LAY PROVIDERS CAN DELIVER EFFECTIVE COGNITIVE BEHAVIOR THERAPY FOR OLDER ADULTS WITH GENERALIZED ANXIETY DISORDER: A RANDOMIZED TRIAL
Background 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 examine...
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| Veröffentlicht in: | Depression and anxiety 2014-05, Vol.31 (5), p.391-401 |
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| creator | 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. |
| description | Background
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.
Methods
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.
Results
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%).
Conclusion
Lay providers, working under the supervision of licensed providers, can deliver effective CBT. |
| doi_str_mv | 10.1002/da.22239 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_1518816393</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3281411631</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3889-8022c940981e0e8d68b3a4a45431efafaec07f6136350111d53726452a60dc0e3</originalsourceid><addsrcrecordid>eNpd0d1u0zAUB3ALgdgYSDwBssQNNxnHH0ls7kzitpZCsqVZt3JjeYkrdbTrSFaxPcDeG5ONIXF1_tL5Hcs6B6H3BI4JAP3cuWNKKZMv0CGJKUQJk_xlyCBJxGkiD9CbYbgCACEFvEYHlMdpKnh6iB4KtcQndbUwua7nOFMlznVhFrrGejLRWRMizqppacb0Vc_UwlQ1bma6VidLPAm5KsIsVvlZ0czxuWlmeKrL0C7Md51jVV4Y3SxxbuZVHeAXrHCtyrz6Nrab2qjiLXq1cpvBv3uqR-hsoptsFhXV1GSqiFomhIwEUNpKDlIQD150ibhkjjsec0b8yq2cbyFdJYQlLAZCSBezlCY8pi6BrgXPjtCnx3dv-t3PvR9u7XY9tH6zcdd-tx8siYkQJGyPBfrxP3q12_fX4XejAgmU8aA-PKn95dZ39qZfb11_b_8uOIDoEfxab_z9c5-A_XM42zk7Hs7maqz__Hq49XfP3vU_bJKyNLbn5dSeXnCWZuLUEvYb_mqLLQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1518090234</pqid></control><display><type>article</type><title>LAY PROVIDERS CAN DELIVER EFFECTIVE COGNITIVE BEHAVIOR THERAPY FOR OLDER ADULTS WITH GENERALIZED ANXIETY DISORDER: A RANDOMIZED TRIAL</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>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.</creator><creatorcontrib>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.</creatorcontrib><description>Background
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.
Methods
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.
Results
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%).
Conclusion
Lay providers, working under the supervision of licensed providers, can deliver effective CBT.</description><identifier>ISSN: 1091-4269</identifier><identifier>EISSN: 1520-6394</identifier><identifier>DOI: 10.1002/da.22239</identifier><identifier>PMID: 24577847</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Age Factors ; Aged ; Anxiety ; Anxiety Disorders - diagnosis ; Anxiety Disorders - psychology ; Anxiety Disorders - therapy ; Behavior modification ; Cognition & reasoning ; Cognitive Therapy - education ; controlled clinical trial ; Female ; Follow-Up Studies ; Humans ; Insomnia ; Male ; Mental health ; Middle Aged ; Older people ; Primary Health Care ; Professional Competence ; Professional-Patient Relations ; psychotherapy ; Quality of Life - psychology ; Surveys and Questionnaires ; Telephone ; United States</subject><ispartof>Depression and anxiety, 2014-05, Vol.31 (5), p.391-401</ispartof><rights>Published 2014. This article is a U.S. Government work and is in the public domain in the USA.</rights><rights>2014 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3889-8022c940981e0e8d68b3a4a45431efafaec07f6136350111d53726452a60dc0e3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fda.22239$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fda.22239$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24577847$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stanley, Melinda A.</creatorcontrib><creatorcontrib>Wilson, Nancy L.</creatorcontrib><creatorcontrib>Amspoker, Amber B.</creatorcontrib><creatorcontrib>Kraus-Schuman, Cynthia</creatorcontrib><creatorcontrib>Wagener, Paula D.</creatorcontrib><creatorcontrib>Calleo, Jessica S.</creatorcontrib><creatorcontrib>Cully, Jeffrey A.</creatorcontrib><creatorcontrib>Teng, Ellen</creatorcontrib><creatorcontrib>Rhoades, Howard M.</creatorcontrib><creatorcontrib>Williams, Susan</creatorcontrib><creatorcontrib>Masozera, Nicholas</creatorcontrib><creatorcontrib>Horsfield, Matthew</creatorcontrib><creatorcontrib>Kunik, Mark E.</creatorcontrib><title>LAY PROVIDERS CAN DELIVER EFFECTIVE COGNITIVE BEHAVIOR THERAPY FOR OLDER ADULTS WITH GENERALIZED ANXIETY DISORDER: A RANDOMIZED TRIAL</title><title>Depression and anxiety</title><addtitle>Depress Anxiety</addtitle><description>Background
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.
