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Evidence-based assessment of treatment outcomes for late-life generalized anxiety disorder using the Penn State Worry Questionnaire (PSWQ) and Penn State Worry Questionnaire – Abbreviated (PSWQ-A)

Published online by Cambridge University Press:  05 April 2021

Carly Johnco Open the ORCID record for Carly Johnco [Opens in a new window] ,
Viviana M. Wuthrich ,
Gretchen A. Brenes ,
Julie Loebach Wetherell  and
Jan Mohlman
Carly Johnco*
Affiliation:
Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
Viviana M. Wuthrich
Affiliation:
Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
Gretchen A. Brenes
Affiliation:
Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
Julie Loebach Wetherell
Affiliation:
Mental Health Impact Unit 3, VA San Diego Healthcare System and Department of Psychiatry, University of California, San Diego, CA, USA
Jan Mohlman
Affiliation:
Department of Psychology, William Paterson University, Wayne, NJ, USA
*
Correspondence should be addressed to: Carly Johnco, Department of Psychology, Macquarie University, Sydney, NSW2109, Australia. Phone: +61 9850 8053. E-mail: [email protected]
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Abstract

Objective:

The Penn State Worry Questionnaire (PSWQ) is a commonly used measure of treatment outcome for late-life generalized anxiety disorder (GAD). However, there is considerable variability in the definitions used to define treatment response and remission. This study aimed to provide empirically derived guidelines for assessing treatment response and remission among older adults with GAD using the PSWQ and the abbreviated PSWQ (PSWQ-A).

Design:

Longitudinal assessment of GAD symptoms pre- and posttreatment.

Participants:

Participants were 259 older adults aged 60–86 years with a diagnosis of GAD who were assessed before and after treatment.

Intervention:

Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions.

Measurements:

Signal-detection analyses using receiver operating characteristic (ROC) methods were used to determine optimal agreement between structured diagnostic interviews and scores on the PSWQ and PSWQ-A.

Results:

Results suggest that a score of ≤51 was optimal for defining diagnostic remission status on the PSWQ, and a score of ≤24 was optimal on the PSWQ-A. A 9% reduction or ≥4-point reduction was optimal for assessing treatment response on the PSWQ. The PSWQ-A was poor at identifying treatment response status.

Conclusions:

Findings suggest that most of the previously used definitions have underestimated the treatment effects for late-life GAD. However overall, the PSWQ and PSWQ-A are suboptimal for assessing treatment outcome for late-life GAD. The standardization of response and remission criteria has implications for comparison between treatment trials, and for the benchmarking of outcomes in clinical practice.

Keywords

anxietygeneralized anxiety disorderPenn State Worry Questionnairegeriatricolder adultelderly
Type
Original Research Article
Information
International Psychogeriatrics , Volume 34 , Special Issue 5: Issue Theme: Advances in Assessment of Psychopathology , May 2022 , pp. 489 - 501
Copyright
© International Psychogeriatric Association 2021

