Cognitive-behavioral therapy for management of anxiety and medication taper in older adults

Objective: The authors hypothesized that patients with late-life anxiety undergoing cognitive-behavioral therapy plus medical management for medication raper (CBT-MM) would realize greater reduction in medication use and greater improvement in psychological symptoms than a control group undergoing medical management alone (MM). Methods: Forty-two patients (age > 60) who wanted to reduce anxiolytic medication were allocated to the two groups (CBT-MM versus MM), using a randomization plus difference-minimization procedure (to equate for medication use). Results: CBT-MM completers significantly reduced medication use, but not at a greater rate than MM completers. At the same time, CBT-MM completers experienced significantly greater alleviation of psychological symptoms than did MM completers. Some, but not all, treatment gains were maintained at 6-month follow-up. Intention-to-treat analyses using the mixed-effects model showed similar, but weaker, treatment effects than completer analyses. Conclusions: Cognitive-behavioral therapy can alleviate psychological symptoms in elderly patients with anxiety even as patients reduce anxiolytic medication.