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Harper N, Delgadillo M, Erickson A, Boese A, Schulte T, Fairchild JK. Mindfulness attenuates the impact of worry on late-life cognitive function. Aging Ment Health 2023; 27:399-407. [PMID: 35006021 DOI: 10.1080/13607863.2021.2017851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: Worry has been shown to have a negative impact on many aspects of neurocognitive performance. Interestingly, research indicates mindfulness both improves aspects of cognitive ability and reduces worry symptoms. Yet, the impact of mindfulness on the relationship between worry and cognition has yet to be explored. Based on research discussed herein, we hypothesize that those with higher levels of dispositional mindfulness will have better cognitive performance than those with lower levels of dispositional mindfulness, regardless of worry level. The present study investigated the potential moderating influence of mindfulness on the relationship between worry and cognitive performance.Methods: The sample included 113 older veterans who were screened at the VA Palo Alto Health Care System in Palo Alto, CA. Cognitive domains of interest included learning and memory, processing speed, attention, working memory, and executive function. Mindfulness was assessed with the Five Facet Mindfulness Questionnaire (FFMQ), and worry symptoms were assessed using the Penn State Worry Questionnaire (PSWQ). Hypotheses were tested with multiple regression analyses using the Hayes (2003) PROCESS macro.Results: Contrary to what was hypothesized, only mindful awareness significantly moderated the relationship between worry and processing speed.Conclusion: This finding has important implications for introducing mindfulness techniques into older adults' routines to decrease worry and mitigate its negative effects on processing speed.
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Affiliation(s)
- Nesha Harper
- Psychology Department, Palo Alto University, Palo Alto, CA, USA
| | - Mia Delgadillo
- Psychology Department, Palo Alto University, Palo Alto, CA, USA
| | | | - Aidan Boese
- Psychology Department, Palo Alto University, Palo Alto, CA, USA
| | - Tilman Schulte
- Psychology Department, Palo Alto University, Palo Alto, CA, USA
| | - J Kaci Fairchild
- Department of Veteran Affairs, Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, USA.,Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Evidence-based assessment of treatment outcomes for late-life generalized anxiety disorder using the Penn State Worry Questionnaire (PSWQ) and Penn State Worry Questionnaire - Abbreviated (PSWQ-A). Int Psychogeriatr 2022; 34:489-501. [PMID: 33818343 DOI: 10.1017/s1041610221000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Penn State Worry Questionnaire (PSWQ) is a commonly used measure of treatment outcome for late-life generalized anxiety disorder (GAD). However, there is considerable variability in the definitions used to define treatment response and remission. This study aimed to provide empirically derived guidelines for assessing treatment response and remission among older adults with GAD using the PSWQ and the abbreviated PSWQ (PSWQ-A). DESIGN Longitudinal assessment of GAD symptoms pre- and posttreatment. PARTICIPANTS Participants were 259 older adults aged 60-86 years with a diagnosis of GAD who were assessed before and after treatment. INTERVENTION Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions. MEASUREMENTS Signal-detection analyses using receiver operating characteristic (ROC) methods were used to determine optimal agreement between structured diagnostic interviews and scores on the PSWQ and PSWQ-A. RESULTS Results suggest that a score of ≤51 was optimal for defining diagnostic remission status on the PSWQ, and a score of ≤24 was optimal on the PSWQ-A. A 9% reduction or ≥4-point reduction was optimal for assessing treatment response on the PSWQ. The PSWQ-A was poor at identifying treatment response status. CONCLUSIONS Findings suggest that most of the previously used definitions have underestimated the treatment effects for late-life GAD. However overall, the PSWQ and PSWQ-A are suboptimal for assessing treatment outcome for late-life GAD. The standardization of response and remission criteria has implications for comparison between treatment trials, and for the benchmarking of outcomes in clinical practice.
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Schwarz C, Lange C, Benson GS, Horn N, Wurdack K, Lukas M, Buchert R, Wirth M, Flöel A. Severity of Subjective Cognitive Complaints and Worries in Older Adults Are Associated With Cerebral Amyloid-β Load. Front Aging Neurosci 2021; 13:675583. [PMID: 34408640 PMCID: PMC8365025 DOI: 10.3389/fnagi.2021.675583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/22/2021] [Indexed: 01/19/2023] Open
Abstract
Subjective cognitive decline (SCD) is considered an early risk stage for dementia due to Alzheimer's disease (AD) and the development of pathological brain changes, such as the aggregation of amyloid-beta (amyloid-β) plaques. This study evaluates the association between specific features of SCD and cerebral amyloid-β load measured by positron emission tomography (PET) with 18F-florbetaben in 40 cognitively normal older individuals. Global amyloid-β, as well as regional amyloid-β load for the frontal, temporal, parietal, and cingulate cortex, was quantified. Specific features of SCD, such as subjective cognitive complaints and worry, were assessed using the 39-item Everyday Cognition Scales and the 16-item Penn State Worry Questionnaire. Spearman's rank partial correlation analyses, adjusted for age and apolipoprotein E ε4 status, were conducted to test the associations between specific features of SCD and cerebral amyloid-β load. The severity of subjective cognitive complaints in everyday memory and organization was positively correlated with amyloid-β load in the frontal cortex. In addition, the severity of subjective cognitive complaints in everyday planning was positively correlated with amyloid-β load in the parietal cortex. Higher levels of worry were associated with higher amyloid-β load in the frontal cortex. After correction of the PET data for partial volume effects, these associations were reduced to trend level. In conclusion, the severity of subjective cognitive complaints and the level of trait worry were positively associated with cortical amyloid-β burden, particularly in the frontal and parietal cortex. Further studies are required to elucidate the direction of these associations in order to develop strategies to prevent amyloid deposition and cognitive decline.
