Shannon Jones

GAD Online for older adults: A randomized controlled trial

Doctoral Dissertation Results, Shannon Jones 2013

‘GAD Online for Older Adults’ was made available to adults in Saskatchewan aged 60 years and older from March 2012-November 2013. The therapist-assisted Internet delivered Cognitive Behaviour Therapy (ICBT) program was modified for older adults who experience generalized anxiety (e.g., worry about many topics, difficulty controlling worry). The ICBT program involved 7 interactive modules that included text, graphics, animations, audio, and video. Topics included: (a) education about general anxiety, (b) monitoring anxiety and worry, (c) relaxation techniques and enjoyable activities, (d) examining and challenging unhelpful thoughts, (e) worry reduction strategies, overcoming avoidance and worry behaviours, and (f) problem-solving and sleep hygiene. Forty-six older adults with generalized anxiety disorder or subclinical anxiety were randomized to receive ICBT or waited for treatment.

The findings were very encouraging. General anxiety and depressive symptoms decreased more quickly for adults who received ICBT when compared to those who waited for treatment. Significant differences were also found between the two groups on measures of geriatric anxiety and depression, and on most quality of life scales. ICBT participants continued to improve during the four-week follow-up period – in fact, participants tended to improve the most on symptoms of worry and depression during the follow-up period.

It was also found that ICBT participants who rated the credibility of treatment higher before starting ICBT, improved at a faster rate on a measure of anxiety. Completing more treatment modules, sending more e-mail to the therapist, and writing more to the therapist in the weekly Check-In page was predictive of lower anxiety scores at follow-up, whereas writing more to the therapist in e-mails and taking longer to complete ICBT was predictive of higher anxiety scores at follow-up.

The final component of the study asked older adults about their experiences with ‘GAD Online for Older Adults’. Numerous positive experiences and challenges were identified. Older adults valued being able to access therapy online, liked the convenience, felt that ICBT promoted insight, found the information educational and helpful, and they liked the easy-to-follow format of the program. Older adults appreciated having therapist support while using ICBT. Some participants noted that the content of the program did not always fully match their experiences or difficulties, and felt that there was too much content to cover in the time recommended. Narrative feedback from older adults who took part in this study will help to inform revisions of existing or future ICBT programs in this age group.