More Power to the Executive? A Preliminary Test of CBT Plus Executive Skills Training for Treatment of Late-Life GAD☆

https://doi.org/10.1016/j.cbpra.2007.07.002Get rights and content

Abstract

One hypothesized reason for the lower rates of cognitive behavior therapy (CBT) response among older as compared to younger anxiety patients is that they are more likely to show age-related deficits in executive skills, which are complex cognitive skills involved in the regulation of negative affect. Following an 8-week baseline period, this pilot study tested CBT augmented with an executive skills training program, Attention Process Training II (Sohlberg et al., 2001, Sohlberg and Mateer, 2001) against standard CBT in a small sample of 8 older adults with generalized anxiety disorder (comorbidity allowed) and low scores on executive skills tests. Those who received the augmented version (CBT/APT) evidenced more improvement on executive skills and a weekly process measure of worry than those who received CBT. All of the participants in CBT/APT, as compared to half the participants in CBT, met criteria for response, and more in CBT/APT met criteria for high endstate functioning at posttreatment and follow-up. It may be fruitful to test the intervention in a larger sample, and to continue to investigate the role of executive skills in CBT outcome and anxiety treatment.

Section snippets

Participants

The pilot sample was comprised of eight adults, ages 60 to 74, 63% female, mean age 66.4 (SD = 5.54), recruited through radio and print ads in the Syracuse, New York, area. Most were Caucasian (75%), in good health, had finished high school (88%), and most (88%) had had treatment for a psychiatric or mood problem in the past. All participants were screened initially by phone, and those who reported frequent, uncontrollable worries and other GAD symptoms were scheduled for a comprehensive

Results

Demographic and clinical variables were compared between the groups using analyses of variance (ANOVAs) and Fisher's exact tests. There were no significant differences between the groups on age, sex, health problems, education, marital status, ethnicity, occupational status, or any other demographic variable. However, the CBT/APT group included one more female than the CBT group, and one participant who did not finish high school (see Table 1).

Discussion

Hypotheses tested in this small preliminary study pertained to both the mitigation of anxiety and improvement in executive functioning. The CBT/APT group showed a significant improvement in executive skills following the intervention, presumably evoked by the intensive cognitive training component of the therapy. Twice the number of responders in the CBT/APT group met criteria for response, and more participants in CBT/APT as compared to CBT met criteria for high end-state functioning at

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    ☆

    This research was supported by a Young Investigator Grant from the National Association for Research in Schizophrenia and Depression (NARSAD) awarded to the author.

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