Telephone-Delivered Cognitive-Behavioral Therapy for Older, Rural Veterans with Depression and Anxiety in Home-Based Primary Care.

OBJECTIVES: Rural, homebound older adults are at increased risk for anxiety and depression and have limited access to mental health services. These individuals face many barriers to receiving evidence-based mental health treatment and would benefit from interventions that increase access to and efficiency of care. The aim of this study was to evaluate use of a telephone-delivered, modular, cognitive behavioral therapy (CBT) intervention for both late-life depression and anxiety delivered to rural, homebound Veterans. METHODS: Three cases are presented to illustrate the flexible adaptation of the intervention for use among older Veterans enrolled in home-based primary care, with varying symptom presentations and functional limitations. The Veterans received 7 to 9 sessions of the CBT intervention, with ordering of skill modules based on symptom presentation and determined collaboratively between patient and therapist. RESULTS: The three Veterans showed improvement in depression and/or anxiety symptoms following treatment and provided positive feedback regarding their experiences in this program. CONCLUSIONS: These results suggest that telephone-delivered CBT is acceptable to older adults and can be tailored to individual patient needs. CLINICAL IMPLICATIONS: Clinicians should consider telephone-delivered CBT as an alternate mode of therapy to increase access to mental health care for rural, homebound individuals with depression and anxiety.

Predictors of Outcomes for Older Adults Participating in Calmer Life, a Culturally Tailored Intervention for Anxiety.

OBJECTIVE: Determine predictors of reduced worry and anxiety for older adults participating in the pilot phase of Calmer Life, a modular, personalized cognitive-behavioral treatment for worry. METHODS: Underserved adults (N = 54) over age 50 participated. Therapists were either experts (Ph.D. or Master's) or nonexpert providers (case managers, community health workers, and bachelor's level). Participants completed the Penn State Worry Questionnaire-Abbreviated (PSWQ-A) and the Geriatric Anxiety Inventory-Short Form (GAI-SF) before treatment and at 3 months. RESULTS: Demographic and clinical variables were individually entered into separate regression equations, controlling for pretreatment scores, to determine their associations with post-treatment 1) PSWQ-A and 2) GAI-SF scores. Only younger age and African American race were significant (p < .05) univariate predictors of higher post-treatment PSWQ-A scores. African American race was also a significant predictor of higher post-treatment GAI-SF scores. CONCLUSIONS: African American participants had higher post-treatment PSWQ-A and GAI-SF scores than White and Hispanic participants. Younger age was also associated with more severe PSWQ-A post-treatment scores. CLINICAL IMPLICATIONS: Younger participants may experience additional stressors (e.g., caregiving, working) compared with older participants. Smaller decreases in anxiety in African Americans point to the need for continued focus and additional modification of interventions.

Motivational Interviewing as an Adjunct to Cognitive Behavioral Therapy for Anxiety.

OBJECTIVE: This study examined the effect of a single session motivational interviewing (MI) intervention on engagement in a 12-week transdiagnostic group cognitive behavioral therapy (CBT) treatment for anxiety. METHOD: Participants were randomized to MI (N = 20) or non-MI (N = 19) conditions before enrolling in a 12-week group CBT program. Participants in the MI condition received an individual 50-minute MI session adapted from the longer MI pretreatment protocol, developed by Westra and Dozois () and Westra (). RESULTS: Rates of treatment initiation and treatment expectancies were significantly higher among participants who received the MI pretreatment intervention. Results indicate substantial reduction in clinician-rated anxiety severity after transdiagnostic group CBT, with no significant differences between MI and non-MI conditions. CONCLUSION: These findings suggest that a single MI pretreatment session may have positive effects on proximal measures of treatment engagement, but that these effects may not affect the severity of anxiety symptoms over the course of CBT.

An Experimental Comparison of Techniques: Cognitive Defusion, Cognitive Restructuring, and in-vivo Exposure for Social Anxiety.