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Affiliation(s)
- Claudia Schwarz
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Catharina Lange
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Gloria S Benson
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nora Horn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katharina Wurdack
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mathias Lukas
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Siemens Healthcare GmbH, Berlin, Germany
| | - Ralph Buchert
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Miranka Wirth
- German Center for Neurodegenerative Diseases (DZNE) Site: Dresden, Dresden, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases (DZNE) Site: Greifswald, Greifswald, Germany
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4
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Gray V, Douglas KM, Porter RJ. Emotion processing in depression and anxiety disorders in older adults: systematic review. BJPsych Open 2020; 7:e7. [PMID: 33267933 PMCID: PMC7791559 DOI: 10.1192/bjo.2020.143] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Emotional cognition and effective interpretation of affective information is an important factor in social interactions and everyday functioning, and difficulties in these areas may contribute to aetiology and maintenance of mental health conditions. In younger people with depression and anxiety, research suggests significant alterations in behavioural and brain activation aspects of emotion processing, with a tendency to appraise neutral stimuli as negative and attend preferentially to negative stimuli. However, in ageing, research suggests that emotion processing becomes subject to a 'positivity effect', whereby older people attend more to positive than negative stimuli. AIMS This review examines data from studies of emotion processing in Late-Life Depression and Late-Life Anxiety to attempt to understand the significance of emotion processing variations in these conditions, and their interaction with changes in emotion processing that occur with ageing. METHOD We conducted a systematic review following PRISMA guidelines. Articles that used an emotion-based processing task, examined older persons with depression or an anxiety disorder and included a healthy control group were included. RESULTS In Late-Life Depression, there is little consistent behavioural evidence of impaired emotion processing, but there is evidence of altered brain circuitry during these processes. In Late-Life Anxiety and Post-Traumatic Stress disorder, there is evidence of interference with processing of negative or threat-related words. CONCLUSIONS How these findings fit with the positivity bias of ageing is not clear. Future research is required in larger groups, further examining the interaction between illness and age and the significance of age at disease onset.
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Affiliation(s)
- Vanessa Gray
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago; and Canterbury District Health Board, Christchurch, New Zealand
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Shrestha S, Ramos K, Fletcher TL, Kraus-Schuman C, Stanley MA, Ramsey D, Amspoker AB. Psychometric properties of worry and anxiety measures in a sample of african american and caucasian older adults. Aging Ment Health 2020; 24:315-321. [PMID: 30810345 DOI: 10.1080/13607863.2018.1544217] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The aim of our study was to examine the psychometric properties of commonly used anxiety and worry assessment measures in a community-based, low-income sample of African American and Caucasian older adults.Method: African American and Caucasian participants from three community-based clinical trials testing treatments for late-life worry/anxiety were pooled to examine the factor structure, internal consistency reliability, and convergent, discriminant, and predictive validity of the Penn State Worry Questionnaire-Abbreviated (PSWQ-A), Generalized Anxiety Disorder-7 (GAD-7) and Geriatric Anxiety Inventory-short form (GAI-SF).Results: All three measures demonstrated an adequate fit to a one-factor structure. Internal consistency reliability was adequate for the PSWQ-A and GAD-7 in the total sample and racial subgroups but was acceptable for the GAI-SF only in the African American subgroup. The PSWQ-A and GAD-7 demonstrated good convergent, discriminant, and predictive validity. The GAI-SF has adequate convergent and divergent validity in the African American subgroup.Conclusion: Our study offers preliminary evidence for use of the PSWQ-A and GAD-7 for assessment of anxiety in a sample of low-income, predominantly African American participants. These measures may facilitate identification of anxiety symptoms, which are often overlooked in this population. More research is needed to examine the accuracy of these measures in other racial/ethnic groups.
