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Long-term effectiveness and prediction of treatment outcome in cognitive behavioral therapy and sertraline for late-life anxiety disorders

  • Josien Schuurmans (a1), Hannie Comijs (a2), Paul M. G. Emmelkamp (a3), Ingrid J. C. Weijnen (a4), Marcel van den Hout (a5) and Richard van Dyck (a6)...

Abstract

Background: Although anxiety disorders are prevalent in older adults, randomized controlled trials of treatment effectiveness for late-life anxiety are scarce and have focused primarily on the effectiveness of psychotherapeutic interventions. However, recent findings suggest that in some cases, pharmacological treatment may be more beneficial for late-life anxiety disorders. As yet, there have been no systematic studies investigating prognostic factors for the outcome of cognitive behavioral therapy (CBT) and pharmacotherapy for late-life anxiety. The objective of the present study was to study long-term treatment outcomes and to explore differential predictors for both short-term and long-term treatment outcomes of sertraline and CBT for late-life anxiety disorders.

Methods: Participants of a randomized controlled trial (RCT) comparing sertraline and CBT for the treatment of late-life anxiety were contacted one year after completing their treatment, so that predictors for both short-term and long-term treatment outcome could be established.

Results: Sertraline showed a greater reduction of symptoms than CBT on anxiety (Hamilton Anxiety Rating Scale; HARS) and worry (Worry Domain Questionnaire) ratings at one-year follow-up. The strongest predictor for short-term CBT outcome was poor perceived health, explaining 40% of the variance in post-treatment residual gain scores on the HARS. The strongest predictor for long-term CBT outcome was neuroticism, explaining 20% of the variance in residual gain scores at one-year follow-up. Analyses revealed no significant predictors for treatment outcome in sertraline participants.

Conclusions: Our study suggests that long-term use of sertraline might be more beneficial for late-life anxiety than a 15-week CBT program. Poor perceived health and neuroticism are predictive of less improvement after CBT in anxious older adults. Implications of these findings are discussed.

Copyright

Corresponding author

Correspondence should be addressed to: Josien Schuurmans, Vrije Universiteit, Faculty of Psychology and Education, Department of Clinical Psychology, van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. Phone: +31 (0) 20 598 8464. Email: j.schuurmans@psy.vu.nl.