BACKGROUND: One of the primary differences between Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) for anxiety is the approach to managing negative thoughts. CBT focuses on challenging the accuracy of dysfunctional thoughts through cognitive restructuring exercises, whereas ACT attempts to foster acceptance of such thoughts through cognitive defusion exercises. Previous research suggests that both techniques reduce the distress associated with negative thoughts, though questions remain regarding the benefit of these techniques above and beyond exposure to feared stimuli. AIMS: In the present study, we conducted a brief experimental intervention to examine the utility of cognitive defusion + in-vivo exposure, cognitive restructuring + in-vivo exposure, and in-vivo exposure alone in reducing the impact of negative thoughts in patients with social anxiety disorder. METHOD: All participants completed a brief public speaking exposure and those in the cognitive conditions received training in the assigned cognitive technique. Participants returned a week later to complete a second exposure task and self-report measures. RESULTS: All three conditions resulted in similar decreases in discomfort related to negative thoughts. ANOVA models failed to find an interaction between change in accuracy or importance and assignment to condition in predicting decreased distress of negative thoughts. CONCLUSIONS: These preliminary results suggest that changes in perceived importance and accuracy of negative thoughts may not be the mechanisms by which cognitive defusion and cognitive restructuring affect distress in the short-term.

Identification of Anxiety Symptom Clusters in Patients with COPD: Implications for Assessment and Treatment.

BACKGROUND: Treatment of chronic obstructive pulmonary disease (COPD) is palliative, and quality of life is important. Increased understanding of correlates of quality of life and its domains could help clinicians and researchers better tailor COPD treatments and better support patients engaging in those treatments or other important self-management behaviors. PURPOSE: Anxiety is common in those with COPD; however, overlap of physical and emotional symptoms complicates its assessment. The current study aimed to identify anxiety symptom clusters and to assess the association of these symptom clusters with COPD-related quality of life. METHODS: Participants (N = 162) with COPD completed the Beck Anxiety Inventory (BAI), Chronic Respiratory Disease Questionnaire, Patient Health Questionnaire-9, and Medical Research Council dyspnea scale. Anxiety clusters were identified, using principal component analysis (PCA) on the BAI's 21 items. Anxiety clusters, along with factors previously associated with quality of life, were entered into a multiple regression designed to predict COPD-related quality of life. RESULTS: PCA identified four symptom clusters related to (1) general somatic distress, (2) fear, (3) nervousness, and (4) respiration-related distress. Multiple regression analyses indicated that greater fear was associated with less perceived mastery over COPD (ß = -0.19, t(149) = -2.69, p < 0.01). CONCLUSION: Anxiety symptoms associated with fear appear to be an important indicator of anxiety in patients with COPD. In particular, fear was associated with perceptions of mastery, an important psychological construct linked to disease self-management. Assessing the BAI symptom cluster associated with fear (five items) may be a valuable rapid assessment tool to improve COPD treatment and physical health outcomes.

A review of cognitive behavioral therapy for panic disorder in patients with chronic obstructive pulmonary disease: the rationale for interoceptive exposure.

Panic disorder commonly co-occurs in patients with chronic obstructive pulmonary disease (COPD), and translational interventions are needed to address the fear of physiological arousal in this population. This paper examines the utility of interoceptive exposures (IE), a key component of cognitive behavioral therapy (CBT) for panic disorder, in patients with comorbid panic and COPD. Our translational review of the literature suggests that IE is supported by both cognitive- and learning-theory perspectives of panic, and that the breathing exercises associated with IE are safe and highly compatible with existing pulmonary rehabilitation exercises for COPD. Unfortunately, few research studies have examined the use of CBT to treat anxiety in COPD patients, and none have included IE. Given the strong theoretical and empirical support for the use of IE, we suggest that mental health providers should consider incorporating IE into CBT interventions for patients with comorbid panic and COPD.

Effect of transdiagnostic cbt for anxiety disorders on comorbid diagnoses.

OBJECTIVE: The present study examines the effectiveness of a 12-week transdiagnostic cognitive-behavioral group in reducing comorbid diagnoses. METHOD: Data from 79 treatment completers (60.8% women; M age = 32.57 years) during three previous trials of transdiagnostic cognitive behavior therapy (CBT) were examined to compare treatment effects between those with and without comorbid diagnoses. Additionally, rates of remission of comorbid diagnoses were compared to published diagnosis-specific CBT trials. RESULTS: Results indicate that a majority of clients (64.6%) had at least one comorbid disorder and that those with comorbid diagnoses had higher primary diagnosis severity scores than did those without comorbid diagnoses. The presence of a comorbid diagnosis at pretreatment was not associated with differential improvement in primary diagnosis severity following treatment. Two-thirds of completers with comorbid diagnoses at pretreatment (66.7%) no longer met criteria for a clinically severe comorbid diagnosis at posttreatment, a rate higher than that associated with most trials of diagnosis-specific CBT for anxiety disorders used as benchmarks. CONCLUSIONS: These results suggest that transdiagnostic cognitive-behavioral group treatment for anxiety may be associated with greater decreases in comorbidity than traditional diagnosis-specific CBT.

