Treating Generalized Anxiety in a Community Setting

  • J. Gayle Beck

Despite the fact that older adults are more prevalent than ever before in history, our knowledge about mental health disorders in this segment of the population is surprisingly thin. Anxiety disorders are a case in point. Although our knowledge about anxiety in the elderly is growing steadily, progress has been slow which has impacted knowledge about how to best treat these problems among older adults. Additionally, steadily accumulating evidence suggests that traditional definitions of anxiety disorders, as exemplified by the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000), may not best capture the symptom profiles reported by seniors, which could potentially result in inappropriate treatment (e.g., Jeste, Blazer, & First, 2005). This chapter begins by reviewing what current research indicates with respect to the symptom profile of generalized anxiety among community elders, with particular reference to the interrelationship between anxiety and depression. An overview of available assessment strategies will be included, with emphasis on the importance of conceptualizing the patient’s problem using a functional analysis, in order to understand the interplay between specific symptoms in the context of the older adult’s life circumstances.


Anxiety Disorder Cognitive Behavioral Therapy Anxiety Symptom Generalize Anxiety Disorder Geriatric Depression Scale 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association.Google Scholar
  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Association.Google Scholar
  3. Barlow, D. H. (2002). Anxiety and its disorders. New York: Guilford.Google Scholar
  4. Barlow, D. H., Rapee, R., & Brown, T. A. (1992). Behavioral treatment of generalized anxiety disorder. Behavior Therapy, 23, 551–570.CrossRefGoogle Scholar
  5. Bartels, S. J., Dums, A. R., & Shea, D. G. (2004). Mental health policy and aging. In B. L. Levin, J. Petrila, & K. D. Hennessy (Eds.), Mental health services: A public health perspective (2nd ed., pp. 232–254). New York: Oxford University Press.Google Scholar
  6. Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety. Journal of Consulting and Clinical Psychology, 56, 893–897.CrossRefPubMedGoogle Scholar
  7. Beck, J. G., Novy, D. M., Diefenbach, G. J., Stanley, M. A., Averill, P. M., & Swann, A. C. (2003). Differentiating anxiety and depression in older adults with Generalized Anxiety Disorder. Psychological Assessment, 15, 184–192.CrossRefPubMedGoogle Scholar
  8. Beck, J. G., Stanley, M. A., & Zebb, B. J. (1999). The effectiveness of the Hamilton Anxiety Rating Scale with older Generalized Anxiety Disorder patients. Journal of Clinical Geropsychology, 5, 281–290.CrossRefGoogle Scholar
  9. Beck, A. T., Ward, C., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 53–63.Google Scholar
  10. Beekman, A. T. F., Bremmer, M. A., Deeg, D. J. H., van Balkom, A. J. L. M., Snut, J. H., de Beurs, E., et al. (1998). Anxiety disorders in later life: A report from the Longitudinal Aging Study Amsterdam. International Journal of Geriatric Psychiatry, 13, 717–726.CrossRefPubMedGoogle Scholar
  11. deBeurs, E., Beekman, A. T. F., vanBalkom, A. J. L., Deeg, D. J. H., vanDyck, R. & vanTilburg, W. (1999). Consequences of anxiety in older persons: Its effects on disability, well-being, and use of health services. Psychological Medicine, 29, 583–593.CrossRefPubMedGoogle Scholar
  12. Blazer, D., George, L. K., & Hughes, D. (1991). The epidemiology of anxiety disorders: An age comparison. In C. Salzman & B. D. Lebowitz (Eds.), Anxiety in the elderly: Treatment and research (pp. 17–30). New York: Springer.Google Scholar
