commitment Therapy for generalized anxiety disorder in older adults: a preliminary report. (2011) · cites this paper as Wetherell et al., 2009
The source’s Conclusions (page unavailable) report symptomatic improvement in both the psychotherapy and enhanced-community-treatment groups, which supports the citing authors’ observation of improvement outside their psychotherapy arm. But the Methods (Procedures) and Conclusions say community-treatment patients could receive medication or other care; the study does not establish that their improvement was natural recovery. The 12-week waiting period is the citing authors’ own design, not a feature attributed to this source. (LLM, conf=0.83)
Experimental — accuracy not yet measuredMany 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 Wetherell et al., 2009
This replicates previous findings that older GAD patients may improve over time regardless of treatment.
“This replicates our team’s previous findings that older GAD patients may improve over time regardless of treatment (Wetherell et al., 2009).”
From Acceptance and Commitment Therapy for generalized anxiety disorder in older adults: a preliminary report. (2011) · cites this paper as Wetherell et al., 2009
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- Authors
- Wetherell, J. L., Ayers, C. R., Sorrell, J. T., Thorp, S. R., Nuevo, R., Belding, W., Gray, E., Stanley, M. A., Areán, P. A., Donohue, M., Unützer, J., Ramsdell, J., Xu, R., & Patterson, T. L.
- Affiliations
- University of California San Diego (US)
- San Mateo Medical Center (US)
- Hospital Universitario de La Princesa (ES)
- Michael E. DeBakey VA Medical Center (US)
- University of California, San Francisco (US)
- Corresponding author
- Wetherell, Julie Loebach
- ORCID
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2009-06
- Volume
- 17
- Issue
- 6
- Pages
- 483-492
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC2686119
- OpenAlex
- W1997503859
- Cited by
- 78
- References
- 46
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 4 · 2023: 4 · 2022: 1 · 2021: 4 · 2020: 1 · 2019: 3 · 2018: 6 · 2017: 5 · 2016: 3 · 2015: 4 · 2014: 10 · 2013: 9 · 2012: 4
- FWCI
- 7.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion)
- PubMed Central (acceptedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- National Institute of Mental Health (K23MH067643, MH067643)
- 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
- anxiety disorders, generalized anxiety disorder, older adults, primary care, geriatric mental health, depression, mental health-related quality of life, worry, life events, coping strategies, anxiety maintenance
- MeSH terms
- Aged, Aged, 80 and over, Anxiety Disorders, Community Mental Health Services, Female, Hospitals, University, Humans, Male, Middle Aged, Pilot Projects, Primary Health Care, Psychiatric Status Rating Scales, Psychotherapy, Psychotropic Drugs, Quality of Life, Surveys and Questionnaires, Severity of Illness Index, Socioeconomic Factors, Cognitive Behavioral Therapy, Treatment Outcome
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