Impact of panic disorder on quality of life among veterans in a primary care pilot study.

Panic disorder is a debilitating and costly mental health condition which commonly presents in primary care settings; however, little is known about the impact of panic disorder on quality of life and health utility valuations among Veterans in primary care. A cross-sectional investigation of quality of life was conducted in a sample of 21 Veterans with panic disorder in a VA primary care clinic. Health utilities were determined using an algorithm based upon the Medical Outcomes Study Short-Form 36 Health Survey (SF-36). Veterans in the current sample reported significantly greater impairment on all eight of the SF-36 subscales in comparison to published norms. Veterans with panic and comorbid mood disorders reported significantly greater impairment on the Vitality, Social Functioning, and Mental Health subscales, while Veterans with panic and comorbid anxiety disorders reported significantly greater impairment on the Physical Functioning and Bodily pain subscales. Health utilities for the current sample were comparable to previous reports of Veterans with PTSD and depression, as well as health utilities of persons with chronic pulmonary disease and irritable bowel syndrome. The findings from this study highlight the devastating nature of panic disorder and reflect the need for increased attention to the identification and treatment of panic disorder in VA primary care settings.

Transdiagnostic versus diagnosis-specific cbt for anxiety disorders: a preliminary randomized controlled noninferiority trial.

BACKGROUND: Transdiagnostic cognitive-behavioral treatments for anxiety disorders have been gaining increased attention and empirical study in recent years. Despite this, research on transdiagnostic anxiety treatments has, to date, relied on open trials, or comparisons to waitlist conditions, published benchmarks, or relaxation-based interventions. METHODS: The current study was a randomized clinical trial examining the efficacy of a 12-week transdiagnostic cognitive-behavioral group treatment in comparison to 12-week diagnosis-specific group Cognitive-Behavioral Therapy (CBT) protocols for panic disorder, social anxiety disorder, and generalized anxiety disorder. RESULTS: Results from 46 treatment initiators suggested significant improvement during treatment, strong evidence for treatment equivalence across transdiagnostic and diagnosis-specific CBT conditions, and no differences in treatment credibility. CONCLUSIONS: This study provides evidence supporting the efficacy of transdiagnostic CBT by comparison to current gold-standard diagnosis-specific CBT for social anxiety disorder, generalized anxiety disorder, and panic disorder. Transdiagnostic group CBT has the benefit of potentially easing dissemination and increasing access to evidence-based treatments for anxiety without sacrificing efficacy.

The appraisal of intrusive thoughts in relation to obsessional-compulsive symptoms.

Research has shown that although intrusive thoughts occur universally, the majority of individuals do not view intrusive thoughts as being problematic (Freeston, Ladouceur, Thibodeau, & Gagnon, 1991; Rachman & de Silva, 1978; Salkovskis & Harrison, 1984). Thus, it is not the presence of intrusive thoughts that leads to obsessional problems but rather some other factor that plays a role in the development of abnormal obsessions. According to the cognitive model of obsessive-compulsive disorder (OCD) put forth by Salkovskis (1985), the crucial factor that differentiates between individuals with OCD and those without is the individual's appraisal of the naturally occurring intrusive thoughts. This study aimed to test Salkovskis's model by examining the role of cognitive biases (responsibility, thought-action fusion, and thought control) as well as distress in the relationship between intrusive thoughts and obsessive-compulsive symptoms in an undergraduate sample of 326 students. An existing measure of intrusive thoughts (the Revised Obsessional Intrusions Inventory) was modified for this study to include a scale of distress associated with each intrusive thought in addition to the current frequency scale. When the Yale-Brown Obsessive-Compulsive Scale was used as the measure of OCD symptoms, a significant interaction effect of frequency and distress of intrusive thoughts resulted. Additionally, a significant three-way interaction of Frequency × Distress × Responsibility was found when the Obsessive Compulsive Inventory-Revised was used as the measure of OCD symptoms. These results indicate that the appraisal of intrusive thoughts is important in predicting OCD symptoms, thus providing support for Salkovskis's model of OCD.

