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Randomized controlled trial of group cognitive behavioral therapy compared to a discussion group for co-morbid anxiety and depression in older adults

Published online by Cambridge University Press:  26 November 2015

V. M. Wuthrich ,
R. M. Rapee ,
M. Kangas  and
S. Perini
V. M. Wuthrich*
Affiliation:
Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
R. M. Rapee
Affiliation:
Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
M. Kangas
Affiliation:
Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
S. Perini
Affiliation:
Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
*
*Address for correspondence: Dr V. M. Wuthrich, Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney 2109, Australia. (Email: [email protected])
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Abstract

Background

Co-morbid anxiety and depression in older adults is associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments in older adults. However, there is a paucity of research focused on testing the efficacy of the co-morbid treatment of anxiety and depression in older adults using psychological interventions. Accordingly, the primary objective of the current study was to test the effects of a group cognitive behavior therapy (CBT) program in treating co-morbid anxiety and depression in a sample of older age adults.

Method

A total of 133 community-dwelling participants aged ⩾60 years (mean age = 67.35, s.d. = 5.44, male = 59) with both an anxiety disorder and unipolar mood disorder, as assessed on the Anxiety Disorder Interview Schedule (ADIS), were randomly allocated to an 11-week CBT group or discussion group. Participants with Mini-Mental State Examination scores <26 were excluded. Participants were assessed pre-treatment, post-treatment and at 6 months follow-up on the ADIS, a brief measure of well-being, Geriatric Anxiety Inventory and Geriatric Depression Scale.

Results

Both conditions resulted in significant improvements over time on all diagnostic, symptom and wellbeing measures. Significant group × time interaction effects emerged at post-treatment only for diagnostic severity of the primary disorder, mean severity of all anxiety disorders, mood disorders, and all disorders, and recovery rates on primary disorder.

Conclusion

Group CBT produced faster and sustained improvements in anxiety and depression on diagnostic severity and recovery rates compared to an active control in older adults.

Keywords

Anxietycognitive behavioral therapyco-morbiddepressiongeriatriclate-liferandomized controlled trialtransdiagnostic
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 4 , March 2016 , pp. 785 - 795
Copyright
Copyright © Cambridge University Press 2015 

