Age differences in treatment response to a collaborative care intervention for anxiety disorders
Open accessAbstract
Background: Some data suggest that older adults with anxiety disorders do not respond as well to treatment as do younger adults. Aims: We examined age differences in outcomes from the Coordinated Anxiety Learning and Management (CALM) study, an effectiveness trial comparing usual care to a computer-assisted collaborative care intervention for primary care patients with panic disorder, generalised anxiety disorder, post-traumatic stress disorder (PTSD), and/or social anxiety disorder. This is the first study to examine the efficacy of a collaborative care intervention in a sample that included both younger and older adults with anxiety disorders. We hypothesised that older adults would show a poorer response to the intervention than younger adults. Method: We examined findings for the overall sample, as well as within each diagnostic category (clinicaltrials.gov identifier: NCT00347269). Results: The CALM intervention was more effective than usual care among younger adults overall and for those with generalised anxiety disorder, panic disorder and social anxiety disorder. Among older adults, the intervention was effective overall and for those with social anxiety disorder and PTSD but not for those with panic disorder or generalised anxiety disorder. The effects of the intervention also appeared to erode by the 18-month follow-up, and there were no significant effects on remission among the older adults. Conclusions: These results are consistent with the findings of other investigators suggesting that medications and psychotherapy for anxiety disorders may not be as effective for older individuals as they are for younger people.
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The effect sizes for CBT in anxious older adults are relatively small.
“However, researchers suggest investigating other treatment approaches as well, since the effect sizes for CBT in anxious older adults are relatively small and several analyses suggest that older adults benefit less from CBT for anxiety than the younger adult population [2, 6, 28, 31, 32].”
From An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: study protocol for a cluster randomized controlled trial. (2018) · cites this paper as [32]
The Discussion reports weaker effects of the collaborative care intervention in older than younger adults and says prior findings suggest CBT may be less effective for older people. It does not establish that effect sizes for CBT itself in anxious older adults are relatively small; the authors note that their study does not address the efficacy of specific treatments. (LLM, conf=0.82)
Experimental — accuracy not yet measuredOlder age, previous psychiatric treatment, being unmarried, and higher peaks in relaxation-induced anxiety predict worse outcomes in generalized anxiety disorder treatment.
“older age [30,31], having received previous psychiatric treatment [32], being unmarried [32] and higher peaks in relaxation-induced anxiety [33] predicted worse outcomes.”
From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [31]
Some evidence suggests that CBT is less effective in older adults than in younger samples.
“some evidence suggests that CBT is less effective in older adults than in younger samples [17, 18].”
Older adults benefit less from CBT for anxiety than the younger adult population.
“However, researchers suggest investigating other treatment approaches as well, since the effect sizes for CBT in anxious older adults are relatively small and several analyses suggest that older adults benefit less from CBT for anxiety than the younger adult population [2, 6, 28, 31, 32].”
Some evidence suggests that older adults benefit less from CBT for anxiety than younger adults.
“some evidence suggests that older adults benefit less from CBT for anxiety than younger adults [11,19,20].”
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Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.593 · Cited by 20,391 · see citing works
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139 · see citing works
Statistical Analysis With Missing Data
Lahiff, M., Little, R. J. A., & Rubin, D. B. (1989) · Journal of the American Statistical Association · doi:10.2307/2289883 · Cited by 17,384 · see citing works
(1998) · PubMed · Cited by 10,216 · see citing works
The mini international neuropsychiatric interview
Lecrubier, Y., Sheehan, D. V., Hergueta, T., & Weiller, E. (1998) · European Psychiatry · doi:10.1016/s0924-9338(99)80239-9 · Cited by 5,882 · see citing works
Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection
Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-146-5-200703060-00004 · Cited by 4,741 · see citing works
Statistical Analysis With Missing Data
Ghosh, S., Little, R. J. A., & Rubin, D. B. (1988) · Technometrics · doi:10.2307/1269814 · Cited by 4,730 · see citing works
Unützer, J., Katon, W., Callahan, C. M., Williams, Jr., Hunkeler, E., Harpole, L., Hoffing, M., Della Penna, R. D., Noël, P. H., Lin, E. H. B., et al. (2002) · JAMA · doi:10.1001/jama.288.22.2836 · Cited by 2,405 · see citing works
Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale
Connor, K. M., Davidson, J. R. T., Churchill, L. E., Sherwood, A., Weisler, R. H., & Foa, E. (2000) · British Journal of Psychiatry · doi:10.1192/bjp.176.4.379 · Cited by 1,624 · see citing works
Anxiety and Risk of Incident Coronary Heart Disease
Roest, A. M., Martens, E. J., de Jonge, P., & Denollet, J. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.03.034 · Cited by 865 · see citing works
High Occurrence of Mood and Anxiety Disorders Among Older Adults
Byers, A. L., Yaffe, K. S., Covinsky, K. E., Friedman, M. B., & BRUCE, M. L. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.35 · Cited by 744 · see citing works
PTSD Checklist—Civilian version (PCL-C)
Weathers, F. W., Litz, B. T., Huska, J. A., & Keane, T. M. (1991) · Cited by 734 · see citing works
Handling missing data in survey research
Brick, J. M., & Kalton, G. (1996) · Statistical Methods in Medical Research · doi:10.1177/096228029600500302 · Cited by 535 · see citing works
PTSD Checklist—Civilian Version
Weathers, F. W., Litz, B., Herman, D., Juska, J., & Keane, T. (2012) · PsycTESTS Dataset · doi:10.1037/t02622-000 · Cited by 527 · see citing works
Roy-Byrne, P., Craske, M. G., Sullivan, G., Rose, R. D., Edlund, M. J., Lang, A. J., Bystritsky, A., Welch, S. S., Chavira, D. A., Golinelli, D., et al. (2010) · JAMA · doi:10.1001/jama.2010.608 · Cited by 452 · see citing works
Self-citationReliability of the self-report version of the panic disorder severity scale
Houck, P. R., Spiegel, D. A., Shear, M. K., & Rucci, P. (2002) · Depression and Anxiety · doi:10.1002/da.10049 · Cited by 406 · see citing works
Campbell-Sills, L., Norman, S. B., Craske, M. G., Sullivan, G., Lang, A. J., Chavira, D. A., Bystritsky, A., Sherbourne, C., Roy-Byrne, P., & Stein, M. B. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.03.014 · Cited by 382 · see citing works
Self-citationPenninx, B. W. J. H., Nolen, W. A., Lamers, F., Zitman, F. G., Smit, J. H., Spinhoven, P., Cuijpers, P., de Jong, P. J., van Marwijk, H. W. J., der Meer, K. V., et al. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.03.027 · Cited by 354 · see citing works
A meta-analysis of CBT for pathological worry among clients with GAD
Covin, R., Ouimet, A. J., Seeds, P. M., & Dozois, D. J. A. (2008) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2007.01.002 · Cited by 293 · see citing works
Late-Life Anxiety and Cognitive Impairment: A Review
Beaudreau, S. A., & O'Hara, R. M. (2008) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e31817945c3 · Cited by 290 · see citing works
Areán, P. A., Raue, P., Mackin, R. S., Kanellopoulos, D., McCulloch, C., & Alexopoulos, G. S. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.09091327 · Cited by 275 · see citing works
Tedeschini, E., Levkovitz, Y., Iovieno, N., Ameral, V. E., Nelson, J. C., & Papakostas, G. I. (2011) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.10r06531 · Cited by 269 · see citing works
Gould, R. L., Coulson, M. C., & Howard, R. J. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2011.03824.x · Cited by 267 · see citing works
Stanley, M. A., Wilson, N. L., Novy, D. M., Rhoades, H. M., Wagener, P. D., Greisinger, A. J., Cully, J. A., & Kunik, M. E. (2009) · JAMA · doi:10.1001/jama.2009.458 · Cited by 247 · see citing works
Interventions for generalized anxiety disorder in older adults: Systematic review and meta-analysis
Gonçalves, D. C., & Byrne, G. J. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2011.08.010 · Cited by 227 · see citing works
Pinquart, M., Duberstein, P. R., & Lyness, J. M. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.9.1493 · Cited by 204 · see citing works
Rollman, B. L., Belnap, B. H., Mazumdar, S., Houck, P. R., Zhu, F., Gardner, W., Reynolds, C. F., Schulberg, H. C., & Shear, M. K. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.12.1332 · Cited by 197 · see citing works
Serfaty, M. A., Haworth, D., Blanchard, M., Buszewicz, M., Murad, S., & King, M. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2009.165 · Cited by 190 · see citing works
Cognitive-behavioural therapy for late-life anxiety disorders: a systematic review and meta-analysis
Hendriks, G. J., Oude Voshaar, R. C., Keijsers, G. P. J., Hoogduin, C. A. L., & Van Balkom, A. J. L. M. (2008) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2008.01190.x · Cited by 184 · see citing works
Kok, R. M., Nolen, W. A., & Heeren, T. J. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.02.036 · Cited by 167 · see citing works
El-Gabalawy, R. M., Mackenzie, C. S., Shooshtari, S., & Sareen, J. (2011) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2011.07.005 · Cited by 155 · see citing works
Pinquart, M., & Duberstein, P. R. (2007) · The American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e31806841c8 · Cited by 126 · see citing works
Heo, M., & Leon, A. C. (2010) · Journal of Biopharmaceutical Statistics · doi:10.1080/10543401003618819 · Cited by 119 · see citing works
Sullivan, G., Craske, M. G., Sherbourne, C. D., Edlund, M. J., Rose, R. D., Golinelli, D., Chavira, D. A., Bystritsky, A., Stein, M. B., & Roy‐Byrne, P. (2007) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2007.04.005 · Cited by 109 · see citing works
Self-citationHendriks, G., Keijsers, G. P. J., Kampman, M., Voshaar, R. C. O., Verbraak, M. J. P. M., Broekman, T. G., & Hoogduin, C. A. L. (2009) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2009.01517.x · Cited by 95 · see citing works
Klapow, J. C., Kroenke, K., Horton, T., Schmidt, S., Spitzer, R., & Williams, J. B. W. (2002) · Psychosomatic Medicine · doi:10.1097/01.psy.0000021942.35402.c3 · Cited by 73 · see citing works
Generalized anxiety disorder severity scale (GADSS): a preliminary validation study
Shear, K. M., Belnap, B. H., Mazumdar, S., Houck, P. R., & Rollman, B. L. (2006) · Depression and Anxiety · doi:10.1002/da.20149 · Cited by 73 · see citing works
Age at Onset of Generalized Anxiety Disorder in Older Adults
Chou, K.-L. (2009) · The American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e31818f3a93 · Cited by 61 · see citing works
Brief Intervention for Anxiety in Primary Care Patients
Roy‐Byrne, P., Veitengruber, J., Bystritsky, A., Edlund, M. J., Sullivan, G., Craske, M. G., Welch, S. S., Rose, R., & Stein, M. B. (2009) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2009.02.080078 · Cited by 56 · see citing works
Self-citationSOONER OR LATER: AGE AT ONSET OF GENERALIZED ANXIETY DISORDER IN OLDER ADULTS
Gonçalves, D. C., & Byrne, G. J. (2011) · Depression and Anxiety · doi:10.1002/da.20881 · Cited by 39 · see citing works
Préville, M., Vasiliadis, H., Bossé, C., Dionne, P.-A., Voyer, P., & Brassard, J. (2011) · The Canadian Journal of Psychiatry · doi:10.1177/070674371105600606 · Cited by 19 · see citing works
Escitalopram for Older Adults With Generalized Anxiety Disorder: A Randomized Controlled Trial
Lenze, E. J., Rollman, B. L., Shear, M. K., Dew, M. A., Pollock, B. G., Ciliberti, C., Costantino, M., Snyder, S., Shi, P., Spitznagel, E., et al. (2009) · JAMA · doi:10.1001/jama.2008.977 · Cited by 5 · see citing works
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Research works printed but not linked: 1
- [18]Derogatis LR BSI: Brief Symptom Inventory: administration, scoring, and procedures manual Minneapolis (MN) NCS Pearson, Inc 1993
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Sorted by citations
Exposure therapy for PTSD: A meta-analysis
McLean, C. P., Levy, H. C., Miller, M. L., & Tolin, D. F. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.102115 · Cited by 273 · see citing works
Carl, E., Witcraft, S. M., Kauffman, B. Y., Gillespie, E. M., Becker, E. S., Cuijpers, P., Van Ameringen, M., Smits, J. A. J., & Powers, M. B. (2020) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2018.1560358 · Cited by 151 · see citing works
Titov, N., Fogliati, V. J., Staples, L. G., Gandy, M., Johnston, L., Wootton, B., Nielssen, O., & Dear, B. F. (2016) · BJPsych Open · doi:10.1192/bjpo.bp.115.002139 · Cited by 93 · see citing works
Chen, Y., Lee, J.-Y., Sridhar, S. (., Mittal, V., McCallister, K., & Singal, A. G. (2020) · Journal of Marketing · doi:10.1177/0022242920913025 · Cited by 70 · see citing works
van Eck van der Sluijs, J. F., Castelijns, H., Eijsbroek, V., Rijnders, C. A. T., van Marwijk, H. W. J., & van der Feltz-Cornelis, C. M. (2018) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2017.08.003 · Cited by 59 · see citing works
Witlox, M., Garnefski, N., Kraaij, V., de Waal, M. W. M., Smit, F., Bohlmeijer, E., & Spinhoven, P. (2021) · Journal of Medical Internet Research · doi:10.2196/24366 · Cited by 43 · see citing works
“…of anxiety in later life, alternative treatment options should also be evaluated, because in most studies with active control conditions, effect sizes favoring CBT were small [11], and some evidence suggests that older adults benefit less from CBT for anxiety than younger adults [11,19,20].”
