This review aims to address issues unique to older adults with anxiety disorders in order to inform potential changes in the DSM-V. Prevalence and symptom expression of anxiety disorders in late life, as well as risk factors, comorbidity, cognitive decline, age of onset, and treatment efficacy for older adults are reviewed. Overall, the current literature suggests: (a) anxiety disorders are common among older age individuals, but less common than in younger adults; (b) overlap exists between anxiety symptoms of younger and older adults, although there are some differences as well as limitations to the assessment of symptoms among older adults; (c) anxiety disorders are highly comorbid with depression in older adults; (d) anxiety disorders are highly comorbid with a number of medical illnesses; (e) associations between cognitive decline and anxiety have been observed; (f) late age of onset is infrequent; and (g) both pharmacotherapy and CBT have demonstrated efficacy for older adults with anxiety. The implications of these findings are discussed and recommendations for the DSM-V are provided, including extending the text section on age-specific features of anxiety disorders in late life and providing information about the complexities of diagnosing anxiety disorders in older adults. Depression and Anxiety 27:190-211, 2010.

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Given that the AAQ-II and Self-Distraction and Behavioral Disengagement subscales were not correlated, these findings suggest that experiential and behavioral avoidance are two distinct processes contributing to the severity of specific HD. Results support the utility of avoidance in the cognitive-behavioral model for HD.

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Background: Intolerance of uncertainty (IU) has been proposed as a transdiagnostic risk and maintenance factor underlying various forms of psychopathology. Few studies, however, have examined IU in hoarding disorder (HD)-a condition characterized by excessive urges to acquire and difficulties discarding possessions-core symptoms that may be fueled by inflated IU. We examined cross-sectional relationships between IU and different symptom facets of HD, controlling for anxiety and depression severity, and explored whether pre-treatment levels of IU predicted response to exposure-based treatment for HD. Method: Fifty-seven individuals seeking treatment for HD completed baseline measures of hoarding symptoms, IU, anxiety and depression. Participants then completed 26 sessions of group exposure-based treatment for HD with or without compensatory cognitive training. Hoarding symptoms were assessed following the final treatment session to index treatment response. Results: IU was positively and significantly associated with greater urges to acquire and greater difficulties discarding possessions, beyond shared variance accounted for by anxiety and depression. IU was not significantly related to clutter symptom severity. Higher pre-treatment IU predicted increased odds of treatment non-response. Conclusions: Elevated IU is associated with specific hoarding symptom clusters and may be an important target for HD treatment.

High rates of anxiety disorders at Veteran Affairs (VA) health care centers necessitate increased availability of evidence-based treatments for all anxiety disorders. Group-based transdiagnostic cognitive-behavioral therapy (CBT) for anxiety can help to increase the availability of effective treatment for anxiety. The current study examined group-based transdiagnostic CBT for anxiety when implemented in a VA outpatient mental health clinic. Over a 1-year period, 52 veterans with various anxiety disorders completed transdiagnostic group CBT for anxiety. Veterans completing the group treatment reported significant decreases in general distress, anxiety, depression, and individualized fear hierarchy ratings (ps < .01). Additionally, treatment completers reported high satisfaction with the treatment experience. The current study indicates that transdiagnostic group CBT for anxiety can be effectively implemented in a VA outpatient mental health clinic and holds promise for initiatives aimed at broadly increasing the availability of evidence-based treatment for anxiety disorders in VA health care systems. (PsycINFO Database Record

Comorbidity between panic disorder and major depression is found in the majority of individuals with panic disorder and a substantial minority of individuals with major depression. Comorbidity between panic disorder and depression is associated with substantially more severe symptoms of each of the disorders, greater persistence of each disorder, more frequent hospitalization and help-seeking behavior, more severe occupational impacts, and a significantly higher rate of suicide attempts. These two disorders share many risk factors, such as neuroticism, exposure to childhood abuse, informational processing biases, and elevated amygdala activation in response to negative facial expressions. Research on the temporal priority of panic disorder and major depression has most frequently found that panic attacks and other symptoms of anxiety predate the onset of the first major depressive episode, but the first depressive episode predates the onset of full panic disorder. Treatment studies indicate that cognitive behavioral therapy (CBT) is the most effective treatment for panic disorder. Other forms of treatment include medication, particularly selective serotonin reuptake inhibitors. Comorbid depression does not appear to affect the outcome of CBT for a principal diagnosis of panic disorder, and CBT for panic disorder has positive, yet limited, effects on symptoms of depression.