Methods
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.
Results
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%).
Conclusion
Lay providers, working under the supervision of licensed providers, can deliver effective CBT.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Anxiety</subject><subject>Anxiety Disorders - diagnosis</subject><subject>Anxiety Disorders - psychology</subject><subject>Anxiety Disorders - therapy</subject><subject>Behavior modification</subject><subject>Cognition & reasoning</subject><subject>Cognitive Therapy - education</subject><subject>controlled clinical trial</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Insomnia</subject><subject>Male</subject><subject>Mental health</subject><subject>Middle Aged</subject><subject>Older people</subject><subject>Primary Health Care</subject><subject>Professional Competence</subject><subject>Professional-Patient Relations</subject><subject>psychotherapy</subject><subject>Quality of Life - psychology</subject><subject>Surveys and Questionnaires</subject><subject>Telephone</subject><subject>United States</subject><issn>1091-4269</issn><issn>1520-6394</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0d1u0zAUB3ALgdgYSDwBssQNNxnHH0ls7kzitpZCsqVZt3JjeYkrdbTrSFaxPcDeG5ONIXF1_tL5Hcs6B6H3BI4JAP3cuWNKKZMv0CGJKUQJk_xlyCBJxGkiD9CbYbgCACEFvEYHlMdpKnh6iB4KtcQndbUwua7nOFMlznVhFrrGejLRWRMizqppacb0Vc_UwlQ1bma6VidLPAm5KsIsVvlZ0czxuWlmeKrL0C7Md51jVV4Y3SxxbuZVHeAXrHCtyrz6Nrab2qjiLXq1cpvBv3uqR-hsoptsFhXV1GSqiFomhIwEUNpKDlIQD150ibhkjjsec0b8yq2cbyFdJYQlLAZCSBezlCY8pi6BrgXPjtCnx3dv-t3PvR9u7XY9tH6zcdd-tx8siYkQJGyPBfrxP3q12_fX4XejAgmU8aA-PKn95dZ39qZfb11_b_8uOIDoEfxab_z9c5-A_XM42zk7Hs7maqz__Hq49XfP3vU_bJKyNLbn5dSeXnCWZuLUEvYb_mqLLQ</recordid><startdate>201405</startdate><enddate>201405</enddate><creator>Stanley, Melinda A.</creator><creator>Wilson, Nancy L.</creator><creator>Amspoker, Amber B.</creator><creator>Kraus-Schuman, Cynthia</creator><creator>Wagener, Paula D.</creator><creator>Calleo, Jessica S.</creator><creator>Cully, Jeffrey A.</creator><creator>Teng, Ellen</creator><creator>Rhoades, Howard M.</creator><creator>Williams, Susan</creator><creator>Masozera, Nicholas</creator><creator>Horsfield, Matthew</creator><creator>Kunik, Mark E.</creator><general>Blackwell Publishing Ltd</general><general>Hindawi Limited</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>201405</creationdate><title>LAY PROVIDERS CAN DELIVER EFFECTIVE COGNITIVE BEHAVIOR THERAPY FOR OLDER ADULTS WITH GENERALIZED ANXIETY DISORDER: A RANDOMIZED TRIAL</title><author>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.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3889-8022c940981e0e8d68b3a4a45431efafaec07f6136350111d53726452a60dc0e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Anxiety</topic><topic>Anxiety Disorders - diagnosis</topic><topic>Anxiety Disorders - psychology</topic><topic>Anxiety Disorders - therapy</topic><topic>Behavior modification</topic><topic>Cognition & reasoning</topic><topic>Cognitive Therapy - education</topic><topic>controlled clinical trial</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Insomnia</topic><topic>Male</topic><topic>Mental health</topic><topic>Middle Aged</topic><topic>Older people</topic><topic>Primary Health Care</topic><topic>Professional Competence</topic><topic>Professional-Patient Relations</topic><topic>psychotherapy</topic><topic>Quality of Life - psychology</topic><topic>Surveys and Questionnaires</topic><topic>Telephone</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stanley, Melinda A.