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References

Almeida, OP, Draper, B, Pirkis, J, Snowdon, J, Lautenschlager, NT, Byrne, G, Sim, M, Stocks, N, Kerse, N, Flicker, L, Pfaff, JJ (2012). Anxiety, depression, and co-morbid anxiety and depression: risk factors and outcome over two years. International Psychogeriatrics 24, 1622–1632.CrossRefGoogle Scholar
Barrowclough, C, King, P, Colville, J, Russell, E, Burns, A, Tarrier, N (2001). A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. Journal of Consulting and Clinical Psychology 69, 756–762.CrossRefGoogle ScholarPubMed
Blanco, C, Rubio, J, Wall, M, Wang, S, Jiu, CJ, Kendler, KS (2014). Risk factors for anxiety disorders: common and specific effects in a national sample. Depression and Anxiety 31, 756–764.CrossRefGoogle ScholarPubMed
Cohen, A, Gilman, SE, Houck, PR, Szanto, K, Reynolds, CF (2009). Socioeconomic status and anxiety as predictors of antidepressant treatment response and suicidal ideation in older adults. Social Psychiatry and Psychiatric Epidemiology 44, 272–277.CrossRefGoogle ScholarPubMed
Craske, MG (2012). Transdiagnostic treatment for anxiety and depression. Depression and Anxiety 29, 749–753.CrossRefGoogle ScholarPubMed
Cuijpers, P, Li, J, Hofmann, SG, Andersson, G (2010). Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: a meta-analysis. Clinical Psychology Review 30, 768–778.CrossRefGoogle ScholarPubMed
Cuijpers, P, Van Straten, A, Smit, F (2006). Psychological treatment of late-life depression: a meta-analysis of randomised controlled trials. International Journal of Geriatric Psychiatry 21, 1139–1149.CrossRefGoogle Scholar
Deluca, AK, Lenze, EJ, Mulsant, BH, Butters, MA, Karp, JF, Dew, MA, Pollock, BG, Shear, MK, Houck, PR, Reynolds, CF (2005). Co-morbid anxiety disorder in late life depression: association with memory decline over four years. International Journal of Geriatric Psychiatry 20, 848–854.CrossRefGoogle Scholar
Devilly, GJ, Borkovec, TD (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry 31, 73–86.CrossRefGoogle ScholarPubMed
Di Nardo, PA, Brown, TA, Barlow, DH (1994). Anxiety Disorders Interview Schedule for DSM-IV. Center for Stress and Anxiety Related Disorders, Boston University: Boston.Google Scholar
Evans, C, Margison, F, Barkham, M (1998). The contribution of reliable and clinically significant change methods to evidence-based mental health. Evidence Based Mental Health 1, 70–72.CrossRefGoogle Scholar
Folstein, M, Folstein, S, Mchugh, P (1975). ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.CrossRefGoogle Scholar
Gorenstein, EE, Kleber, MS, Mohlmann, J, Dejesus, M, Gorman, JM, Papp, LA (2005). Cognitive-behavioural therapy for management of anxiety and medication taper in older adults. American Journal of Geriatric Psychiatry 13, 901–909.CrossRefGoogle ScholarPubMed
Gould, RL, Coulson, MC, Howard, RJ (2012 a). Cognitive behavioral therapy for depression in older people: a meta-analysis and meta-regression of randomized controlled trials. Journal of the American Geriatrics Society 60, 1817–1830.CrossRefGoogle ScholarPubMed
Gould, RL, Coulson, MC, Howard, RJ (2012 b). 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
Gum, AM, Arean, PA, Bostrom, A (2007). Low-income depressed older adults with psychiatric co-morbidity: secondary analyses of response to psychotherapy and case management. International Journal of Geriatric Psychiatry 22, 124–130.CrossRefGoogle ScholarPubMed
Hegel, MT, Unutzer, J, Tang, L, Arean, PA, Katon, W, Noel, PH, Williams, JWJ, Lin, EHB (2005). Impact of co-morbid panic and posttraumatic stress disorder on outcomes of collaborative care for late-life depression in primary care. American Journal of Geriatric Psychiatry 13, 48–58.CrossRefGoogle Scholar
Hendriks, GJ, Oude Voshaar, RC, Keijsers, GPJ, Hoogduin, CaL, Van Balkom, AJLM (2008). Cognitive-behavioural therapy for late-life anxiety disorders: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica 117, 403–411.CrossRefGoogle ScholarPubMed
Johnco, C, Wuthrich, VM, Rapee, RM (2014). The influence of cognitive flexibility on treatment outcome and cognitive restructuring skills 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
Jongenelis, K, Pot, AM, Eisses, AMH, Gerritsen, DL, Derksen, M, Beekman, ATF, Kluiter, H, Ribbe, MW (2005). Diagnostic accuracy of the original 30-item and shortened versions of the Geriatric Depression Scale in nursing home patients. International Journal of Geriatric Psychiatry 20, 1067–1074.CrossRefGoogle ScholarPubMed
Keiffer, KM, Reeses, RJ (2002). A reliability generalisation study of the Geriatric Depression Scale. Education and Psychological Measurement 62, 969–994.CrossRefGoogle Scholar
Kendler, KS, Gardner, CO, Gatz, M, Pedersen, NL (2007). The sources of co-morbidity between major depression and generalised anxiety disorder in a Swedish national twin sample. Psychological Medicine 37, 453–462.CrossRefGoogle Scholar