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Affiliation(s)
- Srijana Shrestha
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX.,Department of Psychology, Wheaton College, Wheaton, IL
| | - Katherine Ramos
- Geriatric Education, Research, and Clinical Center, Veterans Affairs Medical Center, Durham, NC.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Terri L Fletcher
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX.,VA South Central Mental Illness Research Education and Clinical Center
| | - Cynthia Kraus-Schuman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX.,Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Melinda A Stanley
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX.,VA South Central Mental Illness Research Education and Clinical Center
| | - David Ramsey
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX.,Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Amber B Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX.,Department of Medicine, Baylor College of Medicine, Houston, TX
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6
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Saade YM, Nicol G, Lenze EJ, Miller JP, Yingling M, Wetherell JL, Reynolds CF, Mulsant BH. Comorbid anxiety in late-life depression: Relationship with remission and suicidal ideation on venlafaxine treatment. Depress Anxiety 2019; 36:1125-1134. [PMID: 31682328 PMCID: PMC6891146 DOI: 10.1002/da.22964] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/14/2019] [Accepted: 09/13/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine the influence of comorbid anxiety symptoms on antidepressant treatment remission in older adults with major depressive disorder (MDD). METHOD In this multisite clinical trial, 468 older adults aged 60 years or older with MDD received open-label protocolized treatment with venlafaxine extended release (ER) titrated to a maximum of 300 mg daily. At baseline, anxiety was assessed with the Anxiety Sensitivity Index, the Brief Symptom Inventory (BSI) anxiety subscale, and the Penn State Worry Questionnaire. To measure treatment response, depressive symptoms and suicidality were assessed every 1-2 weeks with the Montgomery-Asberg Depression Rating Scale and the 19-item Scale for Suicide Ideation; anxiety was assessed with the BSI. Logistic regression and survival analysis were used to evaluate whether anxiety symptoms predicted depression remission. We also examined the relationships between anxiety scores and suicidality at baseline. RESULTS Baseline anxiety symptoms did not predict remission or time to remission of depressive symptoms. Depressive, worry, and panic symptoms decreased in parallel in patients with high anxiety. Anxiety symptoms were associated with the severity of depression and with suicidality. CONCLUSION In older adults with MDD, comorbid anxiety symptoms are associated with symptom severity but do not affect antidepressant remission or time to remission.
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Affiliation(s)
- Yasmina M Saade
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Ginger Nicol
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Eric J Lenze
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - J Philip Miller
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Michael Yingling
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Julie Loebach Wetherell
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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O'Brien B, Shrestha S, Stanley MA, Pargament KI, Cummings J, Kunik ME, Fletcher TL, Cortes J, Ramsey D, Amspoker AB. Positive and negative religious coping as predictors of distress among minority older adults. Int J Geriatr Psychiatry 2019; 34:54-59. [PMID: 30375027 DOI: 10.1002/gps.4983] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/06/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The study replicated and extended previous findings by investigating relationships between positive and negative religious coping and psychological distress in minority older adults. METHODS Older adults were evaluated during screening and baseline procedures of a psychotherapy clinical trial for late-life worry and anxiety. Participants were age 50 years or older and recruited from low-income and predominantly minority neighborhoods. Participants screening positive for worry (PSWQ-A ≥ 23) with no significant cognitive impairment (Six-Item Screener for cognitive impairment ≤2) completed a diagnostic interview and baseline assessments. Positive and negative religious coping were assessed with the positive and negative coping subscales of the Brief Religious Coping scale. Psychological distress was assessed with measures of depression, anxiety, and worry. A set of multiple linear regression models were used to evaluate the relationship between religious coping and each measure of psychological distress. RESULTS Negative religious coping was associated with greater anxiety, worry, and depression. Positive and negative religious coping interacted such that positive religious coping buffered the effects of negative religious coping on anxiety and depression. Significant main effects and interactions remained after controlling for age, gender, race, years of education, and study. CONCLUSIONS The findings of this study are consistent with prior work showing that negative religious coping is associated with greater psychological distress. This study replicates previous findings that positive religious coping may buffer the harmful effects of negative religious coping and extends understandings of the specific psychological impacts that positive and negative religious coping may have on older, minority adults.
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Affiliation(s)
- Brittany O'Brien
- Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Srijana Shrestha
- Baylor College of Medicine, Houston, TX, USA.,Wheaton College, Norton, MA, USA
| | - Melinda A Stanley
- Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Kenneth I Pargament
- Baylor College of Medicine, Houston, TX, USA.,Bowling Green State University, Bowling Green, OH, USA
| | | | - Mark E Kunik
- Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Terri L Fletcher
- Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Jose Cortes
- Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA
| | - David Ramsey
- Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA
| | - Amber B Amspoker
- Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA
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8
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Stanley MA, Wilson NL, Shrestha S, Amspoker AB, Wagener P, Bavineau J, Turner M, Fletcher TL, Freshour J, Kraus-Schuman C, Kunik ME. Community-Based Outreach and Treatment for Underserved Older Adults With Clinically Significant Worry: A Randomized Controlled Trial. Am J Geriatr Psychiatry 2018; 26:1147-1162. [PMID: 30224269 DOI: 10.1016/j.jagp.2018.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/05/2018] [Accepted: 07/24/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether Calmer Life (CL) improved worry, generalized anxiety disorder-related (GAD-related) symptoms, anxiety, depression, sleep, trauma-related symptoms, functional status, and quality of life better than Enhanced Community Care with Resource Counseling (ECC-RC) at 6 months and 9 months. METHODS A randomized, controlled, comparative-effectiveness study involving underserved, low-income, mostly minority neighborhoods in Houston, Texas, looked at individuals ≥50 with significant worry and interest in psychosocial treatment. Interventions were CL, cognitive behavioral therapy with resource counseling, facilitation of communication with primary care providers about worry/anxiety, integration of religion/spirituality, person-centered skill content and delivery and nontraditional community providers, ECC-RC, and enhanced standard community-based information/ resource counseling addressing basic unmet and mental health needs. Primary outcomes were worry and GAD-related symptom severity. Secondary outcomes were anxiety, depression, sleep difficulties, trauma-related symptoms, functional status, quality of life, service use and satisfaction. RESULTS Similar, moderate improvements followed CL and ECC-RC on worry, GAD-related symptoms, anxiety, depression, sleep, trauma-related symptoms, and mental health quality of life at 6 and 9 months, but with symptoms at both times and higher satisfaction with CL at both. Fewer ECC-RC participants reported a hospital admission in the prior 3 months than those in CL at 6 and 9 months; at 9 months, fewer reported a visit with a provider in the previous 3 months. CONCLUSION Both interventions showed similar improvements at 6 and 9 months, but symptoms remained that might require care. Either intervention or a combination may be useful for low-income older adults with identified worry/anxiety.
