Objective: The aim of the present study is to provide an empirical review of controlled trials examining non-pharmacological (psychological) interventions for late-life anxiety, focusing on treatment efficacy and central study characteristics.
Design: Based on a meta-analytic procedure, calculating effect sizes for each trial, studies were eligible for inclusion if comparisons were made either to a control condition and/or to another treatment.
Search process: To identify potential studies for inclusion, computer searches in relevant databases were conducted (Medline, PsychINFO) covering the period from 1967 to 2002. We also included studies by hand searching literature, scrutinizing reference lists of review articles and relevant books. Finally, to minimize publication bias, requests were sent to prominent researchers in the field, thus obtaining unpublished data.
Results: Fifteen studies, published or presented between January 1975 and January 2002 were identified, involving 495 subjects (mean age exceeding 55 years and a grand mean of 69.5 years), and providing 20 separate treatment interventions. Psychological interventions, in terms of individual as well as group formats, were reliably more effective than no-treatment on clinician-rated and self-rated measures of anxiety, yielding an overall effect size of d 0.55. Maintenance of treatment gains (> 6-12 months) was insufficiently reported across studies to allow for a satisfactorily demonstration of an overall estimate of long-term efficacy.
Conclusion: The present meta-analytic review represents a unique quantitative summary of current non-pharmacological anxiety treatment outcome studies focusing on older adults. The analysis indicates that established psychological intervention is reliably more effective than placebo or non-treatment, thus representing a relevant alternative or supplement to pharmacological treatment of anxiety in older adults. Considering the well-known fact that older adults have lower access to psychological treatment than younger patients, it is worth noticing that group treatment turns out to be as effective for older patients as individual treatment. In a resource perspective, therefore, it seems that the group format may serve as a cost-effective approach in treating anxiety in old age. Limitations inherent in the research synthesis are discussed as well as guidelines to conduct more rigorously designed treatment outcome trials in future studies on late-life anxiety.
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