Lesbian, gay, and transgender veterans' experiences in the Veterans Health Administration: Positive signs and room for improvement.

This study explored the characteristics of lesbian, gay, and transgender veteran users of Veterans Health Administration (VHA) services and nonusers, using a national convenience sample. Participants responded to an online, anonymous survey posted on LGBT websites and forwarded through personal contacts, using a snow-ball sampling strategy, resulting in a final sample of 218. Most participants were enrolled in VHA (n = 151). VHA users were older, more ethnically diverse, had less income, and were less public about their sexual or gender minority identity than nonusers. VHA users and nonusers did not differ on depression, anxiety, alcohol use, or tobacco use; although VHA users had more physical limitations and chronic medical conditions and lower health literacy than nonusers. Most lesbian, gay, and transgender VHA users felt welcome at their facility and comfortable disclosing their sexual orientation and gender identity with their provider. Compared with earlier studies, the positive experiences of lesbian, gay, and transgender VHA users in this study provide supportive evidence that VHA staff training efforts to raise awareness and competency have been successful. Additional efforts are needed to understand why transgender men feel less welcome and comfortable disclosing their gender identity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Obsessive-compulsive disorder in the Veterans Health Administration.

Little is known about the diagnosis and treatment of obsessive-compulsive disorder (OCD) in the Veterans Health Administration (VHA). This study examined diagnostic rates of OCD in a national sample of veterans as well as clinical comorbidities and mental health service use following an OCD diagnosis. This study used administrative data extracted from VHA medical records to identify patients with an OCD diagnosis between 2010 and 2011 (N = 20,364). Descriptive analyses examined demographic, clinical, and system-level variables associated with OCD diagnosis as well as mental health service use in a subset of patients newly diagnosed with OCD (n = 5,229). The OCD diagnosis rate in VHA medical records was 0.31% of VHA patients seen in 2010-2011. Examination of new-onset OCD diagnoses in 2010-2011 revealed that OCD was most likely to be diagnosed by physicians (48.6%) and behavioral health providers (31.9%), predominantly in mental health settings (87.5%). In the year following OCD diagnosis, veterans had an average of 3.9 individual psychotherapy and 3.5 psychiatric medication visits. These findings suggest that OCD is likely underrecognized and inadequately treated in the VHA and highlight the need for improved diagnostic and treatment services for veterans with OCD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Increased utilization of prolonged exposure and cognitive processing therapy over time: A case example from a large Veterans Affairs posttraumatic stress disorder clinic.

Prior single-site and regional studies have documented difficulties in implementing prolonged exposure (PE) and cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) into practice in Veterans Affairs (VA) Medical Centers, estimating that between 6% and 13% of VA patients with PTSD receive PE or CPT (Lu, Plagge, Marsiglio, & Dobscha, 2016; Mott et al., 2014; Shiner et al., 2013). However, these studies examined data from fiscal years 2008-2012, and therefore may not reflect more recent utilization patterns. Beginning in 2007, the VA invested heavily in increasing implementation of PE and CPT, including nationwide training rollouts and consultation. Given the length of time required for successful implementation of new practices, it is important to evaluate use of PE and CPT over time. We examined current use of PE and CPT at 1 VA medical center PTSD specialty clinic and compared this to prior rates for the same clinic. Chart reviews for all patients receiving a PTSD clinic initial evaluation between January 1, 2015, and May 31, 2015, indicated that 52% of patients began a course of PE or CPT within the 1-year follow-up period, representing a 5-fold increase from 2008 to 2012. We discuss changes in clinic structure, processes, training, and clinician support that might account for the successful implementation of PE and CPT in this clinic. We also present data on alternative referrals provided to patients not engaging in PE and CPT, and predictors of engagement in PE and CPT. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Morally injurious events and psychological distress among veterans: Examining the mediating role of religious and spiritual struggles.

