Academic journal article The International Journal of Behavioral Consultation and Therapy

Comparison of Younger and Older Adults' Acceptability of Treatment for Generalized Anxiety Disorder Co-Occurring with Parkinson's Disease

Academic journal article The International Journal of Behavioral Consultation and Therapy

Comparison of Younger and Older Adults' Acceptability of Treatment for Generalized Anxiety Disorder Co-Occurring with Parkinson's Disease

Article excerpt

Anxiety disorders are prevalent among older adults and ranges from 3.2-14.2%, depending on methodology used (Forsell & Winblad, 1997), with estimates of general anxiety disorder (GAD) ranging from 1.2-7.3% (Beekman, de Beurs, van Balkom et al., 2000). Psychological comorbidity has been associated with a variety of medical disorders (Scott, Korff, Alonso et al., 2008). Parkinson's disease (PD) and comorbid anxiety disorder has been widely reported (Menza, 1993; Pontone, Williams, Anderson et al., 2009; Stein, 1990) with wide ranging estimates (10-43%), again due to assessment procedures and type of anxiety disorder examined. PD and comorbid anxiety also has been reported to worsen motor symptoms and overall quality of life. Evidence-based pharmacological, cognitive behavior therapy (CBT) for anxiety disorders among psychiatric patients have the greatest scientific support (Ayers, Sorrell, Thorp, Wetherell Loebach, 2007; Baldwin & Polkinghorn, 2005; Borkovec, Newman, Pincus, & Lytle, 2002; Ost & Breitholtz, 2000; Pinquart & Duberstein, 2007). Relaxation training, a form of CBT, has been shown to be one of the most effective interventions for GAD (Borkovec, 2002; Ost & Breitholtz, 2000). Behavioral Relaxation Training (BRT; Poppen, 1998) which does not require tense-release muscle activities, has been successfully used with patients with PD and essential tremor (Chung, Poppen, & Lundervold, 1995; Lundervold & Poppen, 2004; Lundervold, Pahwa, & Lyons, 2009, 2012).

Pharmacotherapy is regularly used to treat PD and comorbid anxiety; however, the approach is different for patients with PD due to the negative side effects of benzodiazepines. Lexapro, a selective serotonin reuptake inhibitor, is a commonly prescribed medication used to treat PD and comorbid anxiety. In the United States, the Federal Drug Administration (FDA) has approved Lexapro for treatment of GAD (Richard, Schiffer & Kurlan, 1996). However, no clinical trials have been conducted evaluating the effectiveness of Lexapro or any other anxiolytic for PD and comorbid anxiety (Walsh & Bennett, 2000; Richards, 2005). Behavioral intervention has also been recommended for treatment of PD and comorbid anxiety, most notably, relaxation training (Marsh, 2000). While use of relaxation training has been suggested for PD and comorbid anxiety, it is unclear if it would be accepted by patients and older adults as a treatment for anxiety.

Evidence-based medicine (EBM) is the driving force in all aspects of health care in America. In addition to determining which treatments are most effective, EBM advances the incorporation of patient values into treatment decision making. Thus, according to Sackett, Strauss, Richardson, Rosenberg and Haynes (2000), EBM is the combined influence of best available research evidence, clinical skills and patient values with respect to treatment selection and acceptability. Treatment acceptability refers to the extent to which consumers of services report the treatment being valuable, beneficial and desirable (Speigler & Gurvremont, 2008). An extensive research of literature has demonstrated that behavioral and cognitive behavioral interventions are rated by consumers and patients as highly acceptable treatments (Calvert & Johnston, 1990). This pattern of results has been shown to generalize to older adults with depression and those with neuropsychiatric disorders affecting behavior; for example, Alzheimer's disease and related disruptive and aggressive behavior (Burgio & Sinnet, 1990; Burgio, Cotter, Stevens et al., 1995; Landreville, Landry, Baillargeon, Guerette, 2001; Landreville & LeBlanc, 2010; Lundervold & Bourland, 1989; Lundervold & Lewin, 1990; Lundervold, Young, & Jackson, 1993). The combined results of this research suggests that older adults' acceptance of behavioral interventions is not significantly affected by complex neuropsychiatric conditions. …

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