title: Cognitive behavior therapy for late-life generalized anxiety disorder delivered by lay and expert providers has lasting benefits.
abstract: Peaceful Living, a cognitive-behavioral treatment (CBT) for late-life generalized anxiety disorder (GAD), produced positive outcomes in GAD severity, anxiety, depression, insomnia, and mental health quality of life relative to usual care with treatment delivered by either bachelor-level lay providers (BLPs) or PhD-level expert providers (PLPs). We examined long-term maintenance of gains during 12 months following CBT for patients in this trial who received the intervention delivered by BLPs and PLPs and completed post-treatment assessments.
  
  
  
  Participants were 112 older adults (mean age, 66.83 years) with GAD recruited from primary care who received CBT from BLPs (n = 52) or PLPs (n = 60) and completed post-treatment assessments. Assessments were given at post-treatment and at 6- and 12-month follow-up. Primary outcomes assessed long-term maintenance of gains in worry (Generalized Anxiety Disorder Severity Scale) and anxiety (State-Trait Anxiety Inventory, Structured Interview Guide for the Hamilton Anxiety Scale). Secondary outcomes assessed depression (Patient Health Questionnaire), mental health quality of life (Medical Outcomes Study Short Form - mental wellness scale), and sleep (Insomnia Severity Index).
  
  
  
  At 6- and 12-month follow-ups, post-treatment reductions in GAD severity, anxiety, depression, and improvements in mental health quality of life and sleep were maintained for patients in both groups. No differences were found, based on provider group.
  
  
  
  Treatment of late-life anxiety delivered by nonexpert lay providers working under supervision of licensed providers has lasting benefits. These findings support the potential of new models of care for older adults that may expand reach of mental health services. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Michael E. DeBakey VA Medical Center, Houston, TX, USA. jcalleo@bcm.edu.|Baylor College of Medicine, Houston, TX, USA. jcalleo@bcm.edu.
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Freshour
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.|Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBAKEY VA Medical Center, Houston, TX, USA.
authors.forename: Amber B
authors.initials: AB
authors.lastname: Amspoker
authors.affiliation: The University of Texas School of Public Health, Houston, TX, USA.
authors.forename: Misung
authors.initials: M
authors.lastname: Yi
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.|Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBAKEY VA Medical Center, Houston, TX, USA.|South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Kunik
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.|Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBAKEY VA Medical Center, Houston, TX, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Wilson
authors.affiliation: Michael E. DeBakey VA Medical Center, Houston, TX, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kraus-Schuman
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.|Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBAKEY VA Medical Center, Houston, TX, USA.|South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cully
authors.affiliation: Michael E. DeBakey VA Medical Center, Houston, TX, USA.|Baylor College of Medicine, Houston, TX, USA.|Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBAKEY VA Medical Center, Houston, TX, USA.|South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Teng
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Williams
authors.affiliation: Michael E. DeBakey VA Medical Center, Houston, TX, USA.|Baylor College of Medicine, Houston, TX, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Masozera
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Horsfield
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.|Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBAKEY VA Medical Center, Houston, TX, USA.|South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Stanley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000458:organization & administration; D003150:Community Health Workers; D003156:Community Mental Health Services / Q000379:methods*; D003866:Depressive Disorder / Q000150:complications; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration; D006801:Humans; D008297:Male; D011788:Quality of Life
keywords: anxiety disorders; clinical trials; cognitive-behavioral therapy; healthcare providers