OBJECTIVE: Potentially morally injurious events (PMIEs)-violations (perpetrated or witnessed) of one's deeply held beliefs or values-have been associated with several forms of psychological distress. The values violated by PMIEs are often influenced by one's religion/spirituality (r/s). Struggles with one's r/s beliefs and/or practices may also contribute to elevated psychological distress. To further develop a framework for understanding and treating the sequelae of PMIE exposure, we examined the role of r/s struggles in the relation between PMIE exposure and psychological distress. METHOD: A diverse sample of 155 veterans at a large Veterans Affairs medical center completed questionnaires assessing PMIE exposure, r/s struggles, and psychological distress. RESULTS: Findings revealed greater PMIE exposure predicted elevated r/s struggles as well as elevated symptoms of anxiety and posttraumatic stress disorder (PTSD). Likewise, greater r/s struggles predicted elevated anxiety, PTSD, and depression symptoms. Regression analyses revealed r/s struggles fully mediated the relation between PMIE exposure and anxiety as well as PTSD, and a significant indirect effect of PMIE exposure on depression symptoms through r/s struggles was observed. Follow-up analyses revealed that no specific domain of r/s struggles accounted for the relation between PMIE exposure and psychological distress; rather, the overarching construct of r/s struggles accounted for this relation. CONCLUSION: These findings advance the evolving theoretical framework of moral injury, elucidating the salience of r/s struggles in the development of distress. Implications for moral injury intervention call for attention to potential dissonance between actions (witnessed or perpetrated) and r/s underpinnings of the individual's moral framework. (PsycINFO Database Record

Health Differences Among Lesbian, Gay, and Transgender Veterans by Rural/Small Town and Suburban/Urban Setting.

PURPOSE: We explored the relationship between geographic location and health indicators for lesbian, gay, and transgender veterans. METHODS: We solicited participation in an online survey through national and city LGBT organizations and personal contacts to examine differences in depression, anxiety, alcohol and tobacco use, and body mass index among lesbian, gay, and transgender veterans (n = 252) in suburban/urban and rural/small town locations. Bisexual participants were too few to include in the analyses. RESULTS: As expected, rural/small town lesbian, gay, and transgender veterans spent more time traveling to their primary care provider. Travel time was also positively related to depressive and anxiety symptoms. However, only suburban/urban and rural/small town gay men differed in measures of depression and anxiety and tobacco use. That is, rural/small town gay men reported greater depressive and anxiety symptoms and greater tobacco use than their suburban/urban counterparts. Consistent with this finding, rural/small town gay men reported less community-related identity than suburban/urban men. Suburban/urban lesbian women showed a nonsignificant trend for community identity compared with rural/small town women. CONCLUSION: Similar to civilian studies, suburban/urban and rural/small town lesbian, gay, and transgender veterans evidenced few health differences, with the exception of suburban/urban gay men. Although rural/small town gay male veterans evidenced more depression and anxiety and less community identity than suburban/urban men, social networks likely differ for lesbian, gay, and transgender subgroups. Lesbian, gay, and transgender veterans may also differ from their civilian counterparts in ways that we do not yet understand.

Recognition of anxiety, depression, and PTSD in patients with COPD and CHF: Who gets missed?

OBJECTIVE: This study sought to identify patient factors associated with mental health (MH) recognition and treatment in medically ill Veterans. METHOD: Retrospective data from patient electronic medical records (EMR) and self-report data were reviewed for 180 Veterans with cardiopulmonary conditions who met diagnostic criteria for anxiety, depression, or posttraumatic stress disorder on the Mini-International Neuropsychiatric Interview. Multivariate logistic regression examined the association of medical record MH recognition and MH service use with patient factors, including anxiety and depression severity, self-efficacy, locus of control, coping, illness intrusiveness, and health-related quality of life (QOL). RESULTS: Seventy veterans (39%) had an MH diagnosis documented in their EMR, and 101 (56%) received at least one MH service (≥1 MH encounter or psychiatric medications). Greater depression (p=0.047) and adaptive coping (p=0.012) were associated with increased likelihood of EMR documentation of MH diagnoses. EMR MH diagnosis (p<0.001), higher internal locus of control (p=0.037), and poorer physical health-related QOL (p=0.014) were associated with greater likelihood of MH service use. DISCUSSION: Veterans with cardiopulmonary conditions experiencing MH problems are under-recognized. Improved MH screening is needed, particularly for patients with poor adaptive coping skills, low internal locus of control, or poor physical health-related QOL.

Treatment decision-making for posttraumatic stress disorder: The impact of patient and therapist characteristics.

