J. Gayle Beck

Cognitive-Behavioral Treatment of Late-Life Generalized Anxiety Disorder

This study addressed the efficacy of cognitive-behavioral therapy (CBT), relative to minimal contact control (MCC), in a sample of 85 older adults (age 60 years and over) with generalized anxiety disorder (GAD). All participants completed measures of primary outcome (worry and anxiety), coexistent symptoms (depressive symptoms and specific fears), and quality of life. Results of both completer and intent-to-treat analyses revealed significant improvement in worry, anxiety, depression, and quality of life following CBT relative to MCC. Forty-five percent of patients in CBT were classified as responders, relative to 8% in MCC. Most gains for patients in CBT were maintained or enhanced over 1-year follow-up. However, posttreatment scores for patients in CBT failed to indicate return to normative functioning.

Psychometric properties of four anxiety measures in older adults.

Despite relatively high prevalence rates of anxiety disorders in older adults, little attention has been paid to the establishment of psychometrically sound measures for this population. The current study addresses this issue by examining the psychometric properties of four self-report anxiety measures: the Spielberger State-Trait Anxiety Inventory (STAI), Worry Scale (WS), Fear Questionnaire (FQ), and Padua Inventory (PI). Two older adult community subsamples were assessed, one with Generalized Anxiety Disorder (GAD; n = 50) and the other with no anxiety complaints (Normal Controls: NC; n = 94). Descriptive data revealed that mean scores in the GAD sample were similar to those reported in studies of younger GAD patients. Mean scores in the NC sample, however, were lower than those reported in studies of younger control samples. Internal consistency for all measures generally was adequate in both the GAD and NC subsamples, although alpha coefficients for two of the FQ subscales were marginal. Test-retest reliability over a 2-4 week interval (assessed in a subgroup of NC subjects) was mixed, with some measures apparently assessing stable, trait-like dimensions of fear and anxiety, and others estimating more state-like clinical features. Intercorrelations among subscales for all four measures in both the GAD and NC groups generally were high and consistent with findings from prior research. Finally, some support for the convergent validity of the four anxiety measures was obtained, particularly in the NC sample. Results are discussed in terms of the utility of these instruments for future investigations of the psychopathology and treatment of anxiety disorders in the elderly.

Is social anxiety associated with impairment in close relationships? A preliminary investigation*

We examined the association between social anxiety and interpersonal functioning. Unlike prior research, we focused specifically on close relationships, given the growing evidence of dysfunction in these relationships among people with psychopathology. We proposed that social anxiety would be associated with specific interpersonal styles. One hundred sixty-eight young adults with a range of social anxiety symptoms were interviewed regarding symptom severity, interpersonal styles, and chronic interpersonal stress. Results indicated that higher levels of social anxiety were associated with interpersonal styles reflecting less assertion, more conflict avoidance, more avoidance of expressing emotion, and greater interpersonal dependency. Moreover, lack of assertion and overreliance on others mediated the association between social anxiety and interpersonal stress. Associations held controlling for depressive symptoms. Implications of these findings for interpersonally oriented conceptualizations of social anxiety disorder are discussed.

Treatment of generalized anxiety in older adults: A preliminary comparison of cognitive-behavioral and supportive approaches

Generalized Anxiety Disorder (GAD) in older adults has received little attention from researchers, despite evidence that anxiety disorders are a significant mental health problem in this population. This study compared the efficacy of cognitive behavior therapy (CBT) and nondirective, supportive psychotherapy (SP) for 48 older adults, ages 55 and up, with well-diagnosed GAD. Treatments were administered in small groups that met for 14 weekly 1 1/2 hour sessions. Treatment effects were assessed at posttreatment and over a 6-month follow-up period. Primary outcome variables targeted anxiety and worry, and transfer effects were assessed with measures of depression and associated fears. Two composite indexes of treatment response were derived to identify treatment responder status and high endstate functioning. Two participants declined participation prior to randomization; 15 others were classified as drop-outs. Results for the remaining 31 participants (CBT: n = 18; SP: n = 13) demonstrated significant improvements on primary outcome and transfer effect variables in both treatment conditions. Effect sizes generally were large, and treatment gains were maintained or improved over the 6-month follow-up phase. Examination of treatment responder status and endstate functioning revealed no significant differences between groups. The data support the potential efficacy of psychosocial group treatment for GAD in older adults, although limitations of the work and suggestions for future research are discussed.

