Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: a randomized clinical trial.
Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: a randomized clinical trial.
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DOI：
10.1001/jama.2009.458
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发表时间：
2009-04-08
影响因子：
120.7
通讯作者：
Kunik, Mark E.
中科院分区：
文献类型：
--
作者：
Stanley, Melinda A.;Wilson, Nancy L.;Novy, Diane M.;Rhoades, Howard M.;Wagener, Paula D.;Greisinger, Anthony J.;Cully, Jeffrey A.;Kunik, Mark E.
认知行为疗法（CBT）对老年广泛性焦虑症（GAD）有效，但是，只有初步研究在初级保健中进行，老年人最常寻求治疗。.研究CBT相对于加强日常护理（EUC）在初级保健中患有GAD的老年人中的作用。2004年3月至2006年8月在两个初级保健机构招募了134名老年人（平均年龄66.9岁）进行随机临床试验。治疗持续3个月;在基线、治疗后（3个月）和12个月随访（6、9、12和15个月）时进行评估。CBT（n = 70）在初级保健诊所进行。治疗包括教育和意识，放松训练，认知疗法，暴露，解决问题的技能训练和行为睡眠管理。分配至EUC的患者（n = 64）每两周接受一次电话联系，以确保患者安全并提供最低限度的支持。主要结果包括担忧严重程度（宾夕法尼亚州立大学担忧问卷）和GAD严重程度（GAD严重程度量表）。次要结局包括焦虑（汉密尔顿焦虑评定量表、贝克焦虑量表）、共存抑郁症状（贝克抑郁量表II）和身心健康生活质量（SF-12）。CBT显著改善了焦虑的严重程度[45.6; 95% CI 44.4至47.8; vs. 54.4; 95% CI 51.4至57.3; p < .0001），抑郁症状（10.2; 95% CI 8.5 - 11.9; vs. 12.8; 95% CI 10.5 - 15.1; p = 0.02）和一般心理健康（49.6; 95% CI 47.4 - 51.8; vs. 45.3; 95% CI 42.6 - 47.9; p= 0.008）与EUC相比。.根据意向治疗分析，根据担忧严重程度定义的应答率在3个月时CBT后高于EUC（40.0% [28/70] vs. 21.9% [14/64]，p = 0.02）。与EUC相比，CBT在初级保健中对GAD老年患者的担忧严重程度、抑郁症状和一般心理健康状况有更大的改善。
Cognitive behavior therapy (CBT) is effective for late-life generalized anxiety disorder (GAD), but, only pilot studies have been conducted in primary care, where older adults most often seek treatment. . To examine effects of CBT relative to enhanced usual care (EUC) in older adults with GAD in primary care. A randomized clinical trial with 134 older adults (mean age, 66.9 years) recruited from March 2004 to August 2006 in two primary care settings. Treatment was provided for 3 months; assessments were conducted at baseline, post-treatment (3 months), and over a 12-month follow-up (6, 9, 12, and 15 months). CBT (n = 70) was conducted in the primary care clinics. Treatment included education and awareness, relaxation training, cognitive therapy, exposure, problem-solving skills training, and behavioral sleep management. Patients assigned to EUC (n = 64) received biweekly calls to ensure patient safety and provide minimal support. Primary outcomes included worry severity (Penn State Worry Questionnaire) and GAD severity (GAD Severity Scale).. Secondary outcomes included anxiety (Hamilton Anxiety Rating Scale, Beck Anxiety Inventory), coexistent depressive symptoms (Beck Depression Inventory II), and physical/mental health quality of life (SF-12). CBT significantly improved worry severity [45.6; 95% CI 44.4 to 47.8; vs. 54.4; 95% CI 51.4 to 57.3; p < .0001), depressive symptoms (10.2; 95% CI 8.5 to 11.9; vs. 12.8; 95% CI 10.5 to 15.1; p = .02), and general mental health (49.6; 95% CI 47.4 to 51.8; vs. 45.3; 95% CI 42.6 to 47.9; p=.008) compared with EUC. . According to intent-to-treat analyses, response rates defined according to worry severity were higher following CBT than EUC at 3 months (40.0% [28/70] vs. 21.9% [14/64], p = .02). Compared to EUC, CBT resulted in greater improvement in worry severity, depressive symptoms, and general mental health for older patients with GAD in primary care.
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影响因子：
4.1
作者：
Mohlman, J;Gorman, JM
通讯作者：
Gorman, JM
影响因子：
7.2
作者：
Brenes, Gretchen A.;Kritchevsky, Stephen B.;Penninx, Brenda W. J. H.
通讯作者：
Penninx, Brenda W. J. H.
影响因子：
5.7
作者：
Gum, AM;Areán, PA;Unützer, J
通讯作者：
Unützer, J
影响因子：
7.2
作者：
Mantella, Rose C.;Butters, Meryl A.;Lenze, Eric J.
通讯作者：
Lenze, Eric J.
影响因子：
5.7
作者：
McHorney, CA
通讯作者：
McHorney, CA