Skip to main content Accessibility help

Randomized controlled trial of group cognitive behavioral therapy compared to a discussion group for co-morbid anxiety and depression in older adults

  • V. M. Wuthrich (a1), R. M. Rapee (a1), M. Kangas (a1) and S. Perini (a1)

Co-morbid anxiety and depression in older adults is associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments in older adults. However, there is a paucity of research focused on testing the efficacy of the co-morbid treatment of anxiety and depression in older adults using psychological interventions. Accordingly, the primary objective of the current study was to test the effects of a group cognitive behavior therapy (CBT) program in treating co-morbid anxiety and depression in a sample of older age adults.


A total of 133 community-dwelling participants aged ⩾60 years (mean age = 67.35, s.d. = 5.44, male = 59) with both an anxiety disorder and unipolar mood disorder, as assessed on the Anxiety Disorder Interview Schedule (ADIS), were randomly allocated to an 11-week CBT group or discussion group. Participants with Mini-Mental State Examination scores <26 were excluded. Participants were assessed pre-treatment, post-treatment and at 6 months follow-up on the ADIS, a brief measure of well-being, Geriatric Anxiety Inventory and Geriatric Depression Scale.


Both conditions resulted in significant improvements over time on all diagnostic, symptom and wellbeing measures. Significant group × time interaction effects emerged at post-treatment only for diagnostic severity of the primary disorder, mean severity of all anxiety disorders, mood disorders, and all disorders, and recovery rates on primary disorder.


Group CBT produced faster and sustained improvements in anxiety and depression on diagnostic severity and recovery rates compared to an active control in older adults.

