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Modular Psychotherapy for Anxiety in Older Primary Care Patients

https://doi.org/10.1097/JGP.0b013e3181a31fb5Get rights and content

Objective:

To develop and test a modular psychotherapy protocol in older primary care patients with anxiety disorders.

Design:

Randomized, controlled pilot study.

Setting:

University-based geriatric medicine clinics.

Participants:

Thirty-one elderly primary care patients with generalized anxiety disorder or anxiety disorder not otherwise specified.

Intervention:

Modular form of psychotherapy compared with enhanced community treatment.

Measurements:

Self-reported, interviewer-rated, and qualitative assessments of anxiety, worry, depression, and mental health-related quality of life.

Results:

Both groups showed substantial improvements in anxiety symptoms, worry, depressive symptoms, and mental health-related quality of life. Most individuals in the enhanced community treatment condition reported receiving medications or some other form of professional treatment for anxiety. Across both conditions, individuals who reported major life events or stressors and those who used involvement in activities as a coping strategy made smaller gains than those who did not.

Conclusions:

Results suggest that modular psychotherapy and other treatments can be effective for anxiety in older primary care patients. Results further suggest that life events and coping through increased activity may play a role in the maintenance of anxiety in older adults.

Section snippets

Participants

Patients were 31 adults at least 60 years old with a principal (e.g., most severe) or coprincipal diagnosis of GAD or ADNOS diagnosed according to the Anxiety Disorders Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (ADIS18) administered by a Ph.D.-level clinician. Recruitment was conducted from August 2004 to August 2005 using a primary care screening procedure and self-referrals. A screening questionnaire consisting of the two GAD items from the

Outcomes

Results from the outcome analyses are presented in Table 3. We found substantial and comparable decreases in anxiety, worry, and depressive symptoms and improvement in mental health-related quality of life in both the community treatment and modular psychotherapy groups. This pattern of results did not change when medication use was removed from the models. The within-group mean effect size (weighted average Hedges' g) for change in worry and anxiety symptoms for the modular psychotherapy

CONCLUSIONS

In a comparison between a modular form of psychotherapy and enhanced community treatment (in which patients and their primary care providers were given information about their anxiety diagnosis), both groups experienced equivalent symptomatic improvement. Substantial, statistically significant improvements were found in anxiety symptoms, worry, depressive symptoms, and mental health-related quality of life in both groups.

Individuals in both conditions used a wide variety of anxiety management

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    The authors gratefully acknowledge the contributions of Georgia Birchler, Debora Goodman, Dilip V. Jeste, M.D., Laura Otis, Ph.D., and Murray B. Stein, M.D., M.P.H. This research was supported by NIMH grant MH067643.

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