The testing of an effective, short-term psychosocial treatment for anxiety is proposed to facilitate the reduction of benzodiazepine (BZD) use by patients with late-life Generalized Anxiety Disorder (GAD). Recent epidemiological surveys suggest that up to 30% of the elderly suffer from anxiety disorders, most commonly from GAD. Most of these patients are treated with benzodiazepines. While they offer a number of advantages over other pharmacotherapies, BZD's may impair cognitive functioning and cause significant sedation. Cognitive behavioral treatment (CBT) has been found to be an effective alternative to the pharmacotherapy of anxiety disorders. CBT may address psychological concerns associated with benzodiazepine use in the elderly and may attenuate the discontinuance syndrome. A cognitive behavioral anxiety management manual that has been found effective in the general population was modified to address specific problems in the elderly and the difficulties associated with BZD taper. Patients with Generalized Anxiety Disorder between the ages of 65 and 80 who are regularly taking BZD's will be randomized to receive CBT in combination with medical management (MM) or MM alone for 13 weeks. MM consists of monitoring BZD taper and side-effects. Blind to treatment condition, assessments will be conducted before and after treatment and at a 6 month follow-up. The results will guide future plans to evaluate the complex relationship between the efficacy of CBT in reducing anxiety and successful BZD taper. The study will form the basis to create a new and much needed late-life anxiety disorders program within the Department of Psychiatry.
| Gorenstein, Ethan E; Kleber, Marc S; Mohlman, Jan et al. (2005) Cognitive-behavioral therapy for management of anxiety and medication taper in older adults. Am J Geriatr Psychiatry 13:901-9 |
| Mohlman, Jan; de Jesus, Marybeth; Gorenstein, Ethan E et al. (2004) Distinguishing generalized anxiety disorder, panic disorder, and mixed anxiety states in older treatment-seeking adults. J Anxiety Disord 18:275-90 |
| Mohlman, Jan; Gorenstein, Ethan E; Kleber, Marc et al. (2003) Standard and enhanced cognitive-behavior therapy for late-life generalized anxiety disorder: two pilot investigations. Am J Geriatr Psychiatry 11:24-32 |