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Affiliation(s)
- Melinda A Stanley
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston; the VA South Central Mental Illness Research, Education and Clinical Center (MAS, TLF, MEK), Houston.
| | - Nancy L Wilson
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Srijana Shrestha
- St. Thomas University (SS), Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Amber B Amspoker
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Paula Wagener
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | | | | | - Terri L Fletcher
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston; the VA South Central Mental Illness Research, Education and Clinical Center (MAS, TLF, MEK), Houston
| | - Jessica Freshour
- Michael E. DeBakey VA Medical Center (JF, CKS), Houston, TX; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Cynthia Kraus-Schuman
- Michael E. DeBakey VA Medical Center (JF, CKS), Houston, TX; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Mark E Kunik
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston; the VA South Central Mental Illness Research, Education and Clinical Center (MAS, TLF, MEK), Houston
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9
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Conti EC, Stanley MA, Amspoker AB, Kunik ME. Sedative-Hypnotic Use Among Older Adults Participating in Anxiety Research. Int J Aging Hum Dev 2016; 85:3-17. [DOI: 10.1177/0091415016685330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Older adults are prescribed sedative-hypnotic medications at higher rates than younger adults. These are not recommended for older adults due to risk of sedation, cognitive impairment, and falls. Severe generalized anxiety disorder (GAD) is a possibly appropriate use of these medications in older people, but little is available on use of sedative-hypnotic medications among older adults with GAD. This study examined the frequency and predictors of sedative-hypnotic medication use among older adults screening positive for anxiety. 25.88% ( n = 125) of participants reported taking sedative-hypnotics over the past 3 months; 16.36% ( n = 79) reported taking benzodiazepines, and 12.22% ( n = 59) reported taking hypnotic sleep medications. Depressive symptoms were more strongly associated with sedative-hypnotic use than insomnia or worry. Major depressive disorder and posttraumatic stress disorder, but not GAD, predicted sedative-hypnotic use. Other medications and treatments are more appropriate and efficacious for depression, anxiety, and insomnia in this population.
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Affiliation(s)
- Elizabeth C. Conti
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Melinda A. Stanley
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Amber B. Amspoker
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Mark E. Kunik
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
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10
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Barrera TL, Cully JA, Amspoker AB, Wilson NL, Kraus-Schuman C, Wagener PD, Calleo JS, Teng EJ, Rhoades HM, Masozera N, Kunik ME, Stanley MA. Cognitive-behavioral therapy for late-life anxiety: Similarities and differences between Veteran and community participants. J Anxiety Disord 2015; 33:72-80. [PMID: 26005839 PMCID: PMC4479977 DOI: 10.1016/j.janxdis.2015.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 04/20/2015] [Accepted: 04/28/2015] [Indexed: 01/18/2023]
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.
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Affiliation(s)
- Terri L Barrera
- 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.
| | - Jeffrey A Cully
- 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
| | - Amber B Amspoker
- 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
| | - Nancy L Wilson
- 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
| | - Cynthia Kraus-Schuman
- Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States
| | - Paula D Wagener
- 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
| | - Jessica S Calleo
- 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
| | - Ellen J Teng
- 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
| | - Howard M Rhoades
- Harris County Psychiatric Center, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nicholas Masozera
- Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States
| | - Mark E Kunik
- 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
| | - Melinda A Stanley
- 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
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Hundt NE, Amspoker AB, Kraus-Schuman C, Cully JA, Rhoades H, Kunik ME, Stanley MA. Predictors of CBT outcome in older adults with GAD. J Anxiety Disord 2014; 28:845-50. [PMID: 25445074 PMCID: PMC4254548 DOI: 10.1016/j.janxdis.2014.09.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 09/25/2014] [Indexed: 11/15/2022]
Abstract
The current study is a secondary analysis of data from a randomized controlled trial of CBT for late-life GAD (Stanley et al., 2014) which provided an opportunity to examine predictors of outcome among those who received CBT. Participants were 150 older adults who were randomized to receive 10 sessions of CBT. Completer analyses found that homework completion, number of sessions attended, lower worry severity, lower depression severity, and recruitment site predicted 6-month worry outcome on the PSWQ-A, whereas homework completion, credibility of the therapy, lower anxiety severity, and site predicted 6-month anxiety outcome on the STAI-T. In intent-to-treat multivariate analyses, however, only initial worry and anxiety severity, site, and number of sessions completed predicted treatment outcome. These results are largely consistent with predictors of outcome in younger adults and suggest that lower initial symptom severity and variables consistent with greater engagement in treatment predict outcome.