  13. Craske, M. G., Barlow, D. H., & O’Leary, T. A. (1992). Mastery of your anxiety and worry. Albany, NY: Graywind Publications.Google Scholar
  14. Diefenbach, G. J., Hopko, D. R., Feigon, S., Stanley, M. A., Novy, D. M., Beck, J. G., et al. (2003). ‘Minor GAD’: Characteristics of subsyndromal GAD in older adults. Behaviour Research and Therapy, 41, 481–487.CrossRefPubMedGoogle Scholar
  15. Diefenbach, G. J., Stanley, M. A., Beck, J. G., Novy, D. M., Averill, P. M., & Swann, A. C. (2001). Examination of the Hamilton Scales in assessment with anxious older adults: A replication and extension. Journal of Psychopathology and Behavioral Assessment, 23, 117–124.CrossRefGoogle Scholar
  16. DiNardo P. A., Brown T. A., & Barlow D. H. (1994). Anxiety disorders interview schedule for DSM-IV. Boston. MA. Center for Stress and Anxiety Related Disorders, Boston University.Google Scholar
  17. Feinson, M. (1985). Aging and mental health: Distinguishing myth from reality. Research on Aging, 7, 155–174.CrossRefPubMedGoogle Scholar
  18. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR Axis I disorders, research version, patient edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
  19. Fisher, J. E., & Noll, J. P. (1996). Anxiety disorders. In L. Carstensen, B. Edelstein, & L. Dornbrand (Eds.), The practical handbook of clinical gerontology (pp. 304–323). Thousand Oaks, CA: Sage Publications.Google Scholar
  20. Fisher, J. E., Zeiss, A. M., & Carstensen, L. L. (2001). Psychopathology in the aged. In P. B. Sutker & H. E. Adams (Eds.), Comprehensive handbook of psychopathology (3rd ed., pp. 921–951). New York: Kluwer Academic/Plenum Publishers.Google Scholar
  21. Fuentes, K. & Cox, B. (2000). Assessment of anxiety in older adults: A community-based survey and comparison with younger adults. Behaviour Research and Therapy, 38, 297–309.CrossRefPubMedGoogle Scholar
  22. Gallagher, D. (1986). The Beck Depression Inventory and older adults. In T. L. Brink (Ed.), Clinical Gerontology: A guide to assessment and intervention (pp. 149–163). New York: Haworth Press.Google Scholar
  23. Gallo, J. J., Anthony, J. C., & Muthén, B. O. (1994). Age differences in the symptoms of depression: A latent trait analysis. Journal of Gerontology: Psychological Sciences, 49, 251–264.Google Scholar
  24. Gould, R. A., Otto, M. N., Pollack, M. H., & Yap, L. (1997). Cognitive behavioral and pharmacological treatment of generalized anxiety disorder: A preliminary meta-analysis. Behavior Therapy, 28, 285–305.CrossRefGoogle Scholar
  25. Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50–55.PubMedGoogle Scholar
  26. Himmelfarb, S., & Murrell, S. (1984). The prevalence and correlates of anxiety symptoms in older adults. Journal of Psychology, 116, 159–167.PubMedGoogle Scholar
  27. Hyberls, C. F., & Blazer, D. G. (2004). Epidemiology of mental disorders in older adults. In B. L. Levin, J. Petrila, and K. D. Hennessy (Eds.), Mental health services: A public health perspective (2nd ed., pp. 211–231). New York: Oxford University Press.Google Scholar
  28. Jeste, D. V., Blazer, D. G., & First, M. (2005). Aging-related diagnostic variations: Need for diagnostic criteria appropriate for elderly psychiatry patients. Biological Psychiatry, 58, 265–271.CrossRefPubMedGoogle Scholar
  29. Kabacoff, R., Segal, D., Hersen, M., & VanHasselt, V. (1997). Psychometric properties and diagnostic utility of the Beck Anxiety Inventory and the State-Trait Anxiety Inventory with older adult psychiatric outpatients. Journal of Anxiety Disorders, 11, 33–47.CrossRefPubMedGoogle Scholar
