CBT-based self-help guided by a lay provider for generalized anxiety in older adults: A randomized controlled trial

Abstract

Treatments for generalized anxiety disorder (GAD) that circumvent the barriers to accessing mental health care in older adults are needed. The main goal of this multisite randomized controlled trial was to evaluate the efficacy of CBT-based self-help guided by a lay provider (LP) for generalized anxiety (i.e., threshold or subthreshold GAD) in older adults. Participants (≥ 60 years) were block randomized based on diagnosis to an experimental (n = 75) or wait-list control group (n = 75). Experimental group participants used a manual presenting CBT-based readings and exercises and received brief weekly support calls by LPs. Groups were similar in terms of sociodemographic characteristics and initially did not differ significantly on outcomes. At post-treatment, the experimental group showed greater improvement across both primary outcomes (i.e., worry tendency, p < .0001, Standardized mean difference [SMD] = −1.5971, and GAD severity, p < .0001, SMD = −1.1639) and most additional outcomes (e.g., targeted psychological vulnerabilities, depressive symptoms, sleep difficulties, and GAD diagnosis) with small to large effect sizes (SMD = −0.4358 to −1.5402). The experimental group also showed maintenance of treatment effects or other improvements at 6- and 12-month follow-up. Participants in the control group who completed the treatment after their waiting period also improved on worry tendency (SMD = −1.2477) and GAD severity (SMD = −0.8443) and most of the other variables (SMD = −0.3728 to −1.0154). Results demonstrate that self-help guided by a LP is effective for treating GAD in older adults and that the improvements are sustained after treatment.