Generalized Anxiety Disorder Severity Research Articles

Correlations Between Amygdala Activity During the Anticipation of Aversion and Trait Worry Symptoms in Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) patients exhibit heightened anticipatory amygdala activity before presentations of affective pictures (Nitschke et al., 2009). Worrying (experienced chronically in GAD) is a future-oriented thought process (Borkovec, 2002) that may similarly reflect anticipatory anxiety in GAD. GAD severity, indexed by the GAD-Q (Newman et al., 2002) might also overlap significantly with anticipatory anxiety indexed by amygdala activity during the anticipation of aversion.

The DSM-IV-Based Generalized Anxiety Disorder Severity Scale

Currently available symptom severity measures for Generalized Anxiety Disorder (GAD) are not optimal. This study investigates the reliability and validity of a new measure for GAD. The Generalized Anxiety Disorder Severity Scale (DGSS), comprising 8 DSM-IV GAD symptoms assessed in terms of frequency and intensity, was used in a trial of agomelatine versus placebo for the treatment of GAD. Internal reliability, concurrent validity, responsiveness to change, most robust items, and factor structure were computed. The DGSS demonstrated good internal reliability, correlated significantly with the Hamilton Anxiety Scale and Clinical Global Impression severity scale, and demonstrated a clear change in response to agomelatine. The most robust DGSS items were derived, and an exploratory factor analysis yielded a 2-factor structure of the DGSS. The DGSS is potentially a useful scale for the assessment of GAD in clinical trials of this disorder.

Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: a randomized clinical trial.

Cognitive behavior therapy (CBT) can be 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. Randomized clinical trial recruiting 134 older adults (mean age, 66.9 years) from March 2004 to August 2006 in 2 primary care settings. Treatment was provided for 3 months; assessments were conducted at baseline, posttreatment (3 months), and over 12 months of follow-up, with assessments at 6, 9, 12, and 15 months. Cognitive behavior therapy (n = 70) conducted in the primary care clinics. Treatment included education and awareness, motivational interviewing, relaxation training, cognitive therapy, exposure, problem-solving skills training, and behavioral sleep management. Patients assigned to receive EUC (n = 64) received biweekly telephone 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 ratings (Hamilton Anxiety Rating Scale, Beck Anxiety Inventory), coexistent depressive symptoms (Beck Depression Inventory II), and physical/mental health quality of life (12-Item Short Form Health Survey). Cognitive behavior therapy compared with EUC significantly improved worry severity (45.6 [95% confidence interval {CI}, 43.4-47.8] vs 54.4 [95% CI, 51.4-57.3], respectively; P < .001), depressive symptoms (10.2 [95% CI, 8.5-11.9] vs 12.8 [95% CI, 10.5-15.1], P = .02), and general mental health (49.6 [95% CI, 47.4-51.8] vs 45.3 [95% CI, 42.6-47.9], P = .008). There was no difference in GAD severity in patients receiving CBT vs those receiving EUC (8.6 [95% CI, 7.7-9.5] vs 9.9 [95% CI, 8.7-11.1], P = .19). In intention-to-treat analyses, response rates defined according to worry severity were higher following CBT compared with EUC at 3 months (40.0% [28/70] vs 21.9% [14/64], P = .02). Compared with EUC, CBT resulted in greater improvement in worry severity, depressive symptoms, and general mental health for older patients with GAD in primary care. However, a measure of GAD severity did not indicate greater improvement with CBT. clinicaltrials.gov Identifier: NCT00308724.

P01-134 Pregabalin GAD-treatment in different patient populations under clinical practice conditions

Background:The safety and efficacy of pregabalin in Generalized Anxiety Disorder (GAD) has been confirmed based on the results of 7 large, placebo-controlled trials. We report data on different patient populations from an open-label non-interventional observational trial under naturalistic conditions.Methods:331 physicians (mainly psychiatrists) recruited 578 adult GAD patients and documented treatment with pregabalin over 4 weeks. GAD severity was rated by the patients using Hospital Anxiety and Depression Scale (HADS) and a 100mm daily Visual Analogue Scale (VAS-anxiety). Spontaneous Adverse Events (AEs) were collected.Results:Most patients received an initial dose of 150mg pregabalin per day, which was then increased to 300mg per day. Mean HADS-A Baseline Score (15.5 vs. 14.6) and Improvement (-5.9 vs. -6.1) was similar in younger (≤65 years, n=484) and older (&gt;65 years, n=71) patients. Treatment naive patients had a lower HADS-A-Score (mean 14.2) than patients who got pregabalin add-on to their current medication (mean 15.8); both groups showed a similar improvement by 5.9 points over 4 weeks. A total of 26 AEs occured during this study, most of them rated mild to moderate in severity with no treatment related serious events. The pattern of events resembled the one known from clinical trials and post-marketing experience. 1.2% of subjects discontinued treatment due to adverse events.Conclusion:Data from this non-interventional study in GAD show that pregabalin demonstrates similar effectiveness in adults and older (≤65 years) patients, regardless of whether used as mono- or adjunctive therapy.