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Affiliation(s)
- Natalie E Hundt
- 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).
| | - Amber B Amspoker
- 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; Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Cynthia Kraus-Schuman
- Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States
| | - Jeffrey A Cully
- 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)
| | - Howard Rhoades
- Harris County Psychiatric Center, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mark E Kunik
- 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)
| | - Melinda A Stanley
- 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)
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12
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Wuthrich VM, Johnco C, Knight A. Comparison of the Penn State Worry Questionnaire (PSWQ) and abbreviated version (PSWQ-A) in a clinical and non-clinical population of older adults. J Anxiety Disord 2014; 28:657-63. [PMID: 25124502 DOI: 10.1016/j.janxdis.2014.07.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/24/2014] [Accepted: 07/04/2014] [Indexed: 10/25/2022]
Abstract
The Penn State Worry Questionnaire (PSWQ) is a widely used measure of worry severity. An 8-item abbreviated version (PSWQ-A) has been developed as a brief screening measure, although there are limited studies assessing the psychometric properties of this measure in a large geriatric population. The aim of this study was to assess the utility of the PSWQ-A compared to the full PSWQ, to identify pathological worry in an older adult sample (N=108) of clinically anxious and depressed older adults, compared to a non-clinical sample (N=53). The PSWQ and PSWQ-A were found to have similarly adequate reliability and validity. The factor structure of the PSWQ-A was replicated, but not for the PSWQ. Both measures accurately distinguished between clinical and non-clinical status with similar sensitivity and specificity. These findings indicate the PSWQ-A is a useful measure for screening or epidemiological studies assessing worry in geriatric populations.
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Affiliation(s)
- Viviana M Wuthrich
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Carly Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Ashleigh Knight
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Ivan MC, Amspoker AB, Nadorff MR, Kunik ME, Cully JA, Wilson N, Calleo J, Kraus-Schuman C, Stanley MA. Alcohol use, anxiety, and insomnia in older adults with generalized anxiety disorder. Am J Geriatr Psychiatry 2014; 22:875-83. [PMID: 23973253 PMCID: PMC3842378 DOI: 10.1016/j.jagp.2013.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/20/2013] [Accepted: 04/06/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine alcohol consumption among older primary care patients with generalized anxiety disorder (GAD); its relationship to demographic variables, insomnia, worry, and anxiety; and its moderating role on the anxiety-insomnia relationship. We expected alcohol use to be similar to previous reports, correlate with higher anxiety and insomnia, and worsen the anxiety-insomnia relationship. DESIGN Baseline data from a randomized controlled trial. SETTING Michael E. DeBakey VA Medical Center and Baylor College of Medicine. PARTICIPANTS 223 patients, 60 years and older, with GAD. MEASUREMENTS Frequency of alcohol use, insomnia (Insomnia Severity Index), worry (Penn State Worry Questionnaire - Abbreviated, Generalized Anxiety Disorder Severity Scale), and anxiety (State-Trait Anxiety Inventory - Trait subscale, Structured Interview Guide for the Hamilton Anxiety Rating Scale [SIGH-A]). RESULTS Most patients endorsed alcohol use, but frequency was low. Presence and frequency were greater than in previous reports of primary care samples. Alcohol use was associated with higher education, female gender, less severe insomnia, and lower worry (Generalized Anxiety Disorder Severity Scale) and anxiety (State-Trait Anxiety Inventory-Trait subscale; SIGH-A). Whites reported more drinks/week than African-Americans. More drinks/week were associated with higher education and lower anxiety (SIGH-A). Weaker relationships between worry/anxiety and insomnia occurred for those drinking. Drink frequency moderated the positive association between the Penn State Worry Questionnaire-Abbreviated and insomnia, which was lower with higher frequency of drinking. CONCLUSIONS Older adults with GAD use alcohol at an increased rate, but mild to moderate drinkers do not experience sleep difficulties. A modest amount of alcohol may minimize the association between anxiety/worry and insomnia among this group.
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Affiliation(s)
- M Cristina Ivan
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center, Houston, TX
| | - Amber B Amspoker
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX
| | - Michael R Nadorff
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX
| | - Mark E Kunik
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX
| | - Jeffrey A Cully
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX
| | - Nancy Wilson
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX
| | - Jessica Calleo
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center, Houston, TX
| | - Cynthia Kraus-Schuman
- Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center, Houston, TX
| | - Melinda A Stanley
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX.
