Category: Adult Anxiety - GAD
Generalized Anxiety Disorder (GAD), which is characterized by persistent and impairing worry, is among the most prevalent mental illnesses in older adulthood (Wolitzky-Taylor et al., 2010). Anxiety symptoms are linked to inadequate use of medical services and increased risk of health problems such as heart disease (Shibeshi et al., 2007), dementia (Wilson et al., 2011), and even early death (Mroczek & Spiro, 2007). Unfortunately, existing therapies for anxiety are less effective for older adults than for younger adults (Covin et al., 2008). Novel interventions are needed that address barriers often faced by older adults, such as limited mobility, stigma, and declines in cognitive functioning. Attention bias modification (ABM) is a transportable treatment that can reduce anxiety and depression in individuals with GAD (Amir et al., 2009) and may address these barriers. The present study provides the first adaptation (to our knowledge) of ABM for older adults with GAD.
Specifically, older adults with GAD (N=8) completed an eight-session computerized ABM intervention. We used a Multiple Baseline Design, which is a cost effective, small-sample size alternative to randomized controlled trials (Hawkins et al., 2007) for gathering evidence of causal change in early stage interventions. To tailor ABM for older adults, the program integrated older adult-relevant concerns into the stimuli, allowed for ideographic selection of primary worry domains, and included breaks during training (watching restorative photographs of nature).
Results indicated that participants were largely satisfied with the quality and effectiveness of treatment according to the Client Satisfaction Scale-Revised (Attkisson & Greenfield, 2004; Ms ≥ 3 on a 4 point scale for 7 of 8 items). However, a mixed pattern emerged in visual plot analyses of symptom trajectories. For worry, the primary outcome measure, there was clinically significant change for only 2 of 8 participants. The results appeared more promising for geriatric anxiety and depression, in which there was significant change for 4 of 8 participants. Finally, no participants experienced significant change in self-reported attentional control.
These mixed results highlight the need to better understand mechanisms that account for positive responding to ABM among anxious older adults. Future research should also unpack the effects of adapted intervention components, such as using older-adult relevant, idiographic stimuli. Finally, it is critical to tease apart whether the greater reductions of geriatric anxiety relative to worry were due to unique effects of this intervention, differences in the measures’ abilities to detect change among older adults, or other explanations.