Generalized Anxiety and the Older Person:
Taking Back Control

Generalized anxiety is a psychiatric condition that often goes untreated. The disorder may have been with the patient for decades, in some cases almost their whole life.

"The patient may have mentioned several symptoms over the years - either to family and friends or to their physician," says Dr. Melinda A. Stanley, associate professor of psychiatry and behavioral science at The University of Texas-Houston Medical School. "There may have been a pattern of poor sleep, or various physical complaints. But generalized anxiety doesn't just `come on' suddenly. And as a person ages, it probably becomes more severe."

Worry is common. When it is excessive - when the worry actually begins to control a person's life - it can be miserable. And very anxious people worry about all sorts of things. They may be in a constant state of dread about being fired at work, or about their job performance. They may worry incessantly about their grades at school. They may constantly be worried about the state of their marriage or a close relationship. Very anxious people tend to worry greatly about their health and the health of family members.

"Often in generalized anxiety, there is a good deal of procrastination," says Dr. Stanley. "For example, a 60-year-old person may worry nearly constantly about their health, but they will not go to a doctor. The complaints may be the common complaints of a 60-year-old, and they might be things that could be easily managed. The procrastination is part of the generalized anxiety cycle in this case." Dr. Stanley has seen many patients who worry incessantly about family members. "They will call about their children or grandchildren frequently, to see if everyone is OK - I mean frequently each day. The calls can become annoying."

Dr. Stanley says that the irony about this kind of generalized anxiety is that the person knows the worry is excessive and unreasonable. "The person knows that things are going all right. They tell us, `My finances are adequate,' or `I know the kids are going to be OK,' or `Overall, I think I am in good health.' But the reasonableness doesn't seem to last very long and the anxiety takes over again."

Severe anxiety can be a crushing condition for the elderly. Frequently living alone, lacking the support system of family members in the home or colleagues to see daily at work, the elderly can spiral into a state of anxiety where worry compounds upon worry.

Treating generalized anxiety in the older adult depends on the severity of the anxiety. Medications can help. "Especially in cases where there is some fairly severe depression along with the anxiety, medications can be effective pretty quickly," says Dr. Stanley. At the UT-Houston Mental Sciences Institute she and her colleagues in the TENSE Program (Treating Elders' Nervous Symptoms Effectively) believe a good way to start treating their clients' symptoms is without medications. TENSE is a research program assisting adults 60 years of age and older.

"We screen very carefully for the TENSE Program," says Dr. Stanley. "Because our protocol doesn't include medications, if the person is thought to be a good candidate for an anti-anxiety or anti-depressive then they are referred to one of our doctors. The TENSE Program is behavioral; we want to help the person learn to cope through several strategies. If, in the end, medications may be even more helpful, then that's another therapy - a combination of behavioral therapy and medications can work very, very well."

"TENSE has three stages," says Dr. Gretchnen Diefenbach, recruitment coordinator for the program. "After the person contacts us, we work with them on several questionnaires and surveys about their worries, life satisfaction and quality of their life. We do a thorough physical exam to rule out medical causes.

"The core of TENSE is the second stage, the 15-week schedule of group meetings - once a week for 90 minutes," says Dr. Diefenbach. "They are small groups, five or six people and the therapist, usually with a pretty varied membership. They exchange stories of course, but the real key is learning to adopt strategies that help manage the anxiety."

In the cognitive-behavioral model that TENSE utilizes, people are taught skills which help them change the way they think about things; then, these skills help change behavior. Progressive muscle relaxation and deep breathing are physical techniques which are also emphasized.

"Over time, certain behaviors can be decreased. The number of phone calls each day to check on the grandchildren, for example, goes from six to one. As people face their fears and discuss them, they do lessen and the procrastination tapers off also," says Dr. Diefenbach.

The third stage of TENSE follows the 15-week group sessions. This is the follow- up period where the project participants return - at three, six and 12 month intervals - for interviews with the therapists and additional questionnaires. "We need to know if the benefits are being maintained, of course," says Dr. Diefenbach. "We're pleased with outcomes at this point in the study. Most importantly, many of our clients have had a very positive change in their lives."

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©2006 Texas Medical Center

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