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Stanley MA, Wilson NL, Amspoker AB, Kraus-Schuman C, Wagener PD, Calleo JS, Cully JA, Teng E, Rhoades HM, Williams S, Masozera N, Horsfield M, Kunik ME. Lay providers can deliver effective cognitive behavior therapy for older adults with generalized anxiety disorder: a randomized trial. Depress Anxiety 2014; 31:391-401. [PMID: 24577847 DOI: 10.1002/da.22239] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/27/2013] [Accepted: 01/07/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Institute of Medicine recommends developing a broader workforce of mental health providers, including nontraditional providers, to expand services for older adults. Cognitive behavior therapy (CBT) is effective for late-life generalized anxiety disorder (GAD), but no study has examined outcomes with delivery by lay providers working under the supervision of licensed providers. The current study examined the effects of CBT delivered by lay, bachelor-level providers (BLP) relative to Ph.D.-level expert providers (PLP), and usual care (UC) in older adults with GAD. METHODS Participants were 223 older adults (mean age, 66.9 years) with GAD recruited from primary care clinics at two sites and assigned randomly to BLP (n = 76), PLP (n = 74), or UC (n = 73). Assessments occurred at baseline and 6 months. CBT in BLP and PLP included core and elective modules (3 months: skills training; 3 months: skills review) delivered in person and by telephone, according to patient choice. RESULTS CBT in both BLP and PLP groups significantly improved GAD severity (GAD Severity Scale), anxiety (Spielberger State-Trait Anxiety Inventory; Structured Interview Guide for the Hamilton Anxiety Scale), depression (Patient Health Questionnaire), insomnia (Insomnia Severity Index), and mental health quality of life (Short-Form-12), relative to UC. Response rates defined by 20% reduction from pre- to posttreatment in at least three of four primary outcomes were higher for study completers in BLP and PLP relative to UC (BLP: 38.5%; PLP: 40.0%; UC: 19.1%). CONCLUSION Lay providers, working under the supervision of licensed providers, can deliver effective CBT.
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Affiliation(s)
- Melinda A Stanley
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas; Baylor College of Medicine, Houston, Texas; South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, Texas
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Abstract
To increase the sustainability of cognitive behavior therapy (CBT) in primary care for late-life anxiety, we incorporated nonexpert counselors, options for telephone meetings, and integration with primary care clinicians. This open trial examines the feasibility, satisfaction, and clinical outcomes of CBT delivered by experienced and nonexperienced counselors for older adults with generalized anxiety disorder (GAD). Clinical outcomes assessed worry (Penn State Worry Questionnaire), GAD (Generalized Anxiety Disorder Severity Scale), and anxiety (Beck Anxiety Inventory and Structured Interview Guide for Hamilton Anxiety Scale). After 3 months of treatment, Cohen's d effect sizes for worry and anxiety ranged from 0.48 to 0.78. Patients treated by experienced and nonexperienced counselors had similar reductions in worry and anxiety, although treatment outcomes were more improved on the Beck Anxiety Inventory for experienced therapists. Preliminary results suggest that adapted CBT can effectively reduce worry. The piloted modifications can provide acceptable and feasible evidence-based care.
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Rodríguez-Biglieri R, Vetere GL. Psychometric Characteristics of the Penn State Worry Questionnaire in an Argentinean Sample: A Cross-Cultural Contribution. SPANISH JOURNAL OF PSYCHOLOGY 2013; 14:452-63. [DOI: 10.5209/rev_sjop.2011.v14.n1.41] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although studies in several populations have provided support for Penn State Worry Questionnaire (PSQW) reliability and validity, factor analysis studies carried out on different populations show divergent results. The aim of this article is to contribute with the cross-cultural literature on PSWQ. This report describes two studies examining the psychometric characteristics of a revised Argentinean version of the PSWQ. In the first study, items of original PSWQ were translated into Spanish and then back-translated into English. Then, in order to examine its reliability and factorial structure, the instrument was completed by 400 community participants. The second study included two groups of participants as follows: patients with generalized anxiety disorder (GAD), and patients with other anxiety disorders (AC). Results revealed appropriated test-retest reliability over a four-week period, high internal consistency, and good convergent and discriminant validity for PSWQ. In concordance with some results reported in previous studies, a single factorial structure was confirmed for the Argentinean version of PSWQ. By the other hand, a receiver operating characteristic analysis was made to evaluate the ability of PSWQ to discriminate GAD from individuals with others anxiety disorders. A total score of 63 simultaneously optimized sensitivity and specificity in discriminating GAD patients from patients with others anxiety disorders.
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Abstract
OBJECTIVE In clinically anxious individuals, selective attention to negative cues in the environment may perpetuate a vicious cycle of emotional dysfunction. However, very little is known regarding the role of negative attentional bias in anxious older adults. There is evidence that in older adults without clinical anxiety, the opposite bias (toward positive, and away from negative, emotional material) is present. We explored how these age-related changes in emotional processing interact with anxiety. METHOD Sixty older adults (age 60+) completed the emotional Stroop (eStroop) task, a widely used measure of attentional bias, which requires rapid identification of the color in which neutral and emotional words are printed. Participants were stratified into high-, mid-, and low-worry groups on the basis of a self-report measure, the Penn State Worry Questionnaire. RESULTS The high-worry group exhibited a bias toward threat-related words whereas the low- and mid-worry groups showed a bias away from threat-related words. By contrast, the low- and mid-worry groups showed a bias toward positive words, potentially consistent with an established positivity effect in older adults whereas the high-worry group showed a bias away from positive items. CONCLUSION Older adults who worry frequently exhibit a pattern of eStroop performance that is broadly consistent with the younger adult literature, suggesting that selective attention toward threat-related information may be seen as a relevant factor in older, as in younger, anxiety.