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References

Barrera, T. L. et al. (2015). Cognitive-behavioral therapy for late-life anxiety: similarities and differences between Veteran and community participants. Journal of Anxiety Disorders, 33, 72–80.CrossRefGoogle ScholarPubMed
Beck, J. G., Stanley, M. A. and Zebb, B. J. (1995). Psychometric properties of the Penn State Worry Questionnaire in older adults. Journal of Clinical Geropsychology, 1, 33–42.Google Scholar
Beekman, A. T. et al. (1998). Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam. International journal of geriatric psychiatry, 13, 717–726.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
Bradford, A. et al. (2011). Early response to psychotherapy and long-term change in worry symptoms in older adults with generalized anxiety disorder. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 19, 347–356.CrossRefGoogle ScholarPubMed
Brenes, G. A., Danhauer, S. C., Lyles, M. F., Hogan, P. E. and Miller, M. E. (2015). Telephone-delivered cognitive behavioral therapy and telephone-delivered nondirective supportive therapy for rural older adults with generalized anxiety disorder: a randomized clinical trial. JAMA Psychiatry, 72, 1012–1020.CrossRefGoogle ScholarPubMed
Caporino, N. E. et al. (2013). Defining treatment response and remission in child anxiety: signal detection analysis using the pediatric anxiety rating scale. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 57–67.CrossRefGoogle ScholarPubMed
Craske, M. G., Barlow, D. H. and O’Leary, T. A. (1992). Mastery of your anxiety and worry. Albany, NY: Graywind Publications.Google Scholar
Di Nardo, P. A., Brown, T. A. and Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV. Boston: Center for Stress and Anxiety Related Disorders, Boston University.Google Scholar
First, M. B., Spitzer, R. L., Miriam, G. and Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders. New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
Gonçalves, D. C. and Byrne, G. J. (2012). Interventions for generalized anxiety disorder in older adults: systematic review and meta-analysis. Journal of Anxiety Disorders, 26, 1–11.CrossRefGoogle ScholarPubMed
Gould, R. L., Coulson, M. C. and Howard, R. J. (2012). Efficacy of cognitive behavioral therapy for anxiety disorders in older people: a meta-analysis and meta-regression of randomized controlled trials. Journal of the American Geriatrics Society, 60, 218–229.CrossRefGoogle ScholarPubMed
Hall, J., Kellett, S., Berrios, R., Bains, M. K. and Scott, S. (2016). Efficacy of cognitive behavioral therapy for generalized anxiety disorder in older adults: systematic review, meta-analysis, and meta-regression. The American Journal of Geriatric Psychiatry, 24, 1063–1073.CrossRefGoogle ScholarPubMed
Hendriks, G. J., Oude Voshaar, R. C., Keijsers, G. P. J., Hoogduin, C. A. L. and Van Balkom, A. J. L. M. (2008). Cognitive-behavioural therapy for late-life anxiety disorders: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica, 117, 403–411.CrossRefGoogle ScholarPubMed
Hopko, D. R. et al. (2003). Assessing worry in older adults: confirmatory factor analysis of the Penn State Worry Questionnaire and psychometric properties of an abbreviated model. Psychological Assessment, 15, 173–183.CrossRefGoogle ScholarPubMed
Houghton, D. C. et al. (2015). Defining treatment response in trichotillomania: a signal detection analysis. Journal of Anxiety Disorders, 36, 44–51.CrossRefGoogle ScholarPubMed
Jacobson, N. S. and Truax, P. 1991. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.CrossRefGoogle ScholarPubMed
Johnco, C. J., De Nadai, A. S., Lewin, A. B., Ehrenreich-May, J., Wood, J. J. and Storch, E. A. (2015a). Defining treatment response and symptom remission for anxiety disorders in pediatric autism spectrum disorders using the Pediatric Anxiety Rating Scale. Journal of Autism and Developmental Disorders, 45, 3232–3242.CrossRefGoogle ScholarPubMed
Johnco, C. J., Salloum, A., Lewin, A. B. and Storch, E. A. (2015b). Refining clinical judgment of treatment response and symptom remission identification in childhood anxiety using a signal detection analysis on the pediatric anxiety rating scale. Journal of Child and Adolescent Psychopharmacology, 25, 674–683.CrossRefGoogle ScholarPubMed
Johnco, C. J., Wuthrich, V. M. and Rapee, R. M. (2014). The influence of cognitive flexibility on treatment outcome and cognitive restructuring skill acquisition during cognitive behavioural treatment for anxiety and depression in older adults: results of a pilot study. Behaviour Research and Therapy, 57, 55–64.CrossRefGoogle ScholarPubMed
Landis, J. R. and Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.CrossRefGoogle ScholarPubMed
Mandrekar, J. N. (2010). Receiver operating characteristic curve in diagnostic test assessment. Journal of Thoracic Oncology, 5, 1315–1316.CrossRefGoogle ScholarPubMed
Meyer, T. J., Miller, M. L., Metzger, R. L. and Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487–495.CrossRefGoogle ScholarPubMed
Mohlman, J. (2008). More power to the executive? A preliminary test of CBT plus executive skills training for treatment of late-life GAD. Cognitive and Behavioral Practice, 15, 306–316.CrossRefGoogle Scholar
Mohlman, J. (2020). Neurocognitive predictors of long-term outcome in CBT for late life generalized anxiety disorder. Journal of Anxiety Disorders, 74, 102246.CrossRefGoogle ScholarPubMed
Mohlman, J., Gorenstein, E. E., Kleber, M., de Jesus, M., Gorman, J. M. and Papp, L. A. (2003). Standard and enhanced cognitive-behavior therapy for late-life generalized anxiety disorder: two pilot investigations. The American Journal of Geriatric Psychiatry, 11, 24–32.Google ScholarPubMed
