LAY PROVIDERS CAN DELIVER EFFECTIVE COGNITIVE BEHAVIOR THERAPY FOR OLDER ADULTS WITH GENERALIZED ANXIETY DISORDER: A RANDOMIZED TRIAL

Authors

  • Melinda A. Stanley Ph.D.,

    Corresponding author
    1. Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas
    2. Baylor College of Medicine, Houston, Texas
    3. South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, Texas
    • Correspondence to: Melinda A. Stanley, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston VA Center for Innovations in Quality, Effectiveness and Safety (MEDVAMC 152), 2002 Holcombe Boulevard, Houston, TX 77030.

      E-mail: mstanley@bcm.tmc.edu

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  • Nancy L. Wilson M.S.W.,

    1. Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas
    2. Baylor College of Medicine, Houston, Texas
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  • Amber B. Amspoker Ph.D.,

    1. Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas
    2. Baylor College of Medicine, Houston, Texas
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  • Cynthia Kraus-Schuman Ph.D.,

    1. South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, Texas
    2. Michael E. DeBakey VA Medical Center, Houston, Texas
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  • Paula D. Wagener B.A.,

    1. Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas
    2. Baylor College of Medicine, Houston, Texas
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  • Jessica S. Calleo Ph.D.,

    1. Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas
    2. Baylor College of Medicine, Houston, Texas
    3. South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, Texas
    4. Michael E. DeBakey VA Medical Center, Houston, Texas
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  • Jeffrey A. Cully Ph.D.,

    1. Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas
    2. Baylor College of Medicine, Houston, Texas
    3. South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, Texas
    4. Michael E. DeBakey VA Medical Center, Houston, Texas
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  • Ellen Teng Ph.D.,

    1. Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas
    2. Baylor College of Medicine, Houston, Texas
    3. South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, Texas
    4. Michael E. DeBakey VA Medical Center, Houston, Texas
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  • Howard M. Rhoades Ph.D.,

    1. Harris County Psychiatric Center, The University of Texas Health Science Center at Houston, Houston, Texas
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  • Susan Williams M.D.,

    1. Baylor College of Medicine, Houston, Texas
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  • Nicholas Masozera M.D.,

    1. South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, Texas
    2. Michael E. DeBakey VA Medical Center, Houston, Texas
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  • Matthew Horsfield M.D.,

    1. Baylor College of Medicine, Houston, Texas
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  • Mark E. Kunik M.D., M.P.H.

    1. Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas
    2. Baylor College of Medicine, Houston, Texas
    3. South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, Texas
    4. Michael E. DeBakey VA Medical Center, Houston, Texas
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  • Conflict of interest. All the authors declare no conflicts of interest.

  • Trial Registration: ClinicalTrials.gov. NCT00765219, http://clinicaltrials.gov/ct2/show/NCT00765219?term=Melinda+Stanley&rank=5

  • Grant sponsor: National Institute of Mental Health; Grant number: R01-MH53932, Supported in part by the Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety; (CIN-13-413).

Abstract

Background

The Institute of Medicine recommends developing a broader workforce of mental health providers, including nontraditional providers, to expand services for older adults. Cognitive behavior therapy (CBT) is effective for late-life generalized anxiety disorder (GAD), but no study has examined outcomes with delivery by lay providers working under the supervision of licensed providers. The current study examined the effects of CBT delivered by lay, bachelor-level providers (BLP) relative to Ph.D.-level expert providers (PLP), and usual care (UC) in older adults with GAD.

Methods

Participants were 223 older adults (mean age, 66.9 years) with GAD recruited from primary care clinics at two sites and assigned randomly to BLP (n = 76), PLP (n = 74), or UC (n = 73). Assessments occurred at baseline and 6 months. CBT in BLP and PLP included core and elective modules (3 months: skills training; 3 months: skills review) delivered in person and by telephone, according to patient choice.

Results

CBT in both BLP and PLP groups significantly improved GAD severity (GAD Severity Scale), anxiety (Spielberger State-Trait Anxiety Inventory; Structured Interview Guide for the Hamilton Anxiety Scale), depression (Patient Health Questionnaire), insomnia (Insomnia Severity Index), and mental health quality of life (Short-Form-12), relative to UC. Response rates defined by 20% reduction from pre- to posttreatment in at least three of four primary outcomes were higher for study completers in BLP and PLP relative to UC (BLP: 38.5%; PLP: 40.0%; UC: 19.1%).

Conclusion

Lay providers, working under the supervision of licensed providers, can deliver effective CBT.

Ancillary