title: Cognitive-behavioral therapy for late-life anxiety: Similarities and differences between Veteran and community participants.
abstract: Cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety; however, a growing body of research suggests that CBT effect sizes are smaller in Veteran samples. The aim of this study was to perform secondary data analyses of a randomized controlled trial of CBT for late-life generalized anxiety disorder compared with treatment as usual (TAU) in a Veteran (n = 101) and community-based (n = 122) sample. Veterans had lower income and less education than community participants, greater severity on baseline measures of anxiety and depression, poorer physical health, and higher rates of psychiatric comorbidity. Treatment effects were statistically significant in the community sample (all ps < 0.01), but not in Veterans (all ps > 0.05). Further analyses in Veterans revealed that poorer perceived social support significantly predicted poorer outcomes (all ps < 0.05). Our results underscore the complexity of treating Veterans with anxiety, and suggest that additional work is needed to improve the efficacy of CBT for Veterans, with particular attention to social support.
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States; South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, United States. Electronic address: terrib@bcm.edu.
authors.forename: Terri L
authors.initials: TL
authors.lastname: Barrera
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States; South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, United States.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cully
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States.
authors.forename: Amber B
authors.initials: AB
authors.lastname: Amspoker
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Wilson
authors.affiliation: Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kraus-Schuman
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States.
authors.forename: Paula D
authors.initials: PD
authors.lastname: Wagener
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States.
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Calleo
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States; South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, United States.
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Teng
authors.affiliation: Harris County Psychiatric Center, The University of Texas Health Science Center at Houston, Houston, TX, United States.
authors.forename: Howard M
authors.initials: HM
authors.lastname: Rhoades
authors.affiliation: Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Masozera
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States; South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, United States.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Kunik
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States; South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, United States.
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Stanley
mesh_terms: D000368:Aged; D001008:Anxiety Disorders / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012944:Social Support; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology
keywords: Anxiety; Cognitive–behavioral therapy; Psychotherapy; Randomized controlled trial; Veterans