Cognitive Behavior Therapy Eases Anxiety for Older People

April 7 (HealthDay News) -- For older adults, anxiety is an increasingly common problem, and new research suggests that cognitive behavior therapy may help them ease their worries more than standard care does.

Researchers found that people over age 60 who were treated with cognitive behavior therapy (CBT) had less worry, fewer depressive symptoms and improved general mental health at the end of the study compared to people who received biweekly telephone calls from their health-care provider.

"This kind of treatment (CBT) can be useful for people who have anxiety, and it can help them learn how to manage it better," said the study's lead author, Melinda Stanley, a professor in the Menninger department of psychiatry and behavioral sciences at Baylor College of Medicine in Houston.

"Many older adults are not always thrilled with the use of medications for anxiety. Many times, they're already on medications for chronic health conditions, and they may be afraid of side effects. This is a non-medication treatment option," she noted.

The findings were published in the April 8 issue of the Journal of the American Medical Association.

The prevalence of generalized anxiety disorder is estimated to be more than 7 percent in older people living in the community. People who are more anxious later in life have a higher risk of physical disabilities, memory problems, a lower quality of life, increased use of health-care services and death, according to background information in the study.

Medications are often prescribed to treat anxiety disorders. Benzodiazepines, such as Valium and Xanax, or antidepressants, such as Lexapro and Paxil, are commonly prescribed for people with anxiety, according to the study. But, many people are concerned about the side effects of these medications, particularly benzodiazepines, which may be sedating.

Another study, however, confirmed that Lexapro (escitalopram) was an effective anxiety treatment. This study, published in the Jan. 21 issue of the Journal of the American Medical Association, found that Lexapro was more effective than a placebo in reducing anxiety in older adults, and even helped reduce blood pressure, too.

In the new study, about 42 percent of the volunteers were taking either a benzodiazepine or an antidepressant at the start of the trial. Stanley said the researchers didn't ask anyone to stop the use of their medications, because they wanted to "make this a more real-world trial." Stanley said the researchers told the study volunteers that they could change their medication if they needed to, but the study didn't require it.

The study included a total of 134 people with an average age of 67 years. All were being treated in primary care for their anxiety. About half underwent cognitive behavior therapy with experienced therapists. They had up to 10 sessions of CBT over three months that included relaxation training, problem-solving exercises, behavioral sleep management, cognitive therapy and education and awareness training.

The other half received standard primary care, and they were called biweekly to ensure their safety and provide support if needed. Both groups were told to call the therapists if their symptoms worsened.

Response rates were higher in the CBT group versus the usual care -- 40 percent compared to 22 percent, respectively. Worry severity and depressive symptoms were more reduced in the CBT group, and overall mental health was improved more in the CBT group, based on the Penn State Worry Questionnaire.

On another measure, the GAD Severity Scale, the researchers didn't find a significant statistical difference, but this scale hasn't really been validated as a measure of change, according to Dr. Gary Kennedy, director of the division of geriatric psychiatry at Montefiore Medical Center in New York City.

"I think this was a very carefully done study that moves us another step along in treating anxiety in older people," Kennedy said. "Cognitive therapy works for older adults. It significantly reduced people's anxiety."

Stanley and Kennedy both said they weren't aware of any trials that compared the use of medications to CBT. But, Kennedy pointed out that the two treatments aren't "mutually exclusive."


SOURCES: Melinda Stanley, Ph.D., professor, Menninger department of psychiatry and behavioral sciences, Baylor College of Medicine, Houston; Gary Kennedy, M.D., director, division of geriatric psychiatry, Montefiore Medical Center, New York City; April 8, 2009, Journal of the American Medical Association

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