  30. Kogan, J. N., & Edelstein, B. A. (2004). Modification and psychometric examination of a self-report measure of fear in older adults. Journal of Anxiety Disorders, 18, 397–409.CrossRefPubMedGoogle Scholar
  31. Levy, B. R., Conway, K., Brommelhoff, J., & Merikengas, K. (2003). Intergenerational differences in the reporting of elders’ anxiety. Journal of Mental Health and Aging, 9, 233–241.Google Scholar
  32. Lowe, P. A., & Reynolds, C. R. (2006). Examination of the psychometric properties of the Adult Manifest Anxiety Scale – Elderly version scores. Educational and Psychological Measurement, 66, 93–115.CrossRefGoogle Scholar
  33. Mehta, K. M., Simonsick, E. M., Penninx, B. W. J. H., Schulz, R., Rubin, S. M., Satterfield, S., et al. (2003). Prevalence and correlates of anxiety symptoms in well-functioning older adults: Findings from the Health Aging and Body Composition Study. Journal of the American Geriatric Society, 51, 499–504.CrossRefGoogle Scholar
  34. Meyer, T., Miller, M., Metzger, R., & Borkovec, T. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487–495.CrossRefPubMedGoogle Scholar
  35. Mohlman, J. (2004). Psychosocial treatment of late-life generalized anxiety disorder: Current status and future directions. Clinical Psychology Review, 24, 149–169.CrossRefPubMedGoogle Scholar
  36. Morin, C., Landreville, P., Colecchi, C., McDonald, K., Stone, J., & Ling, W. (1999). The Beck Anxiety Inventory: Psychometric properties with older adults. Journal of Clinical Geropsychology, 5, 19–29.CrossRefGoogle Scholar
  37. Peng, T. R., Navaie-Waliser, M., & Feldman, P. H. (2003). Social support, home health service use, and outcomes among four racial-ethnic groups. The Gerontologist, 43, 503–513.PubMedGoogle Scholar
  38. Regier, D., Boyd, J., Burke, J., Rae, D., Myers, J., Kramer, M., et al. (1988). One-month prevalence of mental disorders in the United States. Archives of General Psychiatry, 45, 977–986.PubMedGoogle Scholar
  39. Schoevers, R. A., Deeg, D. J. H., vanTilburg, W., & Beekman, A. T. F. (2005). Depression and generalized anxiety disorder. American Journal of Geriatric Psychiatry, 13, 31–39.PubMedGoogle Scholar
  40. Schuurmans, J., Comijs, H. C., Beekman, A. T. F., deBeurs, E., Deeg, D. J. H., Emmelkamp, P. M. G., et al. (2005). The outcome of anxiety disorders in older people at 6-year follow-up: Results from the longitudinal aging study Amsterdam. Acta Psychiatrica Scandaniva, 111, 420–428.CrossRefGoogle Scholar
  41. Segal, D., Hersen, M., VanHasselt, V., Kabacoff, R., & Roth, L. (1993). Reliability of diagnosis in older psychiatric patients using the Structured Clinical Interview for DSM-III-R. Journal of Psychopathology and Behavioral Assessment, 15, 347–356.CrossRefGoogle Scholar
  42. Sheikh, J. I. (1992). Anxiety and its disorders in old age. In J. E. Birren, R. B. Sloane, & G. D. Cohen (Eds.), Handbook of mental health and aging (2nd ed., pp. 409–432). San Diego, CA: Academic Press.Google Scholar
  43. Sheikh, J. I., Swales, P. J., Carlson, E. B., & Lindley, S. E. (2004). Aging and panic disorder: Phenomenology, comorbidity, and risk factors. American Journal of Geriatric Psychiatry, 12, 102–109.PubMedGoogle Scholar
  44. Sheikh, J. I. & Yesavage, J. A. (1986). Geriatric Depression Scale (GDS). In T. L. Brink (Ed.) Clinical Gerontology: A guide to assessment and intervention (pp. 165–173). New York: Haworth Press.Google Scholar
  45. Sinoff, G., Ore, L., Zlotogorsky, D., & Tamir, A. (1999). Short anxiety screening test – A brief instrument for detecting anxiety in the elderly. International Journal of Geriatric Psychiatry, 14, 1062–1071.CrossRefPubMedGoogle Scholar