Corresponding author
*Address for correspondence: Dr V. M. Wuthrich, Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney 2109, Australia. (Email:
Hide All
Almeida, OP, Draper, B, Pirkis, J, Snowdon, J, Lautenschlager, NT, Byrne, G, Sim, M, Stocks, N, Kerse, N, Flicker, L, Pfaff, JJ (2012). Anxiety, depression, and co-morbid anxiety and depression: risk factors and outcome over two years. International Psychogeriatrics 24, 16221632.
Barrowclough, C, King, P, Colville, J, Russell, E, Burns, A, Tarrier, N (2001). A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. Journal of Consulting and Clinical Psychology 69, 756762.
Blanco, C, Rubio, J, Wall, M, Wang, S, Jiu, CJ, Kendler, KS (2014). Risk factors for anxiety disorders: common and specific effects in a national sample. Depression and Anxiety 31, 756764.
Cohen, A, Gilman, SE, Houck, PR, Szanto, K, Reynolds, CF (2009). Socioeconomic status and anxiety as predictors of antidepressant treatment response and suicidal ideation in older adults. Social Psychiatry and Psychiatric Epidemiology 44, 272277.
Craske, MG (2012). Transdiagnostic treatment for anxiety and depression. Depression and Anxiety 29, 749753.
Cuijpers, P, Li, J, Hofmann, SG, Andersson, G (2010). Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: a meta-analysis. Clinical Psychology Review 30, 768778.
Cuijpers, P, Van Straten, A, Smit, F (2006). Psychological treatment of late-life depression: a meta-analysis of randomised controlled trials. International Journal of Geriatric Psychiatry 21, 11391149.
Deluca, AK, Lenze, EJ, Mulsant, BH, Butters, MA, Karp, JF, Dew, MA, Pollock, BG, Shear, MK, Houck, PR, Reynolds, CF (2005). Co-morbid anxiety disorder in late life depression: association with memory decline over four years. International Journal of Geriatric Psychiatry 20, 848854.
Devilly, GJ, Borkovec, TD (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry 31, 7386.
Di Nardo, PA, Brown, TA, Barlow, DH (1994). Anxiety Disorders Interview Schedule for DSM-IV. Center for Stress and Anxiety Related Disorders, Boston University: Boston.
Evans, C, Margison, F, Barkham, M (1998). The contribution of reliable and clinically significant change methods to evidence-based mental health. Evidence Based Mental Health 1, 7072.
Folstein, M, Folstein, S, Mchugh, P (1975). ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189198.
Gorenstein, EE, Kleber, MS, Mohlmann, J, Dejesus, M, Gorman, JM, Papp, LA (2005). Cognitive-behavioural therapy for management of anxiety and medication taper in older adults. American Journal of Geriatric Psychiatry 13, 901909.
Gould, RL, Coulson, MC, Howard, RJ (2012 a). Cognitive behavioral therapy for depression in older people: a meta-analysis and meta-regression of randomized controlled trials. Journal of the American Geriatrics Society 60, 18171830.
Gould, RL, Coulson, MC, Howard, RJ (2012 b). Efficacy of cognitive behavioral therapy for anxiety disorders in older people: a meta-analysis and meta-regression of randomized controlled trials. Journal of the American Geriatrics Society 60, 218229.
Gum, AM, Arean, PA, Bostrom, A (2007). Low-income depressed older adults with psychiatric co-morbidity: secondary analyses of response to psychotherapy and case management. International Journal of Geriatric Psychiatry 22, 124130.
Hegel, MT, Unutzer, J, Tang, L, Arean, PA, Katon, W, Noel, PH, Williams, JWJ, Lin, EHB (2005). Impact of co-morbid panic and posttraumatic stress disorder on outcomes of collaborative care for late-life depression in primary care. American Journal of Geriatric Psychiatry 13, 4858.
Hendriks, GJ, Oude Voshaar, RC, Keijsers, GPJ, Hoogduin, CaL, Van Balkom, AJLM (2008). Cognitive-behavioural therapy for late-life anxiety disorders: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica 117, 403411.
Johnco, C, Wuthrich, VM, Rapee, RM (2014). The influence of cognitive flexibility on treatment outcome and cognitive restructuring skills acquisition during cognitive behavioural treatment for anxiety and depression in older adults: results of a pilot study. Behaviour Research and Therapy 57, 5564.
Jongenelis, K, Pot, AM, Eisses, AMH, Gerritsen, DL, Derksen, M, Beekman, ATF, Kluiter, H, Ribbe, MW (2005). Diagnostic accuracy of the original 30-item and shortened versions of the Geriatric Depression Scale in nursing home patients. International Journal of Geriatric Psychiatry 20, 10671074.
Keiffer, KM, Reeses, RJ (2002). A reliability generalisation study of the Geriatric Depression Scale. Education and Psychological Measurement 62, 969994.
Kendler, KS, Gardner, CO, Gatz, M, Pedersen, NL (2007). The sources of co-morbidity between major depression and generalised anxiety disorder in a Swedish national twin sample. Psychological Medicine 37, 453462.
