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Cognitive Errors, Symptom Severity, and Response to Cognitive Behavior Therapy in Older Adults With Generalized Anxiety Disorder

From the Departments of Educational Psychology (DDC) and Psychology (ACS), University of Houston, Houston, TX; the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine (MEK, MAS), and the Department of Medicine, Baylor College of Medicine, (MEK, NLW); the Department of Psychiatry and Behavioral Sciences, The University of Texas Health Sciences Center, Houston, TX (DDC, HMR); the Houston Center for Quality of Care & Utilization Studies, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (ACS, MEK, NLW, MAS); the Department of Psychiatry, University of California, San Diego, CA (JLW); the Veterans Affairs San Diego Health Care System, Psychology Service (JLW); the Department of Psychology, University at Buffalo–SUNY (JGB); and the Center for Mental Health and Aging, Department of Psychology, University of Alabama, Tuscaloosa, AL (ALS).

Objective: Recent research by Wetherell et al. investigating the differential response to group-administered cognitive behavior therapy (CBT) for generalized anxiety disorder (GAD) in older adults found that GAD severity, homework adherence, and psychiatric comorbidity predicted statistically significant improvement. The current study investigated whether the presence/absence of cognitive errors on separate domains of the Mini-Mental State Exam (MMSE) predicted baseline differences in symptom severity and improvement following CBT, above and beyond already established predictors.

Methods: Baseline characteristics were investigated in a sample of 208 older patients diagnosed with GAD. Predictors of treatment response were examined in a subsample of 65 patients who completed CBT and were included in a prior study by Wetherell et al. of response predictors.

Results: Results from the baseline sample indicated that only subjects who committed an error on the MMSE Working Memory domain exhibited increased severity in anxiety and depressive symptoms. Results from the treatment sample indicated that an error on the MMSE Orientation domain was a significant predictor of outcome at 6-month follow-up, while controlling for previously established predictors. Patients who committed at least one error in this domain showed decreased response relative to patients who committed no errors.

Conclusion: In this sample of older adults diagnosed with GAD, poor performance on the MMSE Working Memory domain was associated with increased baseline anxiety and depression, while baseline performance differences on the MMSE Orientation domain predicted outcome six months after CBT intervention.

Key Words: Generalized anxiety disorder • cognitive behavior therapy • older adults • Mini-Mental Status Examination

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				A. J. Flint Anxiety Disorders in Later Life: From Epidemiology to Treatment Am J Geriatr Psychiatry, August 1, 2007; 15(8): 635 - 638. [Full Text] [PDF]