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Wu SM, Schuler TA, Edwards MC, Yang HC, Brothers BM. Factor analytic and item response theory evaluation of the Penn State Worry Questionnaire in women with cancer. Qual Life Res 2012; 22:1441-9. [PMID: 22903634 DOI: 10.1007/s11136-012-0253-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2012] [Indexed: 12/26/2022]
Abstract
PURPOSE Cancer survivors frequently experience worry about a variety of topics, including fear of recurrence. However, general measures of worry still require examination of reliability for this vulnerable population. This study utilized modern psychometric methods to examine the reliability of a worry measure in women with breast or gynecologic cancer. METHODS Women with cancer (n = 332) completed the 16-item Penn State Worry Questionnaire (PSWQ), which has an abbreviated 8-item version (PSWQ-A). Categorical confirmatory factor analysis (CCFA) was used to determine the factor structure and item response theory (IRT) was used to examine score reliability. RESULTS CCFA supported a two-factor structure with 11 positively worded items and the 5 negatively worded items loading on different factors. IRT analysis of the 11 positively worded items showed that each was contributing meaningful information to the overall scores. The 11 positively worded items and the PSWQ-A produced the most reliable scores for levels of worry ranging from one θ below to two θ above the mean. CONCLUSIONS The 11 positively worded items of the PSWQ and the 8-item PSWQ-A were suitable for use in cancer patients while the full PSWQ was unsuitable due to inclusion of the negatively worded items. Future research should consider measuring worry when examining distress in cancer survivors.
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Affiliation(s)
- Salene M Wu
- Department of Psychology, The Ohio State University, 1835 Neil Ave, Columbus, OH 43210-1222, USA.
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Staples AM, Mohlman J. Psychometric properties of the GAD-Q-IV and DERS in older, community-dwelling GAD patients and controls. J Anxiety Disord 2012; 26:385-92. [PMID: 22306131 DOI: 10.1016/j.janxdis.2012.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 09/22/2011] [Accepted: 01/09/2012] [Indexed: 11/16/2022]
Abstract
Thirty-seven community-dwelling, older generalized anxiety disorder (GAD) patients and 37 nonanxious controls completed the Generalized Anxiety Disorder Questionnaire for DSM-IV (GAD-Q-IV; Newman et al., 2002), the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), and other measures of anxiety and depression. The GAD-Q-IV and DERS were assessed for internal consistency reliability, construct validity, and test-retest reliability, with results indicating good psychometric performance. Receiver operating characteristic (ROC) analysis conducted on the full sample suggested that the optimal GAD-Q-IV cutoff for classifying GAD cases was 3.71, with .97 sensitivity and .92 specificity. The cutoff score for classifying those participants with GAD and comorbid conditions was higher, however. ROC analysis with the full sample revealed an optimal DERS cutoff score of 62.5, with .76 sensitivity and .86 specificity. Findings support the use of the GAD-Q-IV and DERS as screening instruments for GAD in older, community-dwelling adults in a research setting.
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Affiliation(s)
- Alison M Staples
- Department of Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Road, Piscataway, NJ 08854, USA.
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Mild worry symptoms predict decline in learning and memory in healthy older adults: a 2-year prospective cohort study. Am J Geriatr Psychiatry 2012; 20:266-75. [PMID: 22354117 PMCID: PMC3285262 DOI: 10.1097/jgp.0b013e3182107e24] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE : Theoretical models of cognitive aging are increasingly recognizing the importance of anxiety and depressive symptoms in predicting age-related cognitive changes and early dementia. This study examined the association between mild worry and depressive symptoms, and cognitive function in healthy, community-dwelling older adults. METHOD : A total of 263 healthy older adults participated in an observational prospective cohort study that assessed worry and depression symptoms, and a broad range of cognitive functions over a 2-year period. RESULTS : Older adults with mildly elevated worry symptoms at baseline performed worse than older adults with minimal worry symptoms on measures of visual and paired associate learning. They were also more likely to show clinically significant (> 1.5 standard deviation) decline in visual learning and memory at a 2-year follow-up assessment (9.4% versus 2.5%; odds ratio = 3.8). CONCLUSION : Assessment of worry symptoms, even mild levels, may have utility in predicting early cognitive decline in healthy, community-dwelling older adults.
