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

Published online by Cambridge University Press:  13 July 2009

Josien Schuurmans*
Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands
Hannie Comijs
GGZinGeest, Amsterdam, The Netherlands
Paul M. G. Emmelkamp
Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
Ingrid J. C. Weijnen
Riagg Maastricht, Maastricht, The Netherlands
Marcel van den Hout
Department of Social Sciences, University of Utrecht, The Netherlands
Richard van Dyck
Department of Psychiatry and Institute for Research in Extramural Medicine, VU Medical Centre, Amsterdam, The Netherlands
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:


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.

Research Article
Copyright © International Psychogeriatric Association 2009

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