Information processing bias and pharmacotherapy outcome in older adults with generalized anxiety disorder

https://doi.org/10.1016/j.janxdis.2012.10.007Get rights and content

Abstract

Information processing bias was evaluated in a sample of 25 older adults with generalized anxiety disorder (GAD) over the course of 12 weeks of escitalopram pharmacotherapy. Using the CANTAB Affective Go/No Go test, treatment response (as measured by the Hamilton Anxiety Rating Scale, Penn State Worry Questionnaire, and Generalized Anxiety Disorder Severity Scale) was predicted from a bias score (i.e., difference score between response latencies for negative and positive words) using mixed-models regression. A more positive bias score across time predicted better response to treatment. Faster responses to positive words relative to negative words were associated with greater symptomatic improvement over time as reflected by scores on the GADSS. There was a trend toward significance for PSWQ scores and no significant effects related to HAMA outcomes. These preliminary findings offer further insights into the role of biased cognitive processing of emotional material in the manifestation of late-life anxiety symptoms.

Highlights

► Cognitive processing of emotional words was evaluated in a sample of 25 older adults with generalized anxiety receiving pharmacotherapy. ► We measured biased processing by subtracting the speed of response to negative words from the speed of response to positive words. ► Faster responses to positive words relative to negative words were associated with better response to medication. ► Findings represent a step toward understanding the role of emotional information processing bias in anxiety in later life.

Section snippets

Participants

Participants in the present study were 25 older adults (age 60 years or older) with a principal or co-principal (i.e., most severe) diagnosis of GAD according to criteria established by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) who were awaiting randomization into a study evaluating the effects of cognitive-behavioral therapy as an augmentation to pharmacotherapy. GAD diagnosis was established using

Descriptive statistics and change over treatment

Means, standard deviations, and pre-post comparisons of the clinical and AGN variables at each time point are presented in Table 1. At baseline, participants reported moderate levels of anxiety, worry, and GAD symptoms. Paired t-tests comparing week 0 and 12 means suggest that participants had significant decreases on the HAMA, t(24) = 12.47, p < .01, PSWQ, t(23) = 2.93, p < .01, and GADSS, t(24) = 5.12, p < .01. There were no significant changes in information processing bias over the treatment period, t

Discussion

To our knowledge, the current study represents the first attempt to examine emotionally biased information processing in older adults with a clinical anxiety disorder diagnosis over the course of treatment. Overall, these preliminary results suggest that biased processing of affective material, as measured by a difference score calculated by subtracting the response latency for negative words from the response latency for positive words, is related to response to psychopharmacological treatment

References (47)

  • J.I. Mattia et al.

    The revised Stroop color-naming task in social phobics

    Behaviour Research and Therapy

    (1993)
  • T.J. Meyer et al.

    Development and validation of the Penn State Worry Questionnaire

    Behaviour Research and Therapy

    (1990)
  • K. Mogg et al.

    A follow-up study of cognitive bias in generalized anxiety disorder

    Behaviour Research and Therapy

    (1995)
  • J. Mohlman et al.

    The role of executive functioning in CBT: a pilot study with anxious older adults

    Behaviour Research and Therapy

    (2005)
  • E.K. Porensky et al.

    The burden of late-life generalized anxiety disorder: effects on disability, health-related quality of life, and healthcare utilization

    American Journal of Geriatric Psychiatry

    (2009)
  • R.B. Price et al.

    Emotional Stroop performance in older adults: effects of habitual worry

    American Journal of Geriatric Psychiatry

    (2012)
  • M.A. Stanley et al.

    Assessing older adults with generalized anxiety: a replication and extension

    Behaviour Research and Therapy

    (2001)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2000)
  • N. Amir et al.

    Attention modification program in individuals with generalized anxiety disorder

    Journal of Abnormal Psychology

    (2009)
  • J.G. Beck et al.

    Psychometric properties of the Penn State Worry Questionnaire

    Journal of Clinical Geropsychology

    (1995)
  • J.G. Beck et al.

    Effectiveness of the Hamilton Anxiety Rating Scale with older generalized anxiety disorder patients

    Journal of Clinical Geropsychology

    (1999)
  • B.P. Bradley et al.

    Selective processing of negative information: effects of clinical anxiety, concurrent depression, and awareness

    Journal of Abnormal Psychology

    (1995)
  • B.P. Bradley et al.

    Attentional bias for emotional faces in generalized anxiety disorder

    The British Journal of Clinical Psychology

    (1999)

    • Cited by (0)

    View full text
    Published by Elsevier Ltd.