References

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American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Text Revision, 4th edn. Washington, DC: American Psychiatric Association.
Barrowclough, C., King, P., Colville, J., Russell, E., Burns, A. and Tarrier, N. (2001). A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. Journal of Consulting and Clinical Psychology, 69, 756762.
Beck, A. T. and Steer, R. A. (1990). Manual for the Beck Anxiety Inventory. San Antonio, TX: Psychological Corporation.
Borkovec, T. D. and Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61, 611619.
Clark, D. M. and Salkovskis, P. M. (1986). A Manual for the Cognitive Therapy of Panic Disorder. New York: Oxford University Press.
Clark, L. A., Watson, D., and Mineka, S. (1994). Temperament, personality and the mood and anxiety disorders. Journal of Abnormal Psychology, 103, 103116.
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Hillsdale, NJ: Erlbaum.
Eysenck, S. B. G., Eysenck, H. J., and Barret, P. (1985). A revised version of the psychoticism scale. Personality and Inidividual Differences, 6, 2129.
First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (1999). Structured Clinical Interview for DSM-IV Axis I Disorders: Patient Edition (Scid-I/P, Version 2.0). Lisse: Swets & Zeitlinger B.V.
Flint, A. J. (1994). Epidemiology and co-morbidity of anxiety disorders in the elderly. American Journal of Psychiatry, 151, 640649.
Folstein, M. E., Folstein, S. E., and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
French, D. D., Campbell, R., Spehar, A., Cunningham, F., Bulat, T., and Luther, S. L. (2006). Drugs and falls in community-dwelling older people: a national veterans study. Clinical Therapeutics, 28, 619630.
Gibbons, R. D. et al. (1993). Some conceptual and statistical issues in analysis of longitudinal psychiatric data: application to the NIMH treatment of Depression Collaborative Research Program dataset. Archives of General Psychiatry, 50, 739750.
Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 5055.
Hollon, S. D., Stewart, M. O. and Strunk, D. (2006). Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology, 57, 285315.
Lenze, E. J., Mulsant, B. H., Shear, M. K., Dew, M. A., Miller, M. D., Pollock, B. G. et al. (2005). Efficacy and tolerability of citalopram in the treatment of late-life anxiety disorders: results from an 8-week randomized, placebo-controlled trial. American Journal of Psychiatry, 162, 146150.
Mohlman, J. (2004). Psychosocial treatment of late-life generalized anxiety disorder: current status and future directions. Clinical Psychology Review, 24, 149169.
Mohlman, J. (2005). Does executive dysfunction affect treatment outcome in late-life mood and anxiety disorders? Journal of Geriatric Psychiatry and Neurology, 18, 97108.
Ormel, J., Rosmalen, J. and Farmer, A. (2004). Neuroticism: a non-informative marker of vulnerability to psychopathology. Social Psychiatry and Psychiatric Epidemiology, 39, 906912.
Ost, L. G. (1990). The Agoraphobia Scale: an evaluation of its reliability and validity. Behaviour Research and Therapy, 28, 323329.
Pinquart, M. and Duberstein, P. R. (2007). Treatment of anxiety disorders in older adults: a meta-analytic comparison of behavioral and pharmacological interventions. American Journal of Geriatric Psychiatry, 15, 639651.
Quitkin, F. M., Rabkin, J. D., Markowitz, J. M., Stewart, J. W., McGrath, P. J. and Harrison, W. (1987). Use of pattern analysis to identify true drug response: a replication. Archives of General Psychiatry, 44, 259264.
Radloff, L. S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measures, 1, 385401.
Rijsoort, S. van, Emmelkamp, P. M. G., and Vervaeke, G. (1999). The Penn State Worry Questionnaire and the Worry Domains Questionnaire: structure, reliability and validity. Clinical Psychology and Psychotherapy, 6, 297307.
Scheibe, G. and Albus, M. (1997). Predictors and outcome in panic disorder: a 2-year prospective follow-up study. Psychopathology, 30, 177184.
Schneider, L. S. et al. (2003). An 8-week multicenter, parallel-group, double-blind, placebo-controlled study of sertraline in elderly outpatients with major depression. American Journal of Psychiatry, 160, 12771285.
Schneider, G. et al. (2004). What influences self-perception of health in the elderly? The role of objective health condition, subjective well-being and sense of coherence. Archives of Gerontology and Geriatrics, 39, 227237.
Scholing, A. and Emmelkamp, P. M. (1999). Prediction of treatment outcome in social phobia: a cross-validation. Behaviour Research and Therapy, 37, 659670.
Scholing, A. and Emmelkamp, P. M. G. (1995). Sociale Fobie (4 vols.) Houten: Bohn Stafleu van Loghum.
Schuurmans, J. et al. (2005). The outcome of anxiety disorders in older people at 6-year follow-up: results from the Longitudinal Aging Study Amsterdam. Acta Psychiatica Scandinavica, 111, 420428.
Schuurmans, J. et al. (2006). A randomized controlled trial of the effectiveness of cognitive-behavioral therapy and sertraline versus a wait-list control group for anxiety disorders in older adults. American Journal of Geriatric Psychiatry, 14, 255263.
Seivewright, H., Tyrer, P. and Johnson, T. (1998). Prediction of outcome in neurotic disorder: a 5-year prospective study. Psychological Medicine, 28, 11491157.
Slaap, B. R. and den Boer, J. A. (2001). The prediction of nonresponse to pharmacotherapy in panic disorder: a review. Depression and Anxiety, 14, 112122.
Solvason, H. B., Ernst, H. and Roth, W. (2003). Predictors of response in anxiety disorders. Psychiatric Clinics of North America, 26, 411433.
Stanley, M. A. et al. (2009). Cognitive-behavior therapy for generalized anxiety disorder among older adults in primary care: a randomized clinical trial. JAMA, 301, 1460–167.
Stein, D. J., Montgomery, S. A., Kasper, S. and Tanghoj, P. (2001). Predictors of response to pharmacotherapy with citalopram in obsessive-compulsive disorder. International Clinical Psychopharmacology, 16, 357361.
Steketee, G. and Chambless, D. L. (1992). Methodological issues in prediction of treatment outcome. Clinical Psychology Review, 12, 387400.
Stewart, A. L., Hays, R. D. and WareJ. E., Jr. J. E., Jr. (1988). The MOS short-form general health survey. Reliability and validity in a patient population. Medical Care, 26, 724735.
van Schaik, D. J. et al. (2004). Patients’ preferences in the treatment of depressive disorder in primary care. General Hospital Psychiatry, 26, 184189.
Wetherell, J. L., Gatz, M. and Craske, M. G. (2003). Treatment of generalized anxiety disorder in older adults. Journal of Consulting and Clinical Psychology, 71, 3140.
Woods, S. W. et al. (1998). Efficient allocation of patients to treatment cells in clinical trials with more than two treatment conditions. American Journal of Psychiatry, 155, 14461448.

Keywords

Long-term effectiveness and prediction of treatment outcome in cognitive behavioral therapy and sertraline for late-life anxiety disorders

  • Josien Schuurmans (a1), Hannie Comijs (a2), Paul M. G. Emmelkamp (a3), Ingrid J. C. Weijnen (a4), Marcel van den Hout (a5) and Richard van Dyck (a6)...

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