Kessler, RC, Nelson, CB, Mcgonagle, KA, Liu, J, Swartz, M, Blazer, DG (1996). Co-morbidity of DSM-III-R major depressive disorder in the general population: results from the US National Co-morbidity Survey. British Journal of Psychiatry 30, 8–21.Google Scholar
Kukull, WA, Larson, EB, Teri, L, Bowen, J, Mccormick, W, Pfanschmidt, ML (1994). The Mini-Mental State Examination Score and the clinical diagnosis of dementia. Journal of Clinical Epidemiology 47, 1061–1067.CrossRefGoogle ScholarPubMed
Kvaal, K, McDougall, FA, Brayne, C, Matthews, FE, Dewey, ME (2008). Co-occurrence of anxiety and depressive disorders in a community sample of older people: results from the MRC CFAS (Medical Research Council Cognitive Function and Ageing Study). International Journal of Geriatric Psychiatry 23, 229–237.CrossRefGoogle Scholar
Lenze, EJ, Mulsant, BH, Shear, MK, Schulberg, HC, Dew, MA, Begley, AE, Pollock, BG, Reynolds, CF (2000). Co-morbid anxiety disorders in depressed elderly patients. American Journal of Psychiatry 157, 722–728.CrossRefGoogle Scholar
Luborsky, L, Barber, JP, Siqueland, L, Johnson, S, Najavits, LM, Frank, A, Daley, D (1996). The revised helping alliance 1uestionniare. Journal of Psychotherapy Practice and Research 5, 260–271.Google Scholar
Mackin, RS, Arean, PA (2005). Evidence-based psychotherapeutic interventions for geriatric depression. Psychiatric Clinics of North America 28, 805–820.CrossRefGoogle ScholarPubMed
Norton, PJ, Barrera, TL, Mathew, AR, Chamberlain, LD, Szafranski, DD, Reddy, R, Smith, AH (2013). Effect of transdiagnostic CBT for anxiety disorders on co-morbid disorders. Depression and Anxiety 30, 168–173.CrossRefGoogle Scholar
Odgaard, EC, Fowler, RL (2010). Confidence intervals for effect sizes: Compliance and clinical significance in the Journal of Consulting and Clinical Psychology . Journal of Consulting and Clinical Psychology 78, 287–297.CrossRefGoogle ScholarPubMed
Pachana, NA, Byrne, GJ, Siddle, H, Koloski, N, Harley, E, Arnold, E (2007). Development and validation of the Geriatric Anxiety Inventory. International Psychogeriatrics 19, 103–114.CrossRefGoogle ScholarPubMed
Prina, AM, Ferri, CP, Guerra, M, Brayne, C, Prince, M (2011). Co-occurance of anxiety and depression amongst older adults in low- and middle-income countries: findings from the 10/66 study. Psychological Medicine 41, 2047–2056.CrossRefGoogle Scholar
Serfaty, MA, Haworth, D, Blanchard, M, Buszewicz, M, King, M (2009). Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized control trial. Archives of General Psychiatry 66, 1332–1340.CrossRefGoogle Scholar
Stanley, MA, Beck, JG, Novy, DM, Averill, PM, Swann, AC, Diefenbach, GJ, Hopko, DR (2003 a). Cognitive-behavioral treatment of late-life generalized anxiety disorder. Journal of Consulting and Clinical Psychology 71, 309–319.CrossRefGoogle ScholarPubMed
Stanley, MA, Hopko, DR, Diefenbach, GJ, Bourland, SL, Rodriguez, H, Wagener, P (2003 b). Cognitive-behavior therapy for late-life generalized anxiety disorder in primary care: preliminary findings. American Journal of Geriatric Psychiatry 11, 92–96.Google ScholarPubMed
Treadwell, T, Lavertue, N, Kumar, VK, Veeraraghavan, V (2001). The group cohesion scale-revised: reliability and validity. International Journal of Action Methods 54, 3–11.Google Scholar
Vasiliadis, H-M, Dionne, P-A, Preville, M, Gentil, L, Berbiche, D, Latimer, E (2012). The excess health care costs associated with depression and anxiety in elderly living in the community. American Journal of Geriatric Psychiatry. Published online: March 2012. doi:10.1097/JGP.0b013e318248ae9e.CrossRefGoogle Scholar
Vink, D, Aartsen, MJ, Schoevers, RA (2008). Risk factors for anxiety and depression in the elderly: a review. Journal of Affective Disorders 106, 29–44.CrossRefGoogle ScholarPubMed
Waltz, J, Addis, ME, Koerner, K, Jacobson, NS (1993). Testing the integrity of a psychotherapy protocol: assessment of adherence and competence. Journal of Consulting and Clinical Psychology 61, 620–630.CrossRefGoogle ScholarPubMed
Watson, D, Clark, LA, Weber, K, Assenheimer, JS, Strauss, ME, Mccormick, RA (1995). Testing a tripartite model, II: exploring the symptom structure of anxiety and depression in student, adult, and patient samples. Journal of Abnormal Psychology 104, 15–25.CrossRefGoogle ScholarPubMed
Wetherell, JL, Gatz, M, Craske, MG (2003). Treatment of generalised anxiety disorder in older adults. Journal of Consulting and Clinical Psychology 71, 31–40.CrossRefGoogle ScholarPubMed
WHOQOL Group (1995). The World Health Organisation Quality of Life Assessment (WHOQOL): position paper from the World Health Organisation. Social Science and Medicine 41, 1403.CrossRefGoogle Scholar
Wuthrich, VM, Rapee, RM (2013). Randomized controlled trial of group cognitive behavioral therapy for co-morbid anxiety and depression in older adults. Behaviour Research and Therapy 51, 779–786.CrossRefGoogle Scholar
Yesavage, JA, Brink, TL, Rose, TL, Lum, O, Huang, V, Adley, M, Leirer, VO (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research 1, 37–49.Google Scholar