Cognitive-behavioral therapy for management of anxiety and medication taper in older adults.
OBJECTIVE
The authors hypothesized that patients with late-life anxiety undergoing cognitive-behavioral therapy plus medical management for medication taper (CBT-MM) would realize greater reduction in medication use and greater improvement in psychological symptoms than a control group undergoing medical management alone (MM).


METHODS
Forty-two patients (age >60) who wanted to reduce anxiolytic medication were allocated to the two groups (CBT-MM versus MM), using a randomization plus difference-minimization procedure (to equate for medication use).


RESULTS
CBT-MM completers significantly reduced medication use, but not at a greater rate than MM completers. At the same time, CBT-MM completers experienced significantly greater alleviation of psychological symptoms than did MM completers. Some, but not all, treatment gains were maintained at 6-month follow-up. Intention-to-treat analyses using the mixed-effects model showed similar, but weaker, treatment effects than completer analyses.


CONCLUSIONS
Cognitive-behavioral therapy can alleviate psychological symptoms in elderly patients with anxiety even as patients reduce anxiolytic medication.
Gorenstein
Ethan E
EE
Department of Psychiatry, Columbia University, New York, NY 10032, USA. EEG1@columbia.edu
Kleber
Marc S
MS
Mohlman
Jan
J
Dejesus
Marybeth
M
Gorman
Jack M
JM
Papp
Laszlo A
LA
D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000628:therapy*; D001569:Benzodiazepines / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009294:Narcotics / Q000627:therapeutic use*
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D009294:Narcotics; D001569:Benzodiazepines