</creatorcontrib><creatorcontrib>Wilson, Nancy L.</creatorcontrib><creatorcontrib>Amspoker, Amber B.</creatorcontrib><creatorcontrib>Kraus-Schuman, Cynthia</creatorcontrib><creatorcontrib>Wagener, Paula D.</creatorcontrib><creatorcontrib>Calleo, Jessica S.</creatorcontrib><creatorcontrib>Cully, Jeffrey A.</creatorcontrib><creatorcontrib>Teng, Ellen</creatorcontrib><creatorcontrib>Rhoades, Howard M.</creatorcontrib><creatorcontrib>Williams, Susan</creatorcontrib><creatorcontrib>Masozera, Nicholas</creatorcontrib><creatorcontrib>Horsfield, Matthew</creatorcontrib><creatorcontrib>Kunik, Mark E.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Depression and anxiety</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stanley, Melinda A.</au><au>Wilson, Nancy L.</au><au>Amspoker, Amber B.</au><au>Kraus-Schuman, Cynthia</au><au>Wagener, Paula D.</au><au>Calleo, Jessica S.</au><au>Cully, Jeffrey A.</au><au>Teng, Ellen</au><au>Rhoades, Howard M.</au><au>Williams, Susan</au><au>Masozera, Nicholas</au><au>Horsfield, Matthew</au><au>Kunik, Mark E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>LAY PROVIDERS CAN DELIVER EFFECTIVE COGNITIVE BEHAVIOR THERAPY FOR OLDER ADULTS WITH GENERALIZED ANXIETY DISORDER: A RANDOMIZED TRIAL</atitle><jtitle>Depression and anxiety</jtitle><addtitle>Depress Anxiety</addtitle><date>2014-05</date><risdate>2014</risdate><volume>31</volume><issue>5</issue><spage>391</spage><epage>401</epage><pages>391-401</pages><issn>1091-4269</issn><eissn>1520-6394</eissn><abstract>Background
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.
Methods
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.
Results
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%).
Conclusion
Lay providers, working under the supervision of licensed providers, can deliver effective CBT.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>24577847</pmid><doi>10.1002/da.22239</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Depression and anxiety, 2014-05, Vol.31 (5), p.391-401 |
| issn | 1091-4269 1520-6394 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Age Factors Aged Anxiety Anxiety Disorders - diagnosis Anxiety Disorders - psychology Anxiety Disorders - therapy Behavior modification Cognition & reasoning Cognitive Therapy - education controlled clinical trial Female Follow-Up Studies Humans Insomnia Male Mental health Middle Aged Older people Primary Health Care Professional Competence Professional-Patient Relations psychotherapy Quality of Life - psychology Surveys and Questionnaires Telephone United States |
| title | LAY PROVIDERS CAN DELIVER EFFECTIVE COGNITIVE BEHAVIOR THERAPY FOR OLDER ADULTS WITH GENERALIZED ANXIETY DISORDER: A RANDOMIZED TRIAL |
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