Treating Late-Life Generalized Anxiety Disorder in Primary Care: An Effectiveness Pilot Study
Open accessAbstract
To increase the sustainability of cognitive behavior therapy (CBT) in primary care for late-life anxiety, we incorporated nonexpert counselors, options for telephone meetings, and integration with primary care clinicians. This open trial examines the feasibility, satisfaction, and clinical outcomes of CBT delivered by experienced and nonexperienced counselors for older adults with generalized anxiety disorder (GAD). Clinical outcomes assessed worry (Penn State Worry Questionnaire), GAD (Generalized Anxiety Disorder Severity Scale), and anxiety (Beck Anxiety Inventory and Structured Interview Guide for Hamilton Anxiety Scale). After 3 months of treatment, Cohen's d effect sizes for worry and anxiety ranged from 0.48 to 0.78. Patients treated by experienced and nonexperienced counselors had similar reductions in worry and anxiety, although treatment outcomes were more improved on the Beck Anxiety Inventory for experienced therapists. Preliminary results suggest that adapted CBT can effectively reduce worry. The piloted modifications can provide acceptable and feasible evidence-based care.
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Among patients, three validated measures were used at post-assessment: the CSQ, WAI, and an adapted ERS.
“Among patients, three validated measures were used at post-assessment. Treatment satisfaction was assessed using the eight-item Client Satisfaction Questionnaire (CSQ; α = .96; Larsen et al., 1979), therapeutic alliance using the 12-item Working Alliance Inventory Short-Form Revised (WAI; α = .92; Hatcher & Gillaspy, 2006), and treatment credibility using an adapted four-item version (Calleo et al”
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 Calleo et al., 2013
The Method > Outcome Measures passage describes a four-item ERS used to assess treatment credibility and expectancy, supporting the citation’s identification of the measure. It specifies that only the first three items assess credibility; the fourth assesses expectancy. The passage also does not describe this version as adapted. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThis CBT protocol has shown efficacy in previous trials of CBT for late-life generalized anxiety disorder in primary care.
“This protocol has demonstrated efficacy in prior trials of CBT for late-life GAD in primary care (Calleo et al., 2013; Stanley et al., 2003, 2009).”
From Cognitive-behavioral therapy for late-life anxiety: Similarities and differences between Veteran and community participants (2015) · cites this paper as Calleo et al., 2013
The Introduction says earlier trials found positive effects of CBT for late-life GAD in primary care. But it describes this paper’s protocol as an adaptation of earlier interventions, and the Discussion and Results report only preliminary improvements from an uncontrolled pilot. The paper therefore supports promising outcomes for the adapted protocol, not demonstrated efficacy for that same protocol in prior trials. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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- Authors
- Calleo, J. S., Bush, A. L., Cully, J. A., Wilson, N. L., Kraus-Schuman, C., Rhoades, H. M., Novy, D. M., Masozera, N., Williams, S., Horsfield, M., Kunik, M. E., & Stanley, M. A.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- Baylor College of Medicine (US)
- The University of Texas Health Science Center at Houston (US)
- The University of Texas MD Anderson Cancer Center (US)
- Corresponding author
- Calleo, Jessica S.
- Cully, Jeffrey A.
- Wilson, Nancy L.
- Kunik, Mark E.
- Stanley, Melinda A.
- Venue
- Journal of Nervous & Mental Disease
- Published
- 2013-05
- Volume
- 201
- Issue
- 5
- Pages
- 414-420
- ISSN
- 0022-3018 (ISSN-L)
- PMC
- PMC3644354
- OpenAlex
- W2018595641
- Cited by
- 17
- References
- 41
- Citations by year
- 2024: 2 · 2022: 1 · 2021: 1 · 2019: 3 · 2018: 3 · 2016: 1 · 2015: 1 · 2014: 3 · 2013: 1 · 2012: 1
- FWCI
- 2.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Nervous and Mental Disease (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 › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- generalized anxiety disorder, late-life anxiety, older adults, cognitive behavioral therapy, primary care, telephone-delivered therapy, worry, anxiety levels, treatment feasibility, therapist experience
- MeSH terms
- Aged, Anxiety, Anxiety Disorders, Female, Humans, Male, Middle Aged, Pilot Projects, Primary Health Care, Psychiatric Status Rating Scales, Cognitive Behavioral Therapy, Treatment Outcome, Patient Satisfaction
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