Les sources du sentiment d’efficacité personnelle à la gestion du poids chez les personnes obèses et normo-pondérales

La combinaison des modèles de l’intolérance à l’incertitude (II) et de la régulation émotionnelle dysfonctionnelle (RÉD) pourrait améliorer l’efficacité du traitement cognitif-comportemental (TCC) du trouble d’anxiété généralisée (TAG). Cette étude préliminaire compare un TCC du TAG basé sur le modèle de l’II (TCC II) à un TCC du TAG basé sur la combinaison des modèles (TCC II + RÉD).Vingt participants ont complété le traitement. Des entretiens semi-structurés ont eu lieu deux semaines pré- et post-traitement. Des questionnaires ont été postés 3 et 6 mois post-traitement.Les analyses par modèles mixtes révèlent que les deux thérapies traitent efficacement le TAG (inquiétudes [F(3, 19,031) = 20,667, p < 0,001], sévérité du TAG [F(3, 29,567) = 20,567, p = < 0,001]). La régulation émotionnelle s’améliore dans les deux conditions (F[3,17,401] = 11,390, p < 0,001). Une différence intergroupe sur la régulation émotionnelle est identifiée par contraste entre le suivi 3 et 6 mois : les participants de la condition combinée s’améliorent davantage (t[15,678] = 2,133, p = 0,049, d de Cohen = 0,076).Un traitement du TAG intégrant la régulation émotionnelle pourrait entraîner une meilleure tolérance aux émotions.Generalized anxiety disorder (GAD) is characterised by excessive and incontrollable worry, and is associated with anxiety symptoms such as restlessness, insomnia, concentration difficulties and irritability. This condition has consequences in personal life, such as social withdrawal, and in societal life, such as absenteeism and an increased number of medical consultations. In addition, the evolution of GAD tends to be chronic without adequate treatment. Cognitive-behavioral therapy (CBT) successfully treats generalized anxiety disorder (GAD). More than 50% of individuals with GAD experience a complete remission or significant clinical change after CBT. However, a significant number of people still present GAD symptoms following CBT. Combining interventions from different theoretical GAD models could improve CBT efficacy. In this regard, theoretical links have been suggested between intolerance of uncertainty (IU ; Dugas et al., 1998) and emotion dysregulation (EDr ; Mennin et al., 2005) models (Ouellet, 2014; Riskind, 2005). The IU model posits that GAD development and maintenance is explained by a vulnerability to uncertainty. This vulnerability influences beliefs and attitudes towards worry as well as generates cognitive avoidance. The EDr model explains GAD by difficulties with emotion regulation. GAD individuals, in particular, have difficulties in understanding and react negatively to emotions. They also experience highly intense emotions and use inflexible emotion regulation strategies. Treatments based on these approaches are respectively considered efficient to treat this disorder in GAD literature. This preliminary study aims to compare CBT for GAD based on the IU model (CBT IU) to CBT for GAD based on the IU and EDr models (CBT IU + EDr).Twenty-one participants were randomly assigned to 12 sessions of CBT IU or CBT IU + EDr. The CBT IU included psychoeducation about GAD, exposition to situations of uncertainty, cognitive restructuring, problem-solving training and cognitive exposition. The CBT IU + EDr added psychoeducation, cognitive restructuring and exposure to emotions, as well as emotional awareness training. Twenty participants completed treatment. Evaluations, including the semi-structured Anxiety Disorders Interview Schedule (ADIS-IV) and self-administrated questionnaires, were carried out two weeks before and two weeks after GAD treatment. Follow-up questionnaires were sent by mail 3 and 6 months after therapy.Repeated measures mixed model analyses 2 (treatment conditions) × 4 (measurement time) were conducted and revealed that both treatments are efficacious for GAD symptoms (i.e., excessive worry [F(3, 19.031) = 20.667, P < 0.001], GAD severity [F(3, 29.567) = 20.567, P = < 0.001], anxiety [F(3, 19.375) = 9.176, P = 0.001], depression [F(3, 36.609) = 21.662, P < 0.001], intolerance of uncertainty [F(3, 35.053) = 28.837, P < 0.001]). Both conditions foster a change in emotion regulation (F[3,17.401] = 11.390, P < 0.001). Contrast analyses showed differences in emotion regulation among conditions between the 3-month follow-up and the 6-month follow-up. Participants in CBT IU + EDr seem to continue to improve emotion regulation capacity (t[15.678] = 2.133, P = 0.049, d de Cohen = 0.76), whereas participants in CBT IU seem to present a deterioration on this same variable (t[15.757] = −2.491, P = 0.024, d de Cohen = −0.56).Both treatments (i.e., CBT IU, CBT IU + EDr) are efficacious for GAD. The inclusion of an emotion regulation segment in GAD therapy seems, in a longer-term perspective, to be an advantage in improving emotion regulation in individuals presenting this disorder. The combined therapy (CBT IU + EDr) could cause greater tolerance to emotions or a generalisation effect on emotions. It seems relevant to continue studies on combining IU and EDr models in GAD treatment with a larger sample size and an in-depth therapy segment on emotion regulation.

