Efficacy of cognitive behavioral therapy for anxiety disorders in older people: a meta-analysis and meta-regression of randomized controlled trials.

Gould, Rebecca L., Coulson, Mark and Howard, Robert J. (2012) Efficacy of cognitive behavioral therapy for anxiety disorders in older people: a meta-analysis and meta-regression of randomized controlled trials. Journal of the American Geriatrics Society, 60 (2) . pp. 218-229. ISSN 0002-8614 [Article] (doi:10.1111/j.1532-5415.2011.03824.x)

Abstract

OBJECTIVES: To review the magnitude and duration of
and factors associated with effects of cognitive behavioral
therapy (CBT) for anxiety disorders in older people.
DESIGN: Electronic literature databases and the Cochrane
Trials Registry were searched for articles. A systematic
critical review, random-effects meta-analysis, and meta-
regression of randomized controlled trials were conducted.
SETTING: Community outpatient clinics.
PARTICIPANTS: People with diagnoses of anxiety disor-
ders.
MEASUREMENTS: Outcome measures of anxiety and
depression.
RESULTS: Twelve studies were included. CBT was signifi-
cantly more effective than treatment as usual or being on a
waiting list at reducing anxiety symptoms at 0-month fol-
low-up, with the effect size being moderate, but when
CBT was compared with an active control condition, the
between-group difference in favor of CBT was not statisti-
cally significant, and the effect size was small. At 6- but
not 3- or 12-month follow-up, CBT was significantly more
effective at reducing anxiety symptoms than an active con-
trol condition, although the effect size was again small.
Meta-regression analyses revealed only one factor (type of
control group) to be significantly associated with the mag-
nitude of effect sizes.
CONCLUSION: The review confirms the effectiveness of
CBT for anxiety disorders in older people but is suggestive
of lower efficacy in older than working-age people. The
small effect sizes in favor of CBT over an active control
condition illustrate the need to investigate other treatment
approaches that may be used to substitute or augment
CBT to increase the effectiveness of treatment of anxiety
disorders in older people.

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