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Cognitive-Behavioral Therapy for Management of Anxiety and Medication Taper in Older Adults

Received December 3, 2003; revised September 7, November 8, 2004; accepted November 19, 2004. From the Dept. of Psychiatry, Columbia University, The New York State Psychiatric Institute, Mt. Sinai School of Medicine (JMG) and Rutgers University (JM). Send correspondence and reprint requests to Ethan E. Gorenstein, Ph.D., Box 427, 622 W. 168th St., New York, NY 10032. e-mail: EEG1{at}columbia.edu
© 2005 American Association for Geriatric Psychiatry

Objective: The authors hypothesized that patients with late-life anxiety undergoing cognitive-behavioral therapy plus medical management for medication taper (CBT-MM) would realize greater reduction in medication use and greater improvement in psychological symptoms than a control group undergoing medical management alone (MM). Methods: Forty-two patients (age >60) who wanted to reduce anxiolytic medication were allocated to the two groups (CBT-MM versus MM), using a randomization plus difference-minimization procedure (to equate for medication use). Results: CBT-MM completers significantly reduced medication use, but not at a greater rate than MM completers. At the same time, CBT-MM completers experienced significantly greater alleviation of psychological symptoms than did MM completers. Some, but not all, treatment gains were maintained at 6-month follow-up. Intention-to-treat analyses using the mixed-effects model showed similar, but weaker, treatment effects than completer analyses. Conclusions: Cognitive-behavioral therapy can alleviate psychological symptoms in elderly patients with anxiety even as patients reduce anxiolytic medication.

Key Words: Anxiety Disorders • Cognitive-Behavioral Therapy • Medication Taper

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