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A Randomized, Controlled Trial of the Effectiveness of Cognitive–Behavioral Therapy and Sertraline versus a Waitlist Control Group for Anxiety Disorders in Older Adults

From the Department of Psychiatry and Institute for Research in Extramural Medicine, VU Medical Centre, Amsterdam (JS, RvD); GGZ Buitenamstel, Amsterdam, The Netherlands (HC); the Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands (PMGE); the Department of Clinical Epidemiology and Biostatistics, VU Medical Centre, Amsterdam (CMG); Riagg Maastricht, Maastricht, The Netherlands (IW); and the Department of Social Sciences, University of Utrecht, Utrecht, The Netherlands (MvdH).

Objective: This study is the first to investigate the relative effectiveness of cognitive–behavioral therapy (CBT) compared with a selective serotonin reuptake inhibitor (SSRI; sertraline) in a randomized, controlled trial on the treatment of anxiety disorders in older adults.

Method: Eighty-four patients 60 years of age and over with a principal diagnosis of generalized anxiety disorder, panic disorder, agoraphobia, or social phobia were randomly assigned to one of three conditions: 15 sessions of CBT, pharmacologic treatment with an SSRI (sertraline; maximum dosage 150 mg), or a waitlist control group. Participants completed measures of primary outcome (anxiety) and coexistent worry and depressive symptoms at baseline, posttreatment, and at three-month follow up.

Results: Attrition rates were high in both treatment groups. Consequently, findings are based on a relatively small sample of completers (N = 52). Although both CBT and sertraline led to significant improvement in anxiety, worry, and depressive symptoms both at posttreatment and at three-month follow up, sertraline showed superior results on worry symptoms. Effect size estimates for CBT were in the small to medium range both at posttreatment (mean d = 0.42) and at three-month follow up (mean d = 0.35), whereas effect sizes for sertraline fell into the large range (posttreatment mean d = 0.94 and three-month follow up mean d = 1.02). The waitlist condition showed virtually no effects (posttreatment mean d = .03).

Conclusions: Our findings strongly suggest that the pharmacologic treatment of late-life anxiety with SSRIs has not been given the proper attention in research to date.

Key Words: Anxiety disorders • aged • randomized controlled trial • sertraline • cognitive therapy

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				M. Pinquart and P. R. Duberstein Treatment of Anxiety Disorders in Older Adults: A Meta-analytic Comparison of Behavioral and Pharmacological Interventions Am J Geriatr Psychiatry, August 1, 2007; 15(8): 639 - 651. [Abstract] [Full Text] [PDF]