OBJECTIVE: The purpose of this study was to assess how patient and provider factors influence the use of evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). METHOD: This study used a 2 × 2 survey design to assess providers' willingness to select EBPs for patients presented in clinical case vignettes. PTSD providers (N = 185) were randomized and asked to respond to 1 of 4 case vignettes in which the patients' age and alcohol use comorbidity were manipulated. RESULTS: Results suggested that the majority of providers were favorable toward EBPs, with 49% selecting cognitive processing therapy (CPT) as the first-line intervention, 25% selecting prolonged exposure (PE), and 8% selecting Eye Movement Desensitization Reprocessing therapy. Provider characteristics, but not patient characteristics, influenced treatment selection. Cognitive-behavioral therapy (CBT) orientation, younger age, fewer years of experience, and more time spent treating patients with PTSD were positively related to EBP selection. Provider training in specific EBPs (CPT or PE) increased the likelihood of recommending these treatments as first-line interventions. CONCLUSION: Taken together, these results suggest that providers are increasingly likely to view exposure-based EBPs for PTSD as effective, and that continued dissemination efforts to increase provider familiarity and comfort with these protocols will likely improve rates of EBP use across a variety of practice settings. (PsycINFO Database Record

Intensive weekend group treatment for panic disorder and its impact on co-occurring PTSD: A pilot study.

This pilot study examines the feasibility, acceptability, and potential effectiveness of delivering an intensive weekend group treatment for panic disorder (PD) to Veterans returning from deployments to Iraq and Afghanistan with co-occurring posttraumatic stress disorder (PTSD). The treatment program lasted 6h each day and was delivered by two experienced therapists. Patients received core components of panic treatment, including psychoeducation, cognitive restructuring, and interoceptive exposure. The interoceptive exposure exercises directly targeted anxiety sensitivity, a psychological construct also implicated in the maintenance of PTSD. Eighty-nine percent of patients who expressed interest in the treatment attended a baseline evaluation, and 63% of those who were study eligible initiated treatment. Treatment retention was high, with all 10 patients who initiated treatment completing the program. Veterans reported finding the treatment and delivery format highly acceptable and reported high levels of satisfaction. Panic symptoms improved significantly following the treatment and were maintained at a 7-month follow-up, with 71.4% of the sample reporting being panic free. Co-occurring PTSD symptoms also improved along with symptoms of anxiety and depression. Preliminary findings suggest that brief and intensive group treatments for PD/PTSD are a promising method of delivering cognitive behavioral therapy that may rapidly improve symptoms. This innovative treatment delivery format also may be a cost-effective way of increasing treatment engagement through increased access to quality care.

Correlates of pain intensity in community-dwelling individuals with mild to moderate dementia.

OBJECTIVES: To identify correlates of participant-reported pain in community-dwelling individuals with mild to moderate dementia. METHODOLOGY: Associations among participant-reported pain intensity and depressive symptoms, mental health diagnoses, pain diagnoses, pain medications, level of functional ability, and cognitive impairment were assessed in 136 community-dwelling veterans with mild to moderate dementia and pain. Univariate and multiple regressions were used to assess relationships among the independent variables and participant-reported pain. RESULTS: Pain diagnoses (ß = .23, t 132 = 2.65, P < .01) and pain medications (ß = .21, t 132 = 2.48, P < .05) were correlated with participant-reported pain intensity in univariate regression models. Only pain diagnoses (ß = .20, t 132 = 2.17, P < .05) remained a significant predictor in adjusted models. CONCLUSION: Participant-reported pain in individuals with dementia appears to be a unique construct for which other psychosocial indicators cannot be substituted. Therefore, directly asking community-dwelling individuals with mild to moderate dementia about their pain is a critical component of assessment.

Cognitive-behavioral therapy for late-life anxiety: Similarities and differences between Veteran and community participants.

Cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety; however, a growing body of research suggests that CBT effect sizes are smaller in Veteran samples. The aim of this study was to perform secondary data analyses of a randomized controlled trial of CBT for late-life generalized anxiety disorder compared with treatment as usual (TAU) in a Veteran (n = 101) and community-based (n = 122) sample. Veterans had lower income and less education than community participants, greater severity on baseline measures of anxiety and depression, poorer physical health, and higher rates of psychiatric comorbidity. Treatment effects were statistically significant in the community sample (all ps < 0.01), but not in Veterans (all ps > 0.05). Further analyses in Veterans revealed that poorer perceived social support significantly predicted poorer outcomes (all ps < 0.05). Our results underscore the complexity of treating Veterans with anxiety, and suggest that additional work is needed to improve the efficacy of CBT for Veterans, with particular attention to social support.