Cognitive Therapy And The Elderly

Original Source - The Guardian Online

Talking treatment reduces worry in elderly people.

A type of talking treatment called cognitive behavioural therapy helps elderly people suffering from anxiety, according to a new study. Anxiety and depression often go unrecognised in older people, or else they are treated with medication.

What do we know already?

Sadly, anxiety and depression are common problems for older people. Among this group, more than 7 percent have anxiety severe enough for it to be a medical problem (called generalised anxiety disorder). Unfortunately, mental illnesses in elderly people aren't always recognised and treated.

According to the charity Age Concern, only a third of older people with depression talk to their GP, and of these only half are diagnosed and receive treatment. Even if treatment is offered for anxiety or depression, it can be limited to antidepressant drugs, when many older people say they'd prefer simply to talk to someone.

Cognitive behavioural therapy (CBT) is a short, practical type of talking treatment that tends to focus on problem solving and coping strategies, rather than on discussing the past. It's proven to help with both anxiety and depression, but there hasn't been much research looking particularly at older people suffering from anxiety. In a new study, researchers from Houston, Texas hoped to show that the treatment could be useful.

What does the new study say?

The study was open to anyone over the age of 60, and the researchers found 134 people with generalised anxiety disorder who were able to take part. Half the people had up to 10, hour-long sessions of cognitive behavioural therapy over three months. The other half of people got telephone support and the usual care from a doctor, but no therapy.

After three months, people who'd had therapy scored better on tests designed to measure how much they worried. People's scores dropped by 8 points on average, compared with only 3 points for people who hadn't had therapy. The benefits of therapy lasted for at least a year. However, another test that measured overall anxiety, rather than just worry, failed to show much of a benefit.

How reliable are the findings?

One of the difficulties with looking at depression and anxiety is that they're difficult to measure. It's easy enough to put a number on someone's blood pressure or cholesterol level, but in studies of anxiety, researchers have to ask people about how they're feeling, using a standard questionnaire. People might start to score better on the questionnaire, but it's hard to say whether any improvement carries over into everyday life.

In this case, the researchers thought that an improvement of 8.5 on the worry questionnaire would be a big enough change for someone to notice the benefits in their daily life. About 4 in 10 people who had CBT improved by at least this amount, compared with 2 in 10 people who got telephone support. So, a fair number of older people should feel better after CBT for anxiety.

One problem with the research is that most of the people who took part tended to be well educated, and the average age was 67, so not many very elderly people were included. So, not everyone would necessarily get the same benefit as the people in the study.

The researchers didn't compare cognitive behavioural therapy with drugs for anxiety, such as antidepressants or tranquillisers. So, we can't say which might work best. People who were taking medication for anxiety at the start of the study were allowed to carry on taking it.

Where does the study come from?

The researchers were based at several research centres in Texas, including the University of Texas and Baylor College of Medicine. The study was published in the Journal of the American Medical Association, owned by the American Medical Association. Funding came from the National Institute of Mental Health, a US organisation that pays for research into mental health.

What does this mean for me?

Anxiety can severely disrupt someone's life, and according to the researchers it can also be linked to other problems, like increased physical disability, memory problems and a lower quality of life. When people do get treatment, it's often with drugs, so side effects can be an issue. Elderly people are often taking several drugs already, so there's also a risk of different medications reacting badly to each other.

According to the new study, cognitive behavioural therapy can reduce worry in people with severe anxiety. So, assuming that therapy is available, it may be a better option than drugs for some elderly people.

What should I do now?

Severe anxiety is common among elderly people, but like lots of mental health problems, it's hard to draw the line between what's normal and what's an illness. The usual sign that worry has become an illness is that it interferes with your life. People often think they're just natural worriers or that there's nothing that can help, but there are treatments, like drugs and talking treatments, that can reduce anxiety. If you worry so much that it stops you doing things that you want to do, then talk to your GP.

From:

Stanley MA, Wilson NL, Novy DM, et al. Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: a randomized clinical trial. Journal of the American Medical Association. 2009; 301: 1460-1467.