Health-related quality of life and utilities in primary-care patients with generalized anxiety disorder

Generalized anxiety disorder (GAD) is prevalent and significantly impacts patient health-related quality of life (HRQL) and disability. This study evaluated the effect of GAD and anxiety symptom severity on the HRQL of primary-care patients with GAD. Patients 18 years or older with GAD were recruited from an integrated health care delivery system. Clinical assessments included the Hamilton Anxiety Rating Scale (HAM-A), GAD Questionnaire-IV (GAD-Q-IV), and the Patient Health Questionnaire depression module (PHQ). HRQL was assessed by the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF), Sheehan Disability Scale (SDS), SF-12 Health Survey (SF-6D), and the Health Utilities Index (HUI2, HUI3). The sample included 297 patients, 72% women with mean +/- standard deviation (SD) age of 47.6 +/- 13.7 years. At baseline, the mean HAM-A score was 16.8 +/- 7.6 (suggesting the presence of moderate anxiety symptoms). Anxiety and depression symptoms were significantly correlated with mental component summary (MCS), Q-LES-Q-SF, SDS, SF-6D, HUI2, and HUI3 scores (all P < 0.001). The mean HRQL and all of the preference-based measures varied significantly by anxiety severity groups (all P < 0.001). Anxiety and depression symptoms significantly predicted HRQL and preference-based scores (R(2) values ranged from 0.22 to 0.57). Anxiety symptoms reported by GAD patients resulted in significant impairment to HRQL and functional outcomes.

The utility of the Generalized Anxiety Disorder Severity Scale (GADSS) with older adults in primary care

The Generalized Anxiety Disorder Severity Scale (GADSS) is an interview rating scale designed specifically for assessing symptom severity of generalized anxiety disorder (GAD), which has demonstrated positive psychometric data in a sample of adult primary care patients with GAD and panic disorder. However, the psychometric properties of the GADSS have not been evaluated for older adults. This study evaluated the psychometric properties of the GADSS, administered via telephone, with a sample of older primary care patients (n=223) referred for treatment of worry and/or anxiety. The GADSS demonstrated adequate internal consistency, strong inter-rater reliability, adequate convergent validity, poor diagnostic accuracy, and mixed discriminant validity. Results provide mixed preliminary support for use of the GADSS with older adults.

Generalized Anxiety Disorder Severity Scale Validation in Older Adults

The Generalized Anxiety Disorder Severity Scale (GADSS) is a validated measure of Generalized Anxiety Disorder (GAD) symptom severity. Given the high prevalence of GAD in the elderly and the need for a validated scale to assess GAD severity in this age group, the authors examined the psychometric properties of the GADSS in the elderly. The authors examined a sample of 134 elderly subjects (age 60 and above) who met diagnostic criteria for current GAD, 33 healthy elderly comparison subjects (age 60 and above) and 186 younger subjects (age 18-60) diagnosed with GAD. The GADSS had a high internal consistency in the elderly subjects (raw Cronbach's alpha = 0.76). Pearson correlations showed a significant positive correlation between GADSS, Hamilton Rating Scale for Anxiety and Penn State Worry Questionnaire. Pearson correlations showed an inverse significant correlation between GADSS and the Medical Outcome Study SF-36. There was no correlation between GADSS and Mini Mental State Examination or Cumulative Illness Rating Scale for Geriatrics. The results showed a good convergent, concurrent, and discriminant validity of the GADSS when used for elderly with GAD. The authors conclude that GADSS is a valid measure of GAD symptom severity in older adults.