Kessler, RC, Nelson, CB, Mcgonagle, KA, Liu, J, Swartz, M, Blazer, DG (1996). Co-morbidity of DSM-III-R major depressive disorder in the general population: results from the US National Co-morbidity Survey. British Journal of Psychiatry 30, 821.
Kukull, WA, Larson, EB, Teri, L, Bowen, J, Mccormick, W, Pfanschmidt, ML (1994). The Mini-Mental State Examination Score and the clinical diagnosis of dementia. Journal of Clinical Epidemiology 47, 10611067.
Kvaal, K, McDougall, FA, Brayne, C, Matthews, FE, Dewey, ME (2008). Co-occurrence of anxiety and depressive disorders in a community sample of older people: results from the MRC CFAS (Medical Research Council Cognitive Function and Ageing Study). International Journal of Geriatric Psychiatry 23, 229237.
Lenze, EJ, Mulsant, BH, Shear, MK, Schulberg, HC, Dew, MA, Begley, AE, Pollock, BG, Reynolds, CF (2000). Co-morbid anxiety disorders in depressed elderly patients. American Journal of Psychiatry 157, 722728.
Luborsky, L, Barber, JP, Siqueland, L, Johnson, S, Najavits, LM, Frank, A, Daley, D (1996). The revised helping alliance 1uestionniare. Journal of Psychotherapy Practice and Research 5, 260271.
Mackin, RS, Arean, PA (2005). Evidence-based psychotherapeutic interventions for geriatric depression. Psychiatric Clinics of North America 28, 805820.
Norton, PJ, Barrera, TL, Mathew, AR, Chamberlain, LD, Szafranski, DD, Reddy, R, Smith, AH (2013). Effect of transdiagnostic CBT for anxiety disorders on co-morbid disorders. Depression and Anxiety 30, 168173.
Odgaard, EC, Fowler, RL (2010). Confidence intervals for effect sizes: Compliance and clinical significance in the Journal of Consulting and Clinical Psychology . Journal of Consulting and Clinical Psychology 78, 287297.
Pachana, NA, Byrne, GJ, Siddle, H, Koloski, N, Harley, E, Arnold, E (2007). Development and validation of the Geriatric Anxiety Inventory. International Psychogeriatrics 19, 103114.
Prina, AM, Ferri, CP, Guerra, M, Brayne, C, Prince, M (2011). Co-occurance of anxiety and depression amongst older adults in low- and middle-income countries: findings from the 10/66 study. Psychological Medicine 41, 20472056.
Serfaty, MA, Haworth, D, Blanchard, M, Buszewicz, M, King, M (2009). Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized control trial. Archives of General Psychiatry 66, 13321340.
Stanley, MA, Beck, JG, Novy, DM, Averill, PM, Swann, AC, Diefenbach, GJ, Hopko, DR (2003 a). Cognitive-behavioral treatment of late-life generalized anxiety disorder. Journal of Consulting and Clinical Psychology 71, 309319.
Stanley, MA, Hopko, DR, Diefenbach, GJ, Bourland, SL, Rodriguez, H, Wagener, P (2003 b). Cognitive-behavior therapy for late-life generalized anxiety disorder in primary care: preliminary findings. American Journal of Geriatric Psychiatry 11, 9296.
Treadwell, T, Lavertue, N, Kumar, VK, Veeraraghavan, V (2001). The group cohesion scale-revised: reliability and validity. International Journal of Action Methods 54, 311.
Vasiliadis, H-M, Dionne, P-A, Preville, M, Gentil, L, Berbiche, D, Latimer, E (2012). The excess health care costs associated with depression and anxiety in elderly living in the community. American Journal of Geriatric Psychiatry. Published online: March 2012. doi:10.1097/JGP.0b013e318248ae9e.
Vink, D, Aartsen, MJ, Schoevers, RA (2008). Risk factors for anxiety and depression in the elderly: a review. Journal of Affective Disorders 106, 2944.
Waltz, J, Addis, ME, Koerner, K, Jacobson, NS (1993). Testing the integrity of a psychotherapy protocol: assessment of adherence and competence. Journal of Consulting and Clinical Psychology 61, 620630.
Watson, D, Clark, LA, Weber, K, Assenheimer, JS, Strauss, ME, Mccormick, RA (1995). Testing a tripartite model, II: exploring the symptom structure of anxiety and depression in student, adult, and patient samples. Journal of Abnormal Psychology 104, 1525.
Wetherell, JL, Gatz, M, Craske, MG (2003). Treatment of generalised anxiety disorder in older adults. Journal of Consulting and Clinical Psychology 71, 3140.
WHOQOL Group (1995). The World Health Organisation Quality of Life Assessment (WHOQOL): position paper from the World Health Organisation. Social Science and Medicine 41, 1403.
Wuthrich, VM, Rapee, RM (2013). Randomized controlled trial of group cognitive behavioral therapy for co-morbid anxiety and depression in older adults. Behaviour Research and Therapy 51, 779786.
Yesavage, JA, Brink, TL, Rose, TL, Lum, O, Huang, V, Adley, M, Leirer, VO (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research 1, 3749.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed