title: Effects of Telephone-Delivered Cognitive-Behavioral Therapy and Nondirective Supportive Therapy on Sleep, Health-Related Quality of Life, and Disability.
abstract: The purpose of this study was to compare the effects of cognitive-behavioral therapy delivered by telephone (CBT-T) and telephone-delivered nondirective supportive therapy (NST-T) on sleep, health-related quality of life, and physical disability in rural older adults with generalized anxiety disorder.
  
  
  
  This was a secondary analysis of a randomized clinical trial on 141 rural-dwelling adults 60 years and older diagnosed with generalized anxiety disorder. Sleep was assessed with the Insomnia Severity Index. Health-related quality of life was assessed with the 36-item Short-Form Health Survey (SF-36). Physical disability was assessed with the Pepper Center Tool for Disability. Assessments occurred at baseline, 4 months, 9 months, and 15 months.
  
  
  
  Insomnia declined in both groups from baseline to 4 months, with a significantly greater improvement among participants who received CBT-T. Similarly, Mental and Physical Component Summaries of the SF-36 declined in both groups, with a differential effect favoring CBT-T. Participants in both interventions reported declines in physical disability, although there were no significant differences between the two interventions. Improvements in insomnia were maintained at the 15-month assessment, whereas between-group differences shrank on the Mental and Physical Component Summaries of the SF-36 by the 15-month assessment.
  
  
  
  CBT-T was superior to NST-T in reducing insomnia and improving health-related quality of life. The effects of CBT-T on sleep were maintained 1 year after completing the treatment.
authors.affiliation: Departments of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: gbrenes@wakehealth.edu.
authors.forename: Gretchen A
authors.initials: GA
authors.lastname: Brenes
authors.affiliation: Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Danhauer
authors.affiliation: Internal Medicine-Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Lyles
authors.affiliation: Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Anderson
authors.affiliation: Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012424:Rural Population; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D012944:Social Support; D013689:Telephone; D016896:Treatment Outcome
keywords: Cognitive-behavioral therapy; GAD; RCT; late-life anxiety; psychotherapy; supportive therapy