Mohlman, J. and Gorman, J. M. (2005). The role of executive functioning in CBT: a pilot study with anxious older adults. Behaviour Research and Therapy, 43, 447–465.CrossRefGoogle ScholarPubMed
Pachana, N. A., Byrne, G. J., Siddle, H., Koloski, N., Harley, E. and Arnold, E. (2007). Development and validation of the Geriatric Anxiety Inventory. International Psychogeriatrics, 19, 103–114.CrossRefGoogle ScholarPubMed
Pinquart, M. and Duberstein, P. R. (2007). Treatment of anxiety disorders in older adults: a meta-analytic comparison of behavioral and pharmacological interventions. The American Journal of Geriatric Psychiatry, 15, 639–651.CrossRefGoogle ScholarPubMed
Roseman, A. S. et al. (2011). Treatment response for late-life generalized anxiety disorder: moving beyond symptom-based measures. The Journal of Nervous and Mental Disease, 199, 811–814.CrossRefGoogle ScholarPubMed
Segal, D. L., June, A., Payne, M., Coolidge, F. L. and Yochim, B. (2010). Development and initial validation of a self-report assessment tool for anxiety among older adults: the geriatric anxiety scale. Journal of Anxiety Disorders, 24, 709–714.CrossRefGoogle ScholarPubMed
Skarphedinsson, G., De Nadai, A. S., Storch, E. A., Lewin, A. B. and Ivarsson, T. (2017). Defining cognitive-behavior therapy response and remission in pediatric OCD: a signal detection analysis of the Children’s Yale-Brown Obsessive Compulsive Scale. European Child & Adolescent Psychiatry, 26, 47–55.CrossRefGoogle ScholarPubMed
Stanley, M. A., Beck, J. G. and Glassco, J. D. (1996). Treatment of generalized anxiety in older adults: a preliminary comparison of cognitive-behavioral and supportive approaches. Behavior Therapy, 27, 565–581.CrossRefGoogle Scholar
Stanley, M. A. et al. (2003a). Cognitive-behavioral treatment of late-life generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 71, 309–319.CrossRefGoogle ScholarPubMed
Stanley, M. A. (2003b). The nature of generalized anxiety in older primary care patients: preliminary findings. Journal of Psychopathology and Behavioral Assessment, 25, 273–280.CrossRefGoogle Scholar
Stanley, M. A., Hopko, D. R., Diefenbach, G. J., Bourland, S. L., Rodriguez, H. and Wagener, P. (2003c). Cognitive-behavior therapy for late-life generalized anxiety disorder in primary care: preliminary findings. The American Journal of Geriatric Psychiatry, 11, 92–96.Google ScholarPubMed
Stanley, M. A., Novy, D. M., Bourland, S. L., Beck, J. G. and Averill, P. M. (2001). Assessing older adults with generalized anxiety: a replication and extension. Behaviour Research and Therapy, 39, 221–235.CrossRefGoogle Scholar
Stanley, M. A. et al. (2014). Lay providers can deliver effective cognitive behavior therapy for older adults with generalized anxiety disorder: a randomized trial. Depress Anxiety, 31, 391–401.CrossRefGoogle ScholarPubMed
Stanley, M. A. et al. (2009). Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: a randomized clinical trial. JAMA, 301, 1460–1467.CrossRefGoogle ScholarPubMed
Storch, E. A. et al. (2011). Defining treatment response in pediatric tic disorders: a signal detection analysis of the Yale Global Tic Severity Scale. Journal of Child and Adolescent Psychopharmacology, 21, 621–627.CrossRefGoogle ScholarPubMed
Storch, E. A., Lewin, A. B., De Nadai, A. S. and Murphy, T. K. (2010). Defining treatment response and remission in obsessive-compulsive disorder: a signal detection analysis of the Children’s Yale-Brown Obsessive Compulsive Scale. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 708–717.Google ScholarPubMed
Thorp, S. R., Ayers, C. R., Nuevo, R., Stoddard, J. A., Sorrell, J. T. and Wetherell, J. L. (2009). Meta-analysis comparing different behavioral treatments for late-life anxiety. The American Journal of Geriatric Psychiatry, 17, 105–115.CrossRefGoogle ScholarPubMed
Webb, S. A. et al. (2008). Comparison of self-report measures for identifying late-life generalized anxiety in primary care. Journal of Geriatric Psychiatry and Neurology, 21, 223–231.CrossRefGoogle ScholarPubMed
Wetherell, J. L., Gatz, M. and Craske, M. G. (2003). Treatment of generalized anxiety disorder in older adults. Journal of Consulting and Clinical Psychology, 71, 31–40.CrossRefGoogle ScholarPubMed
Wetherell, J. L. et al. (2005). Cognitive-behavioral therapy for late-life generalized anxiety disorder: who gets better? Behavior Therapy, 36, 147–156.CrossRefGoogle Scholar
Wetherell, J. L. et al. (2013). Antidepressant medication augmented with cognitive-behavioral therapy for generalized anxiety disorder in older adults. The American Journal of Psychiatry, 170, 782–789.CrossRefGoogle ScholarPubMed
Wolitzky-Taylor, K. B., Castriotta, N., Lenze, E. J., Stanley, M. A. and Craske, M. G. (2010).–Anxiety disorders in older adults: a comprehensive review. Depression and Anxiety, 27, 190–211.CrossRefGoogle ScholarPubMed
Wuthrich, V. M. (2009). Ageing WISELY: Group Program for the Treatment of Worry and Low Mood in Older Adults. Sydney, Australia., Centre for Emotional Health, Department of Psychology, Macquarie University.Google Scholar
Wuthrich, V. M., Johnco, C. and Knight, A. (2014). Comparison of the Penn State Worry Questionnaire (PSWQ) and abbreviated version (PSWQ-A) in a clinical and non-clinical population of older adults. Journal of Anxiety Disorders, 28, 657–263.CrossRefGoogle Scholar
Wuthrich, V. M. and Rapee, R. M. (2013). Randomised controlled trial of group cognitive behavioural therapy for comorbid anxiety and depression in older adults. Behaviour Research and Therapy, 51, 779–786.CrossRefGoogle ScholarPubMed