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Objectives: Elevated cortisol in stress and aging, such as has been seen in late-life anxiety disorders, is postulated to accelerate cognitive and physiological decline in this large and increasing population. Selective serotonin-reuptake inhibitors (SSRIs) and cognitive behavior therapy (CBT) are both effective treatments for Generalized Anxiety Disorder (GAD) in older adults. On the other hand, there is very little research examining the effect of combining these therapies on peak cortisol levels. For the current analyses, we examined the effectiveness of CBT augmentation on peak cortisol levels in older adults diagnosed with GAD.

Methods: The sample consisted of 42 individuals with late-life GAD who received an acute course of the SSRI escitalopram and then entered a 16-week randomized phase. Twenty-one participants were randomized to receive 16 sessions of CBT in addition to continuing escitalopram and the remaining 21 participants continued on escitalopram without CBT. Generalized Estimating Equations were performed to assess the effectiveness of CBT augmentation on peak cortisol levels (30 minutes after waking).

Results: Older adults with GAD who received both escitalopram and CBT demonstrated a significant reduction in peak cortisol levels at post-treatment compared to the group who received escitalopram without CBT augmentation.

Conclusions: CBT augmentation of SSRI treatment reduced peak cortisol levels for older adults with GAD. Since persistently high cortisol levels in aging are thought to increase age-related cognitive and medical problems, our findings suggest that there may be a benefit to health and cognition of CBT augmentation for late-life anxiety disorders.


*Corresponding author at: Department of Psychology Box 1121, Southern Illinois University Edwardsville, Edwardsville, Illinois, 62026; phone: 1-618-650-5351; fax: 1-618-650-5087; email:

This is a manuscript copy of an article published by the American Psychological Association in Journal of Consulting and Clinical Psychology . This article may not exactly replicate the authoritative document published in the APA journal. It is not the copy of record. The copy of record is available online at