Barton, S., Karner, C., Salih, F., Baldwin, D. S., & Edwards, S. J. (2014) · Health Technology Assessment · doi:10.3310/hta18500 · Cited by 36 · see citing works
Witlox, M., Kraaij, V., Garnefski, N., Bohlmeijer, E., Smit, F., & Spinhoven, P. (2022) · PLoS ONE · doi:10.1371/journal.pone.0262220 · Cited by 31 · see citing works
“Furthermore, some evidence suggests that CBT is less effective in older adults than in younger samples [17, 18].”
BackgroundNewman, M. G., Basterfield, C., Erickson, T. M., Caulley, E., Przeworski, A., & Llera, S. J. (2022) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2022.2125800 · Cited by 27 · see citing works
“In terms of predictors of negative outcomes, older age [30,31], having received previous psychiatric treatment [32], being unmarried [32] and higher peaks in relaxation-induced anxiety [33] predicted worse outcomes.”
Witlox, M., Kraaij, V., Garnefski, N., de Waal, M. W. M., Smit, F., Hoencamp, E., Gussekloo, J., Bohlmeijer, E. T., & Spinhoven, P. (2018) · Trials · doi:10.1186/s13063-018-2731-3 · Cited by 23 · see citing works
Lack of interventions for anxiety in older people
Voshaar, R. C. O. (2013) · British Journal of Psychiatry · doi:10.1192/bjp.bp.113.127639 · Cited by 13 · see citing works
Anxiety disorders in older adulthood
Petkus, A., Merz, C., & Wetherell, J. L. (2014) · The Wiley Handbook of Anxiety Disorders · doi:10.1002/9781118775349.ch29 · Cited by 2 · see citing works
Self-citation
- Authors
- Wetherell, J. L., Petkus, A. J., Thorp, S. R., Stein, M. B., Chavira, D. A., Campbell-Sills, L., Craske, M. G., Sherbourne, C., Bystritsky, A., Sullivan, G., & Roy-Byrne, P.
- Affiliations
- University of California San Diego (US)
- San Diego State University (US)
- California State University, San Marcos (US)
- University of California, Los Angeles (US)
- RAND Corporation (US)
- Corresponding author
- Wetherell, Julie Loebach
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2013-07
- Volume
- 203
- Issue
- 1
- Pages
- 65-72
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC3696879
- OpenAlex
- W2155162860
- Cited by
- 65
- References
- 43
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 7 · 2023: 2 · 2022: 4 · 2021: 7 · 2020: 4 · 2019: 7 · 2018: 4 · 2017: 9 · 2016: 5 · 2015: 2 · 2014: 6 · 2013: 1
- FWCI
- 6.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Defense
- U.S. Department of Veterans Affairs
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Jazz Pharmaceuticals
- National Institutes of Health (and K24)
- National Institute of Mental Health (U01MH057835, MH065324, MH-64122, K24MH065324, K24MH064122, MH058915, K24MH64122, MH057858, U01MH070022, U01MH070018, U01MH057858, MH070022, U01MH058915)
- 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 › Social Psychology › Mental Health Treatment and Access
- Keywords
- age differences, collaborative care, anxiety disorders, older adults, computer-based intervention, primary care, panic disorder, generalized anxiety disorder, post-traumatic stress disorder, social anxiety disorder, treatment response, remission
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Anxiety Disorders, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Therapy, Computer-Assisted, Anti-Anxiety Agents, Cognitive Behavioral Therapy, Treatment Outcome
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