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Cochrane for Clinicians

Putting Evidence into Practice

Cognitive Behavior Therapy for Anxiety and Related Disorders in Older People

CLINICAL QUESTION

Does cognitive behavior therapy (CBT) decrease anxiety symptoms in adults older than 55 years?

EVIDENCE-BASED ANSWER

Compared with minimal management (ie, no formal treatment), 10 to 15 sessions of CBT reduce posttreatment anxiety severity for 2 to 8 weeks in persons older than 55 years (standardized mean difference [SMD] = −0.51; 95% CI, −0.36 to −0.66; number needed to treat [NNT] = 5).1 (Strength of Recommendation [SOR]: B, low certainty of evidence.) This reduction is not sustained 3 to 6 months posttreatment. Symptoms of worry and depression also are improved 2 weeks after 10 to 15 CBT sessions, and these improvements are sustained at 3 to 6 months posttreatment. (SOR: B, low-certainty evidence.) Available evidence is insufficient to determine the benefits of CBT compared with other psychological therapies in adults older than 55 years.

PRACTICE POINTERS

Anxiety and related disorders (including panic disorder, agoraphobia, generalized anxiety disorder [GAD], social anxiety disorder, specific phobia, obsessive-compulsive disorder, and posttraumatic stress disorder [PTSD]) are the most common mental health conditions in the United States, affecting more than 40 million adults, which is a prevalence of 19.1%.1,2 In US adults older than 55 years, the estimated prevalence of anxiety disorders ranges from 6% to 12%, and these disorders are associated with an increased risk of coronary heart disease and a higher mortality rate.1

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These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

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