Individually tailored internet-based cognitive behaviour therapy for older adults with anxiety and depression

Mixed anxiety and depression is common among older adults (those 60 years and older). Internet-supported cognitive behaviour therapy (ICBT) has been tested for a range of conditions, and one approach is to tailor the treatment according to each client’s symptoms and preferences.

The aim of the study was to compare the effects of an eight-week-long tailored ICBT programme adapted to suit older adults with mixed anxiety and depression and to compare this approach against the provision of weekly general support. A second aim was to investigate if pre-treatment cognitive flexibility and self-reported cognitive problems would be predictive of treatment outcomes. We included 66 older adults (aged over 60 years) with mixed anxiety/depression following media recruitment and randomised them into treatment and control groups. In addition to immediate outcomes after treatment, we included a one-year follow-up. As a measure of executive function, we used the Wisconsin Card Sorting Test (perseverative errors) and the Cognitive Failures Questionnaire during the pre-treatment phase. Results showed a moderate between-group effect on the main outcome measure, the Beck Anxiety Inventory (BAI) (d = 0.50), favouring the treatment group. Nearly half (45.5%) of that group were classified as responders. One person (3%) in the treatment group deteriorated. There were significant correlations between perseverative errors and outcome (on the BAI r = -.45), but not among selfreported cognitive function. We conclude that guided, tailored ICBT may be effective for some older adults and that the role of cognitive function needs to be investigated further.

Photo: Marco Nedermeijer

Read the full paper:

Silfvernagel, K., Westlinder, A., Andersson, S., Bergman, K., Hernandez, R. D., Fallhagen, L., Lundqvist, I., Masri, N., Viberg, L., Forsberg, M.-L., Lind, M., Berger, T., Carlbring, P., & Andersson, G. (in press). Individually tailored internet-based cognitive behaviour therapy for older adults with anxiety and depression: A randomised controlled trial. Cognitive Behaviour Therapy. doi:10.1080/16506073.2017.1388276 [50 free copies]