  46. Snyder, A. G., Stanley, M. A., Novy, D. M., Averill, P. M., & Beck, J. G. (2000). Measures of depression in older adults with Generalized Anxiety Disorder: A psychometric evaluation. Depression and Anxiety, 11, 114–120.CrossRefPubMedGoogle Scholar
  47. Spielberger, C. D., Gorsuch, R., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). STAI manual for the State-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
  48. Stanley, M. A., Beck, J. G., & Zebb, B. J. (1996). Psychometric properties of four anxiety measures in older adults. Behaviour Research and Therapy, 34, 827–838.CrossRefPubMedGoogle Scholar
  49. Stanley, M. A., Novy, D. M., Bourland, S. L., Beck, J. G., & Averill, P. M. (2001). Assessing older adults with generalized anxiety: A replication and extension. Behaviour Research and Therapy, 39, 221–235.CrossRefPubMedGoogle Scholar
  50. Teachman, B. A. (2006). Aging and negative affect: The rise and fall and rise of anxiety and depression symptoms. Psychology and Aging, 21, 201–207.CrossRefPubMedGoogle Scholar
  51. Tolin, D. F., Robison, J. T., Gaztambide, S., & Blank, K. (2005). Anxiety disorders in older Puerto Rican primary care patients. American Journal of Geriatric Psychiatry, 13, 150–156.PubMedGoogle Scholar
  52. Watari, K. & Brodbeck, C. (2000). Culture, health, and financial appraisals: Comparison of worry in older Japanese Americans and European Americans. Journal of Clinical Geropsychology, 6, 25–39.CrossRefGoogle Scholar
  53. Wetherell, J. & Arean, P. (1997). Psychometric evaluation of the Beck Anxiety Inventory with older medical patients. Psychological Assessment, 9, 136–144.CrossRefGoogle Scholar
  54. Wetherell, J. L., Gatz, M., & Pedersen, N. L. (2001). A longitudinal analysis of anxiety and depressive symptoms. Psychology and Aging, 16, 187–195.CrossRefPubMedGoogle Scholar
  55. Wetherell, J. L., LeRoux, H., & Gatz, M. (2003). DSM-IV criteria for generalized anxiety disorder in older adults: Distinguishing the worried from the well. Psychology and Aging, 18, 622–627.CrossRefPubMedGoogle Scholar
  56. Wetherell, J. L., Sorrell, J. T., Thorp, S. R., & Patterson, T. L. (2005). Psychological interventions for late-life anxiety: A review and early lessons from the CALM study. Journal of Geriatric Psychiatry and Neurology, 18, 72–82.CrossRefPubMedGoogle Scholar
  57. Wisocki, P. (2000). Worry Scale – Revised. Unpublished manuscript, University of Massachusetts.Google Scholar
  58. Wisocki, P., Handen, B., & Morse, C. (1986). The Worry Scale as a measure of anxiety among homebound and community active elderly. The Behavior Therapist, 5, 91–95.Google Scholar
  59. Yesavage, J., & Brink, T. L. (1983). Development and validation of a Geriatric Depression Screening Scale: A preliminary report. Journal of Psychiatry Research, 17, 37–49.CrossRefGoogle Scholar
  60. Zauszniewski, J. A, Eggenschwiler, K., Preechawong, S., Chung, C-W., Airey, T. F., Wilke, P. A., et al., (2004). Focused reflection reminiscence group for elders: Implementation and evaluation. Journal of Applied Gerontology, 23, 429–442.CrossRefGoogle Scholar
  61. Zeiss, A. M., & Steffen, A. (1996). Behavioral and cognitive-behavioral treatments: An overview of social learning. In S. H. Zarit & B. G. Knight (Eds.), A guide to psychotherapy and aging: Effective clinical interventions in a life-stage context (pp. 35–60). Washington, DC: American Psychological Association.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • J. Gayle Beck
    • 1
  1. 1.University at Buffalo, State University of New YorkBuffalloUSA

Personalised recommendations