Telephone Psychotherapy for Late-Life Generalized Anxiety Disorder (GAD)

Older adults in rural locations often face significant barriers to treatment, including
stigma, transportation, lack of local appropriately trained service providers, and impaired
mobility. The proposed treatment is delivered in a workbook format and by telephone, which
maximizes its portability. Treatment will be compared with nondirective supportive therapy, a
very credible comparison condition equivalent to the intervention in therapist attention. We
propose to randomize 88 adults ≥ 60 years with a diagnosis of GAD to either cognitive
behavioral therapy delivered by telephone, or nondirective supportive therapy. The 2 primary
treatment outcomes are anxiety symptoms as assessed by the Hamilton Anxiety Rating Scale, and
worry symptoms as assessed by the Penn State Worry Questionnaire-Abbreviated. The proposed
secondary outcomes are depressive symptoms, sleep, disability, and quality of life. Further,
mediators and moderators of the treatment effect will also be examined. Mediators include
process variables (therapeutic alliance, adherence, participant satisfaction, and treatment
credibility) and new psychotropic medication use; moderators include demographic information
(age, education, gender, race, income), psychiatric variables (baseline anxiety severity,
baseline depressive disorders, baseline psychotropic medication use), medical comorbidity,
and therapist assignment. Maintenance of response will be assessed over 6 months. This
research has great public health significance, because it is a low-cost intervention with
high potential for widespread dissemination, and it targets an underserved group -
community-dwelling rural elders - who currently lack effective treatment interventions
tailored to their needs.

Inclusion Criteria:

- 60 years GAD Reside in rural county Proficient in English

Exclusion Criteria:

Current psychotherapy Active alcohol or substance abuse with use within last month Dementia
or global cognitive impairment Psychotic symptoms Active suicidal ideation with plan and
intent Change in psychotropic medications within last 1 month Significant hearing loss