Using online-cognitive behaviour therapy (Online-CBT) to treat general anxiety and worry among older adults: Is it effective and does client engagement matter?

INTERVENTION: Comparing active treatment (therapist‐assisted Online‐CBT) to a non‐active control group (waitlist) The intervention is titled GAD Online for Older Adults, which is an Online‐CBT program designed for treating older adults with generalized anxiety symptoms. The program consists of seven treatment modules containing CBT materials that are accessed online, as well as activities that are to be completed offline. The modules include information about generalized anxiety, how to monitor anxiety and worry, relaxation techniques, how to monitor thoughts and challenge them, how to reduce and control worry, and other coping strategies. Clients should engage in Online‐CBT for approximately 7 to 10 weeks. GAD Online for Older Adults is therapist‐assisted. Each client is assigned an online therapist who communicates with the client on a weekly basis via e‐mail using the secure e‐mail built into the program website. In the weekly e‐mail, the therapist comments on the progress a client has made, addresses homework concerns, and answers any questions the client has for the therapist. The therapist?s role is also to provide support, encouragement and motivation for clients to continue with the program. Participants who receive Online‐CBT will be contacted one month after completing the program to be asked to complete follow‐up measures. Participants randomized to the waitlist control group will be offered the intervention upon completing the second set of questionnaires. They will then be followed for the duration of completing the intervention and the follow‐up measures. CONDITION: Generalized Anxiety Disorder ; Mental and Behavioural Disorders PRIMARY OUTCOME: 1. Generalized Anxiety Disorder‐7 (GAD‐7); 2. Patient Health Questionnaire‐9 (PHQ‐9); 3. Geriatric Anxiety Inventory (GAI); 4. Penn State Worry Questionnaire‐Abbreviated (PSWQ‐A); ; These will be administered at baseline and post‐treatment, as well as one‐month follow‐up for those randomized to receive the intervention. INCLUSION CRITERIA: 1. Resident of Saskatchewan 2. Aged 60 years of age or older, either sex 3. Meets DSM‐IV‐TR criteria for Generalized Anxiety Disorder or sub‐clinical criteria 4. Has regular access to a computer, Internet and printer 5. Comfortable using the Internet and writing e‐mails SECONDARY OUTCOME: 1. Geriatric Depression Scale (GDS); 2. WHO‐Quality of Life‐BREF (WHO‐QOL‐BREF); 3. Credibility/Expectancy Questionnaire (CEQ); 4. Anxiety Change Expectancy Scale (ACES); 5. Therapeutic Alliance Questionnaire (TAQ); 6. Treatment Satisfaction Questionnaire‐Modified; ; Most measures are administered at baseline, post‐treatment and one‐month follow‐up. Some are administered exclusively at post‐treatment.; ; Baseline: Generalized Anxiety Disorder‐7 item (GAD‐7), Patient Health Questionnaire (PHQ‐9), Geriatric Anxiety Inventory (GAI), Penn State Worry Questionnaire‐Abbreviated (PSWQ‐A), Geriatric Depression Scale (GDS), WHO‐Quality of Life‐BREF (WHOQOL‐BREF), Credibility/Expectancy Questionnaires (CEQ), Anxiety Change Expectancy Scale (ACES); ; Post‐Treatment: Generalized Anxiety Disorder‐7 item (GAD‐7), Patient Health Questionnaire (PHQ‐9), Geriatric Anxiety Inventory (GAI), Penn State Worry Questionnaire‐Abbreviated (PSWQ‐A), Geriatric Depression Scale (GDS), WHO‐Quality of Life‐BREF (WHOQOL‐BREF), Anxiety Change Expectancy Scale (ACES), Treatment Satisfaction Questionnaire‐Modified (TSQ‐M), Therapeutic Alliance Questionnaire (TAQ), Client Feedback Open‐Ended Questions; ; One‐Month Follow‐Up: Generalized Anxiety Disorder‐7 item (GAD‐7), Patient Health Questionnaire (PHQ‐9), Geriatric Anxiety Inventory (GAI), Penn State Worry Questionnaire‐Abbreviated (PSWQ‐A), Geriatric Depression Scale (GDS)