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Standard and Enhanced Cognitive–Behavior Therapy for Late-Life Generalized Anxiety Disorder

Two Pilot Investigations

Received May 30, 2002; revised August 28, 2002; accepted September 12, 2002. From Columbia University Department of Psychiatry and the New York State Psychiatric Institute. Address correspondence to Dr. Mohlman, Syracuse University, Department of Psychology, 430 Huntington Hall, Syracuse, NY 13244. e-mail: jmohlman{at}psych.syr.edu

OBJECTIVE: Although cognitive–behavior therapy (CBT) is an efficacious treatment for generalized anxiety disorder (GAD) in younger adults, little is known about its efficacy in older patients. Investigations to date have tested group-format or otherwise nonstandard versions of CBT. The studies described here are, to our knowledge, the first to test the efficacy of individual-format CBT administered in a mental health clinic for treatment of late-life GAD. METHODS: Study 1 tested a standard version, and Study 2 tested an enhanced version (ECBT) that included learning and memory aids designed to make the therapy more effective with elderly patients (e.g., homework reminder and troubleshooting calls, weekly review of all concepts and techniques). RESULTS: Study 1 CBT participants showed significant improvement on GAD severity ratings. Study 2 ECBT participants showed significant improvement on two self-report measures, rates of posttreatment GAD, and GAD severity ratings. ECBT resulted in improvement on more measures and yielded larger effect sizes than standard CBT, when each was compared against a wait-list control group. CONCLUSION: Results of these pilot studies suggest that standard individual-format CBT may not be optimally effective for treating late-life GAD; thus, ECBT should be tested further in randomized trials.

Key Words: Anxiety Disorders (General) • Cognitive Therapy • Outcome Studies

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