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Bradford A, Cully J, Rhoades H, Kunik M, Kraus-Schuman C, Wilson N, Stanley M. Early response to psychotherapy and long-term change in worry symptoms in older adults with generalized anxiety disorder. Am J Geriatr Psychiatry 2011; 19:347-56. [PMID: 21427643 PMCID: PMC3058752 DOI: 10.1097/jgp.0b013e3181f18061] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the association of early and long-term reductions in worry symptoms after cognitive behavior therapy (CBT) for generalized anxiety disorder (GAD) in older adults. DESIGN Substudy of larger randomized controlled trial. SETTING Family medicine clinic and large multispecialty health organization in Houston, TX, between March 2004 and August 2006. PARTICIPANTS Patients (N = 76) aged 60 years or older with a principal or coprincipal diagnosis of GAD, excluding those with significant cognitive impairment, bipolar disorder, psychosis, or active substance abuse. INTERVENTION CBT, up to 10 sessions for 12 weeks, or enhanced usual care (regular, brief telephone calls, and referrals to primary care provider as needed). MEASUREMENTS Penn State Worry Questionnaire (PSWQ) administered by telephone at baseline, 1 month (mid treatment), 3 months (posttreatment), and at 3-month intervals through 15 months (1-year follow-up). The authors used binary logistic regression analysis to determine the association between early (1 month) response and treatment responder status (reduction of more than 8.5 points on the PSWQ) at 3 and 15 months. The authors also used hierarchical linear modeling to determine the relationship of early response to the trajectory of score change after posttreatment. RESULTS Reduction in PSWQ scores after the first month predicted treatment response at posttreatment and follow-up, controlling for treatment arm and baseline PSWQ score. The magnitude of early reduction also predicted the slope of score change from posttreatment through the 15-month assessment. CONCLUSION Early symptom reduction is associated with long-term outcomes after psychotherapy in older adults with GAD.
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Affiliation(s)
- Andrea Bradford
- Houston Center for Quality of Care & Utilization Studies, Department of Family and Community Medicine, Baylor College of Medicine, TX 77030, USA.
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Diefenbach GJ, Tolin DF, Meunier SA, Gilliam CM. Assessment of anxiety in older home care recipients. THE GERONTOLOGIST 2009; 49:141-53. [PMID: 19363010 DOI: 10.1093/geront/gnp019] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This study determined the psychometric properties of a variety of anxiety measures administered to older adults receiving home care services. DESIGN AND METHODS Data were collected from 66 adults aged 65 years and older who were receiving home care services. Participants completed self-report and clinician-rated measures of anxiety and diagnostic interviews for generalized anxiety disorder (GAD). RESULTS Most measures demonstrated acceptable psychometric properties. All of the measures showed excellent interrater reliability to support verbal administration, which is the typical mode of assessment in home care. The ease of use for each measure (e.g., time of administration) was also evaluated. The Geriatric Anxiety Inventory (GAI) demonstrated the strongest and the Beck Anxiety Inventory the weakest psychometric properties. The GAI and the GAD screening questions from The Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire (PHQ) demonstrated the greatest utility in screening for anxiety disorders (either GAD or anxiety disorder not otherwise specified). IMPLICATIONS These data support the use of anxiety measures within a geriatric home care setting. The strengths and weaknesses of each measure are discussed to facilitate selection of the optimal measure depending upon assessment goals and available resources.
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Affiliation(s)
- Gretchen J Diefenbach
- Anxiety Disorders Center, Institute of Living/Hartford Hospital, Hartford, CT 06106, USA.
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Gloster AT, Rhoades HM, Novy D, Klotsche J, Senior A, Kunik M, Wilson N, Stanley MA. Psychometric properties of the Depression Anxiety and Stress Scale-21 in older primary care patients. J Affect Disord 2008; 110:248-59. [PMID: 18304648 PMCID: PMC2709995 DOI: 10.1016/j.jad.2008.01.023] [Citation(s) in RCA: 257] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 01/28/2008] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
Abstract
The Depression Anxiety Stress Scale (DASS) was designed to efficiently measure the core symptoms of anxiety and depression and has demonstrated positive psychometric properties in adult samples of anxiety and depression patients and student samples. Despite these findings, the psychometric properties of the DASS remain untested in older adults, for whom the identification of efficient measures of these constructs is especially important. To determine the psychometric properties of the DASS 21-item version in older adults, we analyzed data from 222 medical patients seeking treatment to manage worry. Consistent with younger samples, a three-factor structure best fit the data. Results also indicated good internal consistency, excellent convergent validity, and good discriminative validity, especially for the Depression scale. Receiver operating curve analyses indicated that the DASS-21 predicted the diagnostic presence of generalized anxiety disorder and depression as well as other commonly used measures. These data suggest that the DASS may be used with older adults in lieu of multiple scales designed to measure similar constructs, thereby reducing participant burden and facilitating assessment in settings with limited assessment resources.
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Affiliation(s)
- Andrew T. Gloster
- Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Germany
| | - Howard M. Rhoades
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Diane Novy
- Department of Anesthesiology and Pain Medicine, University of Texas M. D. Anderson Cancer Center
| | - Jens Klotsche
- Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Germany
| | - Ashley Senior
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine,Houston Center for Quality of Care and Utilization Studies, and Michael E. DeBakey Veterans Affairs Medical Center, Houston
| | - Mark Kunik
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine,Houston Center for Quality of Care and Utilization Studies, and Michael E. DeBakey Veterans Affairs Medical Center, Houston,Department of Medicine, Baylor College of Medicine
| | - Nancy Wilson
- Houston Center for Quality of Care and Utilization Studies, and Michael E. DeBakey Veterans Affairs Medical Center, Houston,Department of Medicine-Geriatrics, Baylor College of Medicine
| | - Melinda A. Stanley
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine,Houston Center for Quality of Care and Utilization Studies, and Michael E. DeBakey Veterans Affairs Medical Center, Houston
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