Salivary cortisol is associated with diagnosis and severity of late-life generalized anxiety disorder

Age-associated alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning may make individuals more susceptible to HPA dysregulation in the context of mood and anxiety disorders. Little to no research has been done to examine HPA axis function in generalized anxiety disorder (GAD), particularly in late-life GAD, the most prevalent anxiety disorder in the elderly. The study sample consisted of 71 GAD subjects and 40 nonanxious comparison subjects over 60 years of age. We examined the hypotheses that elderly individuals with GAD will have elevated salivary cortisol levels compared to nonanxious subjects, and that elevated cortisol levels in GAD will be associated with measures of symptom severity. We report that late-life GAD is characterized by elevated basal salivary cortisol levels, with higher peak cortisol levels and larger areas under the curve, compared to nonanxious subjects. Additionally, severity of GAD as measured by the GAD Severity Scale and the Penn State Worry Questionnaire are positively correlated with cortisol levels. These data demonstrate HPA axis dysfunction in late-life GAD and suggest the need for additional research on the influence of aging on HPA axis function in mood and anxiety disorders.

A Comparison of the Factorial Structure of DSM-IV Criteria for Generalized Anxiety Disorder Between Younger and Older Adults

The controversy concerning the validity and reliability of generalized anxiety disorder (GAD) appears to be particularly relevant in the elderly, since physical symptoms associated with GAD can readily be considered as the consequences of normal aging. This study aims to analyze the structure invariance of a questionnaire assessing the DSM-IV diagnostic criteria across samples of older adults and college students. Ninety-seven adults aged 65 or over and 130 college students completed the Worry and Anxiety Questionnaire (WAQ). The results revealed that factorial invariance could be assumed and, in addition, that scores for severity of GAD symptoms were higher in younger subjects than in older ones. The results support the applicability of DSM-IV criteria for GAD in elderly people, as the factorial structure of the WAQ was the same for this age group as for younger adults. A higher degree of GAD severity was found in the younger sample.

Cognitive Errors, Symptom Severity, and Response to Cognitive Behavior Therapy in Older Adults With Generalized Anxiety Disorder

Recent research by Wetherell et al. investigating the differential response to group-administered cognitive behavior therapy (CBT) for generalized anxiety disorder (GAD) in older adults found that GAD severity, homework adherence, and psychiatric comorbidity predicted statistically significant improvement. The current study investigated whether the presence/absence of cognitive errors on separate domains of the Mini-Mental State Exam (MMSE) predicted baseline differences in symptom severity and improvement following CBT, above and beyond already established predictors. Baseline characteristics were investigated in a sample of 208 older patients diagnosed with GAD. Predictors of treatment response were examined in a subsample of 65 patients who completed CBT and were included in a prior study by Wetherell et al. of response predictors. Results from the baseline sample indicated that only subjects who committed an error on the MMSE Working Memory domain exhibited increased severity in anxiety and depressive symptoms. Results from the treatment sample indicated that an error on the MMSE Orientation domain was a significant predictor of outcome at 6-month follow-up, while controlling for previously established predictors. Patients who committed at least one error in this domain showed decreased response relative to patients who committed no errors. In this sample of older adults diagnosed with GAD, poor performance on the MMSE Working Memory domain was associated with increased baseline anxiety and depression, while baseline performance differences on the MMSE Orientation domain predicted outcome six months after CBT intervention.

Development and validation of the Generalized Anxiety Disorder Inventory (GADI)

The psychometric tools used for the assessment of generalized anxiety disorder (GAD) either do not conform to the current concept of the condition or have important limitations. We aimed to develop and validate a new questionnaire for the assessment of symptom profile and severity of GAD. An original pool of potential scale items was subjected to a series of studies in non-clinical and clinical populations, in order to determine the final composition of the scale. The psychometric properties of the new scale, the Generalized Anxiety Disorder Inventory (GADI), were evaluated using a factor analytic model suitable for ordinal data and the Graded Response Model. The precision of measurement of the GADI was quantified through the item information functions.A total of 197 outpatients and 522 non-clinical subjects participated in four studies and completed the GADI. The final 18-item scale was derived from an original pool of 30 potential items. The GADI showed good reliability, convergent and divergent validity. The scale comprises three factors, relating to cognitive, somatic and sleep symptoms. It accurately distinguished GAD patients from non-patient controls. The cognitive factor also distinguished GAD from other anxiety disorders and depression. The GADI is a useful tool in the assessment of the breadth of symptoms and the severity of generalized anxiety disorder in clinical settings.