The effects of suppressing trauma-related thoughts on women with rape-related posttraumatic stress disorder

A hallmark symptom of posttraumatic stress disorder (PTSD) is the presence of intrusive thoughts that come to mind against an individuals will and are frequently accompanied by considerable distress. This investigation examined the effects of deliberate suppression of rape-related thoughts on female sexual assault survivors, in order to explore this facet of PTSD. Seventeen women with chronic PTSD following a sexual assault were contrasted with nineteen survivors without PTSD, using a thought suppression paradigm (e.g. [Wegner, Schneider, Carter, & White (1987) Paradoxical effects of thought suppression. Journal of Personality and Social Psychology, 53 5-13]). Results indicated that PTSD participants experienced a rebound in the frequency of rape-related thoughts following deliberate suppression, whereas non-PTSD participants did not experience a rebound. Reported level of perceived controllability over rape-related thoughts for the PTSD participants was significantly lower during the suppression phase (as compared with the expression phase) relative to the non-PTSD participants. PTSD participants were significantly more anxious, depressed and distressed throughout the procedure relative to non-PTSD participants, although mood changes did not parallel the rebound effect found with rape-related thoughts in the PTSD group. Results are discussed in light of the role that intrusive thoughts may play in the maintenance of PTSD.

Assessing worry in older adults: Confirmatory factor analysis of the Penn State Worry Questionnaire and psychometric properties of an abbreviated model

The assessment of worry among older adults typically has involved measures designed with younger cohorts. Because of special concerns in assessing older adults, modifications to existing instruments may be necessary. Addressing equivocal factor analytic data on the Penn State Worry Questionnaire (PSWQ) among younger adults, the authors conducted confirmatory factor analyses to evaluate the generalizability of previous models to older adults with generalized anxiety disorder. Data fit poorly with established single- and two-factor models. The single-factor model was modified, resulting in the elimination of 8 items, strong fit indices, high internal consistency, adequate test-retest reliability, and good convergent and divergent validity. Further psychometric work is required to assess whether the revised model is a more parsimonious method to assess late-life anxiety.

The Structure of Distress Following Trauma: Posttraumatic Stress Disorder, Major Depressive Disorder, and Generalized Anxiety Disorder

The current report used confirmatory factor analysis to examine the latent structures of both key features and associated symptoms of three disorders that commonly develop following a traumatic event: posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). Participants were 228 motor-vehicle accident survivors who sought treatment for emotional difficulties. PTSD, MDD, and GAD were assessed with a combination of self-report and interview-based measures. The results of construct level analyses suggested that PTSD, MDD, and GAD are distinguishable but highly correlated disorders following a traumatic event. Symptom level analyses supported a model where the Reexperiencing, Avoidance, and Hypervigilance factors were subsumed under the PTSD construct. However, in this model the Dysphoria factor was a higher order construct correlated with the PTSD, MDD, and GAD factors, suggesting that the Dysphoria cluster may not be unique to PTSD. Diagnostic and theoretical implications of these results are discussed.

Posttraumatic Stress Disorder in Older Adults: A Conceptual Review

Issues that are salient in understanding posttraumatic stress disorder (PTSD) in older adults are examined in this review. Although this issue has received scattered attention in the literature since introduction of the diagnosis of PTSD to the Diagnostic and Statistical Manual (DSM) in 1980, it is clear that numerous conceptual and defining questions exist in our understanding of the aftermath of trauma exposure in older adults. In approaching this issue, studies pertaining to diagnostic status as well as broader dimensions of psychosocial functioning are examined. Concerns that are unique to older adults are highlighted throughout, with particular attention to areas where additional research is warranted.

Psychometric Properties of the Posttraumatic Cognitions Inventory (PTCI): A Replication With Motor Vehicle Accident Survivors.

This study examined the factor structure, internal consistency, concurrent validity, discriminant validity, and discriminative validity of the Posttraumatic Cognitions Inventory (PTCI; E. B. Foa, A. Ehlers, D. M. Clark, D. F. Tolin, and S. M. Orsillo, 1999) in a sample of 112 individuals who had experienced a serious motor vehicle accident. Results generally supported the 3-factor structure of the PTCI: (a) Negative Cognitions About Self, (b) Negative Cognitions About the World, and (c) Self-Blame. Subscales reflecting negative thoughts of the self and world showed adequate internal consistency, as well as good concurrent, discriminant, and discriminative validity. However, difficulties with the subscale representing self-blame emerged, specifically poor concurrent and discriminant validity. Potential reasons for this finding are discussed. The PTCI seems to be a promising measure of negative and dysfunctional posttrauma cognitions, which deserves continuing attention.

Characteristics of Generalized Anxiety Disorder in older adults: A descriptive study

Despite the prevalence of Generalized Anxiety Disorder (GAD) in older adults, little is known about psychopathological features of excessive worry in the elderly. This investigation compared 44 GAD patients (mean age 67.6), diagnosed using structured interview, with a matched sample free of psychiatric disorders on self-report and clinician measures. Results indicated that GAD in the elderly is associated with elevated anxiety, worry, social fears, and depression. Using self-report measures alone, near-perfect classification of Ss into groups was achieved with four measures (PSWQ, WS-Soc, FQ-Soc, and BDI). Using clinician ratings, near-perfect classification was achieved with Hamilton anxiety ratings. Comparison of GAD patients whose symptoms began in childhood vs middle adulthood revealed few differences on these dimensions. Results are discussed in light of features of GAD in the elderly, highlighting implications for further study.