Executive skills in older adults with GAD: Relations with clinical variables and CBT outcome

Although cognitive behavior therapy (CBT) is an effective intervention for treating generalized anxiety disorder (GAD) in older adults, researchers are now considering augmenting the therapy to enhance outcome. We are also long overdue in identifying moderators of CBT response (e.g., cognitive abilities) in late life anxiety. The goals of the current investigation were to examine performance on verbal versus nonverbal tests of executive skills (ES) and to test the relation between ES and clinical indices in older GAD patients. Hierarchical and logistic regression models identified baseline ES predictors of premature termination, homework compliance and quality, and indices of cognitive restructuring, an essential component of CBT. Although the analyses of response on symptom measures did not reveal any significant baseline predictors, an alternative ES grouping scheme showed that those whose ES improved during CBT also responded best in terms of worry reduction. These findings can be applied to the optimization of treatment for older anxiety patients, who are an underserved demographic group.

► Although cognitive behavior therapy is effective for treating generalized anxiety in older adults, researchers are considering augmenting the therapy to enhance outcome. ► GAD patients performed worse than controls on one test in a neuropsychological battery, Digit Span Forward. ► Baseline predictors of premature termination, homework compliance and quality, and indices of cognitive restructuring, an essential component of CBT were identified. ► A grouping scheme based on pre- and posttreatment abilities showed that those whose executive skills improved during CBT also responded best in terms of worry reduction.