Can the Components of a Cognitive Model Predict the Severity of Generalized Anxiety Disorder?

Over the past decade, a number of well-controlled studies have supported the validity of a cognitive model of generalized anxiety disorder (GAD) that has four main components: intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Although these studies have shown that the model components are associated with high levels of worry in nonclinical samples and with a diagnosis of GAD in clinical samples, they have not addressed the question of whether the model components can predict the severity of GAD. Accordingly, the present study sought to determine if the model components are related to diagnostic severity, worry severity, and somatic symptom severity in a sample of 84 patients with a primary diagnosis of GAD. All model components were related to GAD severity, although positive beliefs about worry and cognitive avoidance were only modestly associated with the severity of the disorder. Intolerance of uncertainty and negative problem orientation had more robust relationships with the severity of GAD (and with worry severity, in particular). When participants were divided into Mild, Moderate, and Severe GAD groups, intolerance of uncertainty and negative problem orientation distinguished the Moderate and Severe GAD groups from the Mild GAD group, even when age, gender, and depressive symptoms were statistically controlled. Overall, the results lend further support to the validity of the model and suggest that intolerance of uncertainty and negative problem orientation are related to the severity of GAD, independently of sociodemographic and associated clinical factors. The theoretical and clinical implications of the findings are discussed.

Beliefs about worry in community-dwelling older adults

This study examines the association between several kinds of beliefs about worry and generalized anxiety disorder (GAD) severity in a sample of older individuals recruited from a community setting (N=142, mean age=71.0 years, SD=6.0, range=55-88). Beliefs about worry were assessed with a 17-item scale designed for older adults, including three dimensions: Positive Beliefs, Negative Beliefs, and Responsibility. All three dimensions distinguished between people endorsing GAD symptoms and those without GAD symptoms, and only Negative Beliefs had a significant independent weight when regressed on GAD severity, even after controlling for level of trait worry. Results of this study suggest that negative beliefs appear to be strongly related to pathological worry in older adults. These results are consistent with empirical findings in younger adults and potentially support the use of particular interventions in clinical work with older adults with GAD.

P.8.a.017 A flexible dose open label trial evaluating the efficacy and safety of quetiapine as adjunctive pharmacotherapy for the treatment of generalized anxiety disorder (GAD)

Conventional drug treatments for Generalized Anxiety Disorder (GAD) are often accompanied by substantial side effects, dependence, and/or withdrawal syndrome. A prior controlled study of oral chamomile (Matricaria chamomilla L.) extract showed significant efficacy versus placebo, and suggested that chamomile may have anxiolytic activity for individuals with GAD.We hypothesized that treatment with chamomile extract would result in a significant reduction in GAD severity ratings, and would be associated with a favorable adverse event and tolerability profile.We report on the open-label phase of a two-phase randomized controlled trial of chamomile versus placebo for relapse-prevention of recurrent GAD.Subjects with moderate to severe GAD received open-label treatment with pharmaceutical-grade chamomile extract 1500 mg/day for up to 8 weeks. Primary outcomes were the frequency of clinical response and change in GAD-7 symptom scores by week 8. Secondary outcomes included the change over time on the Hamilton Rating Scale for Anxiety, the Beck Anxiety Inventory, and the Psychological General Well Being Index. Frequency of treatment-emergent adverse events and premature treatment discontinuation were also examined.Of 179 subjects, 58.1% (95% CI: 50.9% to 65.5%) met criteria for response, while 15.6% prematurely discontinued treatment. Significant improvement over time was also observed on the GAD-7 rating (β = −8.4 [95% CI = −9.1 to −7.7]). A similar proportion of subjects demonstrated statistically significant and clinically meaningful reductions in secondary outcome ratings of anxiety and well-being. Adverse events occurred in 11.7% of subjects, although no serious adverse events occurred.Chamomile extract produced a clinically meaningful reduction in GAD symptoms over 8 weeks, with a response rate comparable to those observed during conventional anxiolytic drug therapy and a favorable adverse event profile. Future comparative effectiveness trials between chamomile and conventional drugs may help determine the optimal risk/benefit of these therapies for patients suffering from GAD.

Generalized anxiety disorder severity scale (GADSS): a preliminary validation study

To assist researchers and clinicians in primary care with assessment and treatment of generalized anxiety disorder (GAD), we developed a simple standardized instrument, similar to the Panic Disorder Severity Scale. Independent evaluators used the six-item Generalized Anxiety Disorder Severity Scale (GADSS) to conduct telephone assessments of 330 patients from four primary care facilities with DSM-IV diagnoses of GAD and/or panic disorder who were participating in a study of the effectiveness of collaborative care treatment. Participants were also evaluated at a 12-month follow-up. Internal consistency, convergent and discriminant validity, and sensitivity to change were determined. The GADSS had high internal consistency, and showed good validity and sensitivity to change. Change in GADSS scores discriminated between two different treatment strategies. GADSS is a simple, efficient way to rate severity over the telephone in patients with established diagnoses of GAD.

Cognitive-behavioral therapy for late-life generalized anxiety disorder: Who gets better?

The authors pooled data from three independently conducted treatment outcome studies to examine predictors of outcome from group-administered cognitive-behavioral therapy (CBT) for older adults with generalized anxiety disorder (GAD). Data were collected from 65 patients with a mean age of 67.7 years ( SD = 6.6). Average reliable change indices (RCI) based on 3 outcome measures were calculated at posttreatment and at 6-month follow-up. Approximately half of patients achieved a significant RCI at posttreatment and two-thirds achieved a significant RCI at follow-up. Factors associated with better outcomes included better homework adherence, higher baseline GAD severity, and presence of a comorbid psychiatric diagnosis. Results suggest that at-home practice is associated with better and longer-lasting outcomes from CBT in older adults with GAD.

Insomnia and generalized anxiety disorder:: Effects of cognitive behavior therapy for gad on insomnia symptoms

Although clinical practice suggests that sleep complaints are frequent among patients with generalized anxiety disorder (GAD), frequency, severity, types of insomnia complaints, and relationship to GAD diagnosis severity in patients diagnosed using Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria are not well documented. Clinical data about the impact on insomnia symptoms of treating GAD worries are also lacking. The present study examined these aspects in 44 GAD patients who participated in a treatment study specifically addressing excessive worries through CBT interventions. All patients were assessed using a structured clinical interview and the Anxiety Disorder Interview Schedule-IV (ADIS-IV). They also completed anxiety and insomnia inventories, including the Insomnia Severity Index (ISI), a self-report measure which assesses insomnia type, severity and interference with daily life. Among this sample, 47.7% reported difficulties initiating sleep, 63.6% reported difficulties maintaining sleep, and 56.8% complained of waking too early in the morning. The majority of these patients (86.5%) reported never having experienced insomnia without having excessive worries. However, insomnia severity and GAD severity were not correlated. In this sample, patients with severe GAD did not necessarily report more severe insomnia symptoms. Regarding treatment impact on insomnia complaints, ISI post-treatment scores were significantly lower after treatment. Mean post-treatment scores almost reached ISI’s “absence of clinical insomnia” category. Results indicate that this CBT package for GAD does have a significant impact on sleep quality even if sleep disturbances were not specifically addressed during treatment.

Standard and Enhanced Cognitive–Behavior Therapy for Late-Life Generalized Anxiety Disorder: Two Pilot Investigations

Although cognitive-behavior therapy (CBT) is an efficacious treatment for generalized anxiety disorder (GAD) in younger adults, little is known about its efficacy in older patients. Investigations to date have tested group-format or otherwise nonstandard versions of CBT. The studies described here are, to our knowledge, the first to test the efficacy of individual-format CBT administered in a mental health clinic for treatment of late-life GAD. Study 1 tested a standard version, and Study 2 tested an enhanced version (ECBT) that included learning and memory aids designed to make the therapy more effective with elderly patients (e.g., homework reminder and troubleshooting calls, weekly review of all concepts and techniques). Study 1 CBT participants showed significant improvement on GAD severity ratings. Study 2 ECBT participants showed significant improvement on two self-report measures, rates of posttreatment GAD, and GAD severity ratings. ECBT resulted in improvement on more measures and yielded larger effect sizes than standard CBT, when each was compared against a wait-list control group. Results of these pilot studies suggest that standard individual-format CBT may not be optimally effective for treating late-life GAD; thus, ECBT should be tested further in randomized trials.