An Improved Approach for Treating Anxiety in Old Age

The so-called General Anxiety Disorder, in which people worry constantly about many things in their lives, is common in the elderly. It’s often treated with a benzodiazepine such as Valium®, but this can increase the risk of falls due to its sedative effect. A recent trial of cognitive behavioral therapy (CBT) has proved effective; it’s been reported in the Journal of the American Medical Association.

One group of 134 patients (average age 67) received CBT for 3 months, while an equal-sized group was treated with ‘enhanced usual care’. The CBT consisted of up to 10 therapy sessions with an experienced non-doctoral psychotherapist over a 3- month period, followed by brief phone-based booster sessions, 4 times during the next 10 months. The enhanced usual care was usual care provided by the family physician, beefed up by biweekly phone calls from a psychotherapist. Both groups were allowed to take their usual medications: one in 6 took an anti-anxiety drug and one in 3 took an anti-depressive.

After 3 months, worry scores, depression scores, and the general anxiety disorder scores decreased twice as much in the CBT group as in the usual care group. And mental health status increased twice as much with CBT as with usual care. The relative effectiveness of CBT persisted throughout the additional year of follow-up.

The results are fairly impressive. Obvious questions, however, surround the practicalities of delivering CBT to all those patients who could benefit from it. (CBT is effective in sleep disorder,

One author of this study pointed out that CBT can be “delivered by non-doctoral providers such licensed practical nurses and other lower-cost professionals”. It still sounds an expensive undertaking, compared to a handful of pills. Maybe computerized CBT – recommended by the comparative efficacy board in the British National Health Service (NICE) – can solve the problem. A sample program for warding off depression can be found online.