In a recent study, the effectiveness of Cognitive-Behavioural Therapy (CBT), in combination with a gradual reduction in benzodiazepine, as a long-term treatment for GAD, was assessed. CBT approaches assume that problematic behaviours are due to faulty learning and that this learning can be reversed; CBT is based on techniques which change learning and restructure bad thought patterns. A fundamental goal of CBT is to identify automatic thoughts in an attempt to change maladaptive thinking patterns that lead to distress, anxiety and depression. The specific aim of this study was to determine whether combining CBT with tapering off drug use, was more effective than combining tapering with nonspecific psychological treatments (NST). Two groups were used: 1) treatment group – underwent gradual but flexible tapering of medication, along with weekly CBT sessions; 2) control group – underwent gradual but flexible tapering of medication, along with weekly NST sessions. The results revealed that the treatment group had higher success rates, with nearly 75% of patients reporting complete cessation of medication after 12 weeks of intervention; a 37% success rate was reached for those in the control group. Researchers concluded that benzodiazepine cessation among GAD patients was facilitated by the gradual and flexible tapering of medication. It was concluded that tapering off of medication, combined with CBT, was more effective than when combined with NST. This study allowed researchers to attribute the observed differences between the two groups to the specific ‘active ingredients’ of CBT.
The active ingredients of CBT are aimed to provide clients with tools to allow them to cope with their anxiety and to reduce excessive worrying. This treatment involved psycho-education on anxiety and worrying, cognitive restructuring, problem-solving training, cognitive exposure to worries, situational exposure, and relapse prevention. Therapy sessions were weekly for 12 weeks. This is important, as with CBT, the most important part of learning is believed to occur between sessions when the client can practice what they have learned in real life.
As Benzodiazepine use remains high among older adults, the risk of cognitive decline increases. Studies are needed to examine the best combination of treatment that can be used with tapering off of medications in older adults. Prevalence rates of anxiety disorders among older adults may be as high as 10%; more than 20% of older adults experience anxiety symptoms that do not necessarily meet the DSM criteria. Further studies therefore, remain an important priority.
References:
Ayers, C. R., Sorrell, J. T., Thorp, S. R., & Wetherell, J. L. (2007). Evidence-based psychological treatments for late-life anxiety. Psychology and Aging, 22(1), 8-17.
Caudle, D. D., Senior, A. C., Wetherell, J. L., Rhoades, H. M., Beck, J. G., Kunik, M. E., Snow, A. L., Wilson, N. L., & Stanley, M. A., (2006). Cognitive errors, symptoms severity, and response to cognitive behavior therapy in older adults with generalized anxiety disorder. American Journal of Geriatric Psychiatry, 15(8), 680-687.
Gosselin, P., Ladouceur, R., Morin, C.M., Dugas, M. J., & Baillargeon, L. (2006).
Benzodiazepine discontinuation among adults with GAD: A randomized trial of cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 74(5), 908-919.
Hunsley, J., & Lee, C. M. (2006). Introduction to Clinical Psychology. Mississauga, ON, Canada: Wiley.
Mohlman, J., Gorenstein, E. E., Kleber, M., Dejesus, M., Gorman, J. M., & Papp, L. A. (2003). Standard and enhanced cognitive-behavioral therapy for late-life generalized anxiety disorder. American Journal of Geriatric Psychiatry, 11, 24-32.
Sarason, I. G., & Sarason, B. R. (2005). Abnormal Psychology: The Problems of Maladaptive Behavior. New Jersey, USA: Pearson Prentice Hall.
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