Anxiety can be a significant problem in later life (i.e., after age 65). To cope, a substantial proportion of elderly individuals take benzodiazepine medication, as prescribed by their primary-care physician. Unfortunately, the use of benzodiazepines for the long-term management of anxiety in the elderly carries certain risks, including cognitive impairment, motor impairment, respiratory depression, and addiction. Cognitive behavior therapy, a proven treatment for anxiety in younger individuals, might offer a safe and effective alternative to medication in the older population. We describe the rationale and implementation of a 13-session cognitive-behavioral treatment protocol, currently in use at Columbia-Presbyterian Medical Center. The protocol is designed to address several aspects of anxiety that we have encountered in elderly patients: excessive worry (especially about aging and related health matters); reduced structure of daily life; anxiety over symptoms of autonomic arousal; benzodiazepine dependence; realistic fears; and insomnia.