CBT Found to Be Clinically Effective for Depressed Older Adults in Primary Care

NewStudy-Graphic-72x72_edited-3A new study published in the Archives of General Psychiatry investigated the clinical effectiveness of cognitive behavior therapy (CBT) for older adults in primary care. A total of 204 men and women aged 65 years or older with geriatric depression were randomly assigned to one of three groups: treatment as usual (TAU), TAU plus a talking control (TC), and TAU plus CBT. The CBT and TC treatments were offered over a period of four months and participants were followed up at 10 months. Depressive levels were measured with the Beck Depression Inventory-II (BDI-II) at baseline, at four months (the end of therapy), and again at 10 months. Based on BDI-II scores per session, a significant benefit of CBT versus the TAU and TC was observed, pointing to CBT as an effective treatment for depression in older adults.

This study was the largest CBT study conducted by general practitioner of their patients.

Generalized Anxiety Disorder — CBT Benefits Older Adults in Primary Care

NewStudy-Graphic-72x72_edited-3 The results of a randomized clinical trial published in JAMA indicate that cognitive behavior therapy (CBT) can be effective for older adults with symptoms of worry and depression.

The 3-month CBT protocol was conducted in primary care clinics and included education, cognitive therapy, and problem-solving skills. Measures included the Beck Anxiety Inventory and Beck Depression Inventory II. Post-treatment assessments were conducted every three months over fifteen months.

Compared with the control group, patients who received treatment showed improvement in worry severity, depressive symptoms, and general mental health. A measure of GAD severity, however, did not indicate greater improvement with CBT.

The authors concluded that CBT is useful for this population especially in primary care settings, “where older adults most often seek treatment.”

Study authors: M. A. Stanley, N. L. Wilson, D. M. Novy, H. M. Rhoades, et al.

Older Veterans with Post-traumatic Stress Disorder Helped by CBT

NewStudy-Graphic-72x72_edited-3Medscape: According to a pilot study presented at the Anxiety Disorders Association of America 2009 Annual Conference, older veterans suffering from post-traumatic stress disorder (PTSD) and related symptoms of depression and anxiety – which can persist for decades – may benefit from prolonged exposure therapy (a form of cognitive behavioral therapy). Twelve sessions included “in vivo experience, in which patients are exposed to fears out in the world, and imaginary exposure.”

Measures of efficacy included a Clinician-Administered PTSD Scale (CAPS); after treatment, patients showed a significant reduction in mean CAPS score and 75% no longer met PTSD criteria. Patients showed clinical improvement in most PTSD symptoms along with individual symptoms of avoidance and hyperarousal. Additionally, Beck Depression Inventory (BDI) and other measures showed “clinically significant improvement in both depression and anxiety.” The study author noted that after the treatment, the men were able to “do things they hadn’t done in years.”

These findings are particularly promising because they call into question the “dogma” that older adults cannot tolerate or could be harmed by exposure therapy.

According to the study author, “There are lots of people with PTSD who fought in prior wars or who have the condition for other reasons, who have pushed it aside and coped pretty well throughout their lives. Then a spouse dies, they retire or become medically ill, and their PTSD is something they no longer can put aside, and they need help. We need to know how to treat these people.”

The author is planning a randomized clinical trial in 100 older adults with PTSD.

Study author: S. R. Thorp

Centers for Disease Control panel recommends CBT for Depression in older adults

A recent review in Preventing Chronic Disease reported that about 5% to 15% of community-dwelling older adults (60+ y.o.) suffer from depression, which results in functional impairment and is possibly associated with increased mortality rates through suicide and complications of cardiac disease. As such, it is increasingly recognized as a significant public health problem in that population.

To address this problem, a panel was convened by the National Center for Chronic Disease Prevention and Health Promotion, one of eight centers within the Centers for Disease Control and Prevention. After systematically reviewing 97 studies, “the researcher-practitioner expert panel strongly recommended interventions based on the depression care management (DCM) model and recommended cognitive behavioral therapy (CBT) as treatment for depression in older adults.”

The report discussed strategies to implement its recommendations. It noted that many CBT practitioners work in specialty mental health settings and are not in contact with primary care or community-based programs for older adults. A further obstacle is that many older adults are reluctant to go to mental health specialists.

The panel concluded that partnerships among researchers, health care providers, and policy makers will be necessary to overcome the obstacles to the treatment of depression in older adults.

Study authors: M. Snowden, L. Steinman, J. Frederick