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Anxiety therapy doesn't work as well in elderly: study

By Kerry Grens

NEW YORK (Reuters Health) - A form of talk therapy called cognitive behavioral therapy appears to help older adults battle anxiety disorders slightly better than other approaches, but not as well as in younger adults, according to a new study.

"Cognitive behavioral therapy is the mainstay for treating anxiety disorders in younger adults. Its lower effect in older adults in this study is concerning," said Dr. Eric Lenze, a professor at Washington University School of Medicine, who was not involved in this study.

Anxiety disorders, which include panic disorder, phobias, post-traumatic stress and generalized anxiety disorder, are common in adults over age 55.

The authors write in the Journal of the American Geriatrics Society that three to 14 out of every 100 older adults has an anxiety disorder.

While earlier studies have shown that cognitive behavioral therapy works well for younger and middle-aged adults, there has not been as much research into the treatment for seniors.

"The prevailing assumption tends to be that what works with working-age people will work with older people, but this might not actually be the case," said Rebecca Gould, the lead author of the study and a researcher at King's College London.

Gould's team gathered up the results from 12 previous studies on people over age 55 with an anxiety disorder.

Half of the studies compared cognitive behavioral therapy to other treatments, such as medications or group discussions, while the other half compared the therapy to no treatment.

Cognitive behavioral therapy (CBT) often involves one-on-one meetings with a therapist, with the ultimate goal of solving the defective thinking process that's causing the disorder.

On average in the studies, people went through 12 sessions of therapy.

Compared to doing nothing, cognitive behavioral therapy had a "moderate" effect on helping people's anxiety.

Compared to medications or group discussions, the therapy relieved the disorder slightly better.

Gould's team noted that the improvement over other treatments was small.

"What this might mean clinically is that the client in the CBT condition might be a little less severely or moderately anxious relative to the client in the active control condition," Gould wrote in an email to Reuters Health.

GOING AFTER ROOT CAUSES

Gould says therapy might work better than drugs because it seeks to fix the causes of anxiety rather than the symptoms.

"If we can address the causes of symptoms of anxiety (e.g. by changing how we think about or interpret things) then we can stop them coming back in the future. If we only address the symptoms of anxiety then we can't," she said.

Though Gould's analysis and those of studies in younger adults agree that cognitive behavioral therapy helps treat anxiety, the effect in older adults is small while the effect seen in younger adults is moderate or large, the authors wrote.

Gould said she doesn't know why the therapy seems less effective in older adults, but it's possible that talk therapy might take longer to work for them.

Lenze said that cognitive behavioral therapy is still worthwhile in older adults.

"Until better treatments are developed there are somewhat limited options," he told Reuters Health.

He added that anxiety can take a toll on the mental and physical health of adults if it's not treated.

Gould said more studies that compare cognitive behavioral therapy to other treatments are needed in older adults, and her group is planning a study that explores the benefit of "mindfulness-based" cognitive therapy, which includes practices such as meditation.

Lenze said he and his colleagues are also exploring this approach, as well as combining cognitive behavioral therapy with medications.

SOURCE: http://bit.ly/xnZJJA Journal of the American Geriatrics Society, online January 27, 2012.

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