Although the therapy of elderly patient concerns a significant desideratum of research, one which should come to the fore and be the focus of psychotherapy research immediately, and that too especially in view of the demographic development in Germany, this group of patients has been ignored to date in the context of psychodynamic effectiveness research. Population projections for Germany forecast that for age groups 60 and over, whose share of the population is expected to account for 29.5% in 2020, their share will already rise to 34.6% in 2030 with the overall decline in the population (German Federal Statistical Office, 2015; cf. also Andreas et al., 2013).
At 15.3% of the total, anxiety disorders represent the largest group of mental disorders among 18 to 79-year-old adults in Germany (cf. Jacobi et al., 2014a). In a major Dutch random sample from Beekman et al. (1998), generalised anxiety disorder (GAD) with a six-month prevalence rate of 7.3% was found to be the most frequent anxiety disorder among 55 to 85 year olds. Current figures of the 12-month prevalence rates of GAD in a German random sample are in the 3.4% range for the age group from 50 to 79 years old (Jacobi et al., 2014b). Unlike with many other mental disorders, which initially occur in adolescence or young adulthood especially, the probability of the first manifestation of GAD seems to be highest from the fifth decade of life (Lieb et al., 2005).
The meta-analysis from Keefe et al. (2014) on the effectiveness of psychodynamic therapy (PDT) with anxiety disorders was able to demonstrate that PDT is just as effective with the group of disorders as are other bona fide treatments (for an overview, please also see Leichsenring, Klein & Salzer, 2014a,b). However with regard to the effectiveness of PDT with GAD, at the present point in time only the initial findings are available from the studies by Crits-Christoph et al. (1996, 2005), as well as from Leichsenring, Salzer et al. (2009) and from Salzer et al. (2011). The average ages in these studies amounted to 42.4 years old (Crits-Christoph et al., 2005) and 42.5 years old (Leichsenring et al., 2009; Salzer et al., 2011). Thus there is a complete lack to date of proof of the effectiveness of PDT for elderly patients with GAD.
Study Design: Feasibility study on the psychodynamic treatment of elderly patients aged 60 and over with generalised anxiety disorder (GAD). Adaption and implementation of a manualised, age-sensitive treatment concept (cf. Leichsenring & Salzer, 2014) for elderly patients. Pre-post comparison, process survey and 3-month catamnesis, regular study supervision, recording of the treatment integrity.
Intervention: Conduct an outpatient, manualised, depth-psychology based short-term therapy under the German Regulation on the Conducting of Psychotherapy with up to 24 (+4 probatory) sessions, or observation of the patients for 8 months under treatment as usual.
Random Sample: N=20 patients aged 60 and over (n1=10, n2=10), who fulfil the diagnostic criteria for a GAD (primary diagnosis on basis of ADIS, DiNardo et al., 1993) on the basis of DSM-5 (Falkai & Wittchen, 2015) and who have sufficient knowledge of German.
Exclusion Criteria: Acute suicidal tendency, indication for inpatient psychotherapy, cerebro-organic disorder, psychotic disorder, substance-related addiction, life-threatening somatic illness, clarification required: cognitive deficits as per MMST and clock-drawing test.)
Assessment: Standardised diagnosis on the basis of DSM-5, recording of the symptomatology in external and self-evaluation. Screening, inclusion diagnosis and baseline study, subsequently studies every two months until the end of the therapy or after 8 months, as well as a 3-month catamnesis.
1) Provide evidence of the viability of the study design itself and of the therapy; provide initial guidance on the treatment as usual of this group of patients; permit assessments on the willingness of the patients concerned for psychotherapeutic treatment
2) Provide an initial assessment of the effect levels within the two intervention groups, as well as on the appropriateness of the short-term therapy therapeutic dosage
3) Based on the first therapy, permit the targeted modification and optimisation of the treatment process as required
Prof. Dr. Simone Salzer
International Psychoanalytic University
Tel.: +49 30 300 117-717
Charline Logé, M.A.
International Psychoanalytic University Berlin
Stromstr. 3b - Room 1.44
Tel.: +49 30 300 117-766