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Telephone-delivered CBT more effective for older adults with GAD living in rural areas

For older patients with generalized anxiety disorder, telephone-delivered cognitive behavioral therapy and telephone-delivered nondirective supportive therapy achieved similar positive outcomes, though cognitive behavioral therapy resulted in greater symptom reductions.

“There are a number of barriers that older adults face, particularly those who live in rural areas. Mobility and transportation limitations can make travel to a professional’s office difficult. Older adults are also less likely to receive psychotherapy if they live in a county without a mental health professional, which is more of a problem for rural residents. Further, professionals specializing in late-life mental health disorders are even less common in rural areas. Thus, alternate methods of providing treatment may increase mental health care utilization by this underserved population,” study researcher Gretchen A. Brenes, PhD, of Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues wrote.

Gretchen A. Brenes

To assess efficacy of alternate treatment methods, researchers randomly assigned 141 older adults with generalized anxiety disorder (GAD) to receive telephone-delivered cognitive behavioral therapy (CBT) or telephone-delivered nondirective supportive therapy. Study participants were aged 60 years or older and lived in rural areas.

Telephone-delivered CBT was delivered in at least nine sessions focused on recognition of anxiety symptoms, relaxation, cognitive restructuring, use of coping statements, problem solving, worry control, behavioral activation, exposure therapy and relapse prevention, with optional focus on sleep and pain.

Telephone-delivered nondirective supportive therapy consisted of 10 sessions with the objective of providing a supportive atmosphere in which individuals could share and discuss their feelings. Direct suggestions for coping were not provided.

Interviewers rated anxiety severity via the Hamilton Anxiety Rating Scale and participants reported worry severity via the Penn State worry Questionnaire-Abbreviated at baseline, 2-month follow-up and 4-month follow-up.

Compared with participants who received telephone-delivered nondirective supportive therapy, those who received telephone-delivered CBT experienced a greater decline in worry severity (P = .004) but not in general anxiety symptoms (P = .24) at 4-month follow-up.

Further, there was a greater decline in GAD symptoms (P = .005) and depressive symptoms (P = .02) among participants who received telephone-delivered CBT vs. those who received telephone-delivered nondirective supportive therapy at 4-month follow-up.

Overall, the study findings indicate both treatments reduced symptoms of worry, depression and GAD; however, CBT was superior to nondirective supportive therapy and resulted in a greater symptom reduction, according to researchers.

“The effectiveness findings alone are noteworthy because they close the book on the lingering question of whether CBT is effective in anxious older adults,” Eric J. Lenze, MD, of the Washington University School of Medicine in St Louis, Missouri, wrote in an accompanying editorial. “We are in the midst of the following two unprecedented trends: the aging of the population and the transformation of everything in our lives by mobile technology. These two trends are inextricably linked in the area of geriatric mental health and our search for better, more effective treatments with greater reach.” – by Amanda Oldt

Disclosure: Brenes and colleagues report no relevant financial disclosures. Lenze reports receiving grant/research support from the NIH, FDA, McKnight Brain Research Foundation, Taylor Family Institute for Innovative Psychiatric Research, Barnes Jewish Foundation, Roche, Lundbeck, Takeda, and the Sidney R. Baer Foundation.