Houston Center for Quality of Care & Utilization Studies, Department of Family and Community Medicine, Baylor College of Medicine, TX 77030, USA.
Am J Geriatr Psychiatry. 2011 Apr;19(4):347-56. doi: 10.1097/JGP.0b013e3181f18061.
To determine the association of early and long-term reductions in worry symptoms after cognitive behavior therapy (CBT) for generalized anxiety disorder (GAD) in older adults.
Substudy of larger randomized controlled trial.
Family medicine clinic and large multispecialty health organization in Houston, TX, between March 2004 and August 2006.
Patients (N = 76) aged 60 years or older with a principal or coprincipal diagnosis of GAD, excluding those with significant cognitive impairment, bipolar disorder, psychosis, or active substance abuse.
CBT, up to 10 sessions for 12 weeks, or enhanced usual care (regular, brief telephone calls, and referrals to primary care provider as needed).
Penn State Worry Questionnaire (PSWQ) administered by telephone at baseline, 1 month (mid treatment), 3 months (posttreatment), and at 3-month intervals through 15 months (1-year follow-up). The authors used binary logistic regression analysis to determine the association between early (1 month) response and treatment responder status (reduction of more than 8.5 points on the PSWQ) at 3 and 15 months. The authors also used hierarchical linear modeling to determine the relationship of early response to the trajectory of score change after posttreatment.
Reduction in PSWQ scores after the first month predicted treatment response at posttreatment and follow-up, controlling for treatment arm and baseline PSWQ score. The magnitude of early reduction also predicted the slope of score change from posttreatment through the 15-month assessment.
Early symptom reduction is associated with long-term outcomes after psychotherapy in older adults with GAD.
确定认知行为疗法（CBT）治疗老年广泛性焦虑症（GAD）后早期和长期减轻担忧症状与疗效的关系。
较大的随机对照试验的子研究。
德克萨斯州休斯顿的家庭医学诊所和大型多专科健康组织，时间为 2004 年 3 月至 2006 年 8 月。
年龄在 60 岁或以上，有 GAD 主要或次要诊断的患者（N=76），不包括有明显认知障碍、双相情感障碍、精神病或有活跃物质滥用的患者。
CBT，最多 10 次，为期 12 周，或增强的常规护理（定期进行简短的电话联系，并根据需要转介给初级保健提供者）。
通过电话在基线、1 个月（治疗中期）、3 个月（治疗后）和 3 个月间隔（15 个月，1 年随访）时进行宾夕法尼亚州担忧问卷（PSWQ）。作者使用二项逻辑回归分析来确定早期（1 个月）反应与 3 个月和 15 个月时治疗反应者状态（PSWQ 评分减少超过 8.5 分）之间的关系。作者还使用分层线性模型来确定早期反应与治疗后评分变化轨迹之间的关系。
第一个月 PSWQ 评分的降低预测了治疗后的反应和随访时的反应，控制了治疗臂和基线 PSWQ 评分。早期降低的幅度也预测了从治疗后到 15 个月评估时评分变化的斜率。
老年 GAD 患者心理治疗后早期症状减轻与长期疗效相关。
