Stanley Melinda A, Wilson Nancy L, Amspoker Amber B, Kraus-Schuman Cynthia, Wagener Paula D, Calleo Jessica S, Cully Jeffrey A, Teng Ellen, Rhoades Howard M, Williams Susan, Masozera Nicholas, Horsfield Matthew, Kunik Mark E
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas; Baylor College of Medicine, Houston, Texas; South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, Texas.
Depress Anxiety. 2014 May;31(5):391-401. doi: 10.1002/da.22239. Epub 2014 Feb 27.
The Institute of Medicine recommends developing a broader workforce of mental health providers, including nontraditional providers, to expand services for older adults. Cognitive behavior therapy (CBT) is effective for late-life generalized anxiety disorder (GAD), but no study has examined outcomes with delivery by lay providers working under the supervision of licensed providers. The current study examined the effects of CBT delivered by lay, bachelor-level providers (BLP) relative to Ph.D.-level expert providers (PLP), and usual care (UC) in older adults with GAD.
Participants were 223 older adults (mean age, 66.9 years) with GAD recruited from primary care clinics at two sites and assigned randomly to BLP (n = 76), PLP (n = 74), or UC (n = 73). Assessments occurred at baseline and 6 months. CBT in BLP and PLP included core and elective modules (3 months: skills training; 3 months: skills review) delivered in person and by telephone, according to patient choice.
CBT in both BLP and PLP groups significantly improved GAD severity (GAD Severity Scale), anxiety (Spielberger State-Trait Anxiety Inventory; Structured Interview Guide for the Hamilton Anxiety Scale), depression (Patient Health Questionnaire), insomnia (Insomnia Severity Index), and mental health quality of life (Short-Form-12), relative to UC. Response rates defined by 20% reduction from pre- to posttreatment in at least three of four primary outcomes were higher for study completers in BLP and PLP relative to UC (BLP: 38.5%; PLP: 40.0%; UC: 19.1%).
Lay providers, working under the supervision of licensed providers, can deliver effective CBT.
美国医学研究所建议培养更广泛的心理健康服务人员队伍，包括非传统服务人员，以扩大为老年人提供的服务。认知行为疗法（CBT）对老年期广泛性焦虑症（GAD）有效，但尚无研究考察在有执照的服务人员监督下由非专业服务人员提供该疗法的效果。本研究考察了由本科水平的非专业服务人员（BLP）相对于博士水平的专家服务人员（PLP）以及常规护理（UC）为患有GAD的老年人提供CBT的效果。
从两个地点的初级保健诊所招募了223名患有GAD的老年人（平均年龄66.9岁），并随机分配至BLP组（n = 76）、PLP组（n = 74）或UC组（n = 73）。在基线和6个月时进行评估。BLP组和PLP组的CBT包括核心和选修模块（3个月：技能培训；3个月：技能复习），根据患者选择，通过面对面和电话方式提供。
相对于UC组，BLP组和PLP组的CBT均显著改善了GAD严重程度（GAD严重程度量表）、焦虑（斯皮尔伯格状态-特质焦虑量表；汉密尔顿焦虑量表结构化访谈指南）、抑郁（患者健康问卷）、失眠（失眠严重程度指数）以及心理健康生活质量（简明健康调查问卷12项）。在至少四项主要结局指标中，治疗前后降低20%定义的反应率，BLP组和PLP组的研究完成者高于UC组（BLP组：38.5%；PLP组：40.0%；UC组：19.1%）。
在有执照的服务人员监督下，非专业服务人员可以提供有效的CBT。
