title: A randomized, controlled trial of the effectiveness of cognitive-behavioral therapy and sertraline versus a waitlist control group for anxiety disorders in older adults.
abstract: OBJECTIVE
  This study is the first to investigate the relative effectiveness of cognitive-behavioral therapy (CBT) compared with a selective serotonin reuptake inhibitor (SSRI; sertraline) in a randomized, controlled trial on the treatment of anxiety disorders in older adults.
  
  
  METHODS
  Eighty-four patients 60 years of age and over with a principal diagnosis of generalized anxiety disorder, panic disorder, agoraphobia, or social phobia were randomly assigned to one of three conditions: 15 sessions of CBT, pharmacologic treatment with an SSRI (sertraline; maximum dosage 150 mg), or a waitlist control group. Participants completed measures of primary outcome (anxiety) and coexistent worry and depressive symptoms at baseline, posttreatment, and at three-month follow up.
  
  
  RESULTS
  Attrition rates were high in both treatment groups. Consequently, findings are based on a relatively small sample of completers (N = 52). Although both CBT and sertraline led to significant improvement in anxiety, worry, and depressive symptoms both at posttreatment and at three-month follow up, sertraline showed superior results on worry symptoms. Effect size estimates for CBT were in the small to medium range both at posttreatment (mean d = 0.42) and at three-month follow up (mean d = 0.35), whereas effect sizes for sertraline fell into the large range (posttreatment mean d = 0.94 and three-month follow up mean d = 1.02). The waitlist condition showed virtually no effects (posttreatment mean d = .03).
  
  
  CONCLUSIONS
  Our findings strongly suggest that the pharmacologic treatment of late-life anxiety with SSRIs has not been given the proper attention in research to date.
authors.affiliation: Department of Psychiatry and Institute for Research in Extramural Medicine, VU Medical Centre, Amsterdam, The Netherlands. j.schuurmans@psy.vu.nl
authors.forename: Josien
authors.initials: J
authors.lastname: Schuurmans
authors.forename: Hannie
authors.initials: H
authors.lastname: Comijs
authors.forename: Paul M G
authors.initials: PM
authors.lastname: Emmelkamp
authors.forename: Chad M M
authors.initials: CM
authors.lastname: Gundy
authors.forename: Ingrid
authors.initials: I
authors.lastname: Weijnen
authors.forename: Marcel
authors.initials: M
authors.lastname: van den Hout
authors.forename: Richard
authors.initials: R
authors.lastname: van Dyck
mesh_terms: D000368:Aged; D000379:Agoraphobia / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D010352:Patient Dropouts; D010555:Personality Inventory; D012016:Reference Values; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D020280:Sertraline / Q000009:adverse effects / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D014151:Anti-Anxiety Agents; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline