درمان روانی اجتماعی در اختلال اضطراب فراگیر اواخر عمر: وضعیت فعلی و آینده

Although generalized anxiety disorder (GAD) was once an understudied illness, there has been an increase in research on the disorder over the past several years. A subset of studies has focused on the psychosocial treatment of late-life GAD. It was initially expected that cognitive behavior therapy (CBT) would prove to be the most effective treatment for GAD in the elderly. Although group format CBT has outperformed no-treatment control conditions in some studies, the existing body of work does not clearly indicate the superiority of CBT over alternative interventions [e.g., supportive therapy (ST)]. Trials of individual format CBT have tested augmented or otherwise nonstandard versions of the therapy. Therefore, it may not be appropriate to assume a smooth transfer of CBT benefits across age groups in the treatment of GAD. This review summarizes and discusses the current state of psychosocial interventions for late-life GAD, including group and individual format CBT, limitations of existing research, and suggestions for future directions.

The past several years have marked an increase in research on late-life anxiety disorders. This group of studies has provided a preliminary knowledge base on anxiety in the elderly and, to a lesser degree, psychosocial treatment options. This article focuses specifically on the psychosocial treatment of late-life generalized anxiety disorder (GAD), which is one of the most commonly diagnosed disorders in older adults (Stanley & Novy, 2000). Recent estimates of prevalence of GAD in older adults range from 0.71% to 7.10% (Flint, 1994), indicating that it is a considerable mental health issue that warrants continued attention from researchers and clinicians. Given that medication is currently the first-line treatment for late-life anxiety (Blazer, George, & Hughes, 1991) and that older adults are at increased risk for side effects and drug–drug interactions Krasucki et al., 1999, Sheikh & Cassidy, 2000 and Wengel et al., 1993, identification of effective psychosocial interventions should be made a priority. Current diagnostic criteria, according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV; American Psychiatric Association [APA], 2001), require at least 6 months of anxiety and worry about several real-life problems, occurring more days than not. The individual must have trouble controlling the worry and must also endorse at least three associated symptoms (e.g., tension, irritability, trouble concentrating, and insomnia). The symptoms cannot be better explained by another Axis I disorder or by other conditions, such as a medical problem, and must cause clinically significant impairment or distress.