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Early response to psychotherapy and long-term change in worry symptoms in older adults with generalized anxiety disorder.

OBJECTIVES
To determine the association of early and long-term reductions in worry symptoms after cognitive behavior therapy (CBT) for generalized anxiety disorder (GAD) in older adults.


DESIGN
Substudy of larger randomized controlled trial.


SETTING
Family medicine clinic and large multispecialty health organization in Houston, TX, between March 2004 and August 2006.


PARTICIPANTS
Patients (N = 76) aged 60 years or older with a principal or coprincipal diagnosis of GAD, excluding those with significant cognitive impairment, bipolar disorder, psychosis, or active substance abuse.


INTERVENTION
CBT, up to 10 sessions for 12 weeks, or enhanced usual care (regular, brief telephone calls, and referrals to primary care provider as needed).


MEASUREMENTS
Penn State Worry Questionnaire (PSWQ) administered by telephone at baseline, 1 month (mid treatment), 3 months (posttreatment), and at 3-month intervals through 15 months (1-year follow-up). The authors used binary logistic regression analysis to determine the association between early (1 month) response and treatment responder status (reduction of more than 8.5 points on the PSWQ) at 3 and 15 months. The authors also used hierarchical linear modeling to determine the relationship of early response to the trajectory of score change after posttreatment.


RESULTS
Reduction in PSWQ scores after the first month predicted treatment response at posttreatment and follow-up, controlling for treatment arm and baseline PSWQ score. The magnitude of early reduction also predicted the slope of score change from posttreatment through the 15-month assessment.


CONCLUSION
Early symptom reduction is associated with long-term outcomes after psychotherapy in older adults with GAD.