Cognitive behavioural therapy for older adults with generalised anxiety disorder

Cognitive behavioural therapy (CBT) and applied relaxation are the recommended talking treatments for generalised anxiety disorder (GAD) in adults. No specific recommendations are currently available for older adults with GAD due to paucity of evidence. In order to contribute to the GAD older adult evidence base (1) a meta-analysis of clinical trials has been performed and (2) a case series of providing group CBT has been conducted.

The first part of the thesis reports a meta-analytic review of 14 randomized controlled trials of CBT for GAD in older adults. Results showed CBT to be an effective treatment, but did not provide conclusive evidence of superiority of CBT against other evidenced-based psychotherapies. Avenues for the continued methodological development of field are discussed.

The second part of the thesis presents a case series study evaluating group delivery of an existing GAD treatment protocol with older adults. The focus of the study was on feasibility, acceptability and effectiveness. Mixed methods were used across the three main study phases (baseline, intervention and follow-up) with N=23 eligible participants. Participant dropout was low, homework compliance high, and large treatment effects on the primary outcome measure of worry were found. Merged findings suggested the group intervention was an acceptable, feasible, effective, and durable treatment option. The potential of group interventions for late life GAD are discussed. Taken together, the two studies suggest that group format does not reduce the acceptability and effectiveness of treatment, and provide an opportunity for delivery of cost-effective treatment for older adults with GAD.