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Hendriks GJ, Janssen N, Robertson L, van Balkom AJ, van Zelst WH, Wolfe S, Oude Voshaar RC, Uphoff E. Cognitive behavioural therapy and third-wave approaches for anxiety and related disorders in older people. Cochrane Database Syst Rev 2024; 7:CD007674. [PMID: 38973756 PMCID: PMC11229394 DOI: 10.1002/14651858.cd007674.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is the most researched psychological therapy for anxiety disorders in adults, and known to be effective in this population. However, it remains unclear whether these results apply to older adults, as most studies include participants between 18 and 55 years of age. This systematic review aims to provide a comprehensive and up-to-date synthesis of the available evidence on CBT and third wave approaches for older adults with anxiety and related disorders. OBJECTIVES To assess the effects of Cognitive Behavioural Therapy (CT, BT, CBT and third-wave CBT interventions) on severity of anxiety symptoms compared with minimal management (not providing therapy) for anxiety and related disorders in older adults, aged 55 years or over. To assess the effects of CBT and related therapies on severity of anxiety symptoms compared with other psychological therapies for anxiety and related disorders in older adults, aged 55 years or over. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled studies Register (CCMDCTR), CENTRAL, Ovid MEDLINE, Ovid Embase and Ovid PsycINFO to 21 July 2022. These searches were updated on 2 February 2024. We also searched the international studies registries, including Clinicalstudies.gov and the WHO International Clinical Trials Registry Platform (ICTRP), to identify additional ongoing and unpublished studies. These sources were manually searched for studies up to 12 February 2024. SELECTION CRITERIA We included randomised controlled trials (RCTs) in older adults (≥ 55 years) with an anxiety disorder, or a related disorder, including obsessive compulsive disorder (OCD), acute stress disorder and post-traumatic stress disorder (PTSD), that compared CBT to either minimal management or an active (non-CBT) psychological therapy. Eligible studies had to have an anxiety-related outcome. DATA COLLECTION AND ANALYSIS Several authors independently screened all titles identified by the searches. All full texts were screened for eligibility according to our prespecified selection criteria. Data were extracted and the risk of bias was assessed using the Cochrane tool for RCTs. The certainty of evidence was evaluated using GRADE. Meta-analyses were performed for outcomes with quantitative data from more than one study. MAIN RESULTS We included 21 RCTs on 1234 older people allocated to either CBT or control conditions. Ten studies focused on generalised anxiety disorder; others mostly included a mix of clinical diagnoses. Nineteen studies focused on the comparison between CBT and minimal management. Key issues relating to risk of bias were lack of blinding of participants and personnel, and participants dropping out of studies, potentially due to treatment preference and allocation. CBT may result in a small-to-moderate reduction of anxiety post-treatment (SMD -0.51, 95% CI -0.66 to -0.36, low-certainty evidence). However, compared to this benefit with CBT immediately after treatment, at three to six months post-treatment, there was little to no difference between CBT and minimal management (SMD -0.29, 95% CI -0.59 to 0.01, low-certainty evidence). CBT may have little or no effect on clinical recovery/ improvement post-treatment compared to minimal management, but the evidence is very uncertain (RR 1.56, 95% CI 1.20 to 2.03, very low-certainty evidence). Results indicate that five people would need to receive treatment for one additional person to benefit (NNTB = 5). Compared to minimal management, CBT may result in a reduction of comorbid depression symptoms post-treatment (SMD -0.57, 95% CI -0.74 to -0.40, low-certainty evidence). There was no difference in dropout rates post-treatment, although the certainty of the evidence was low (RR 1.19, 95% CI 0.80 to 1.78). Two studies reported adverse events, both of which related to medication in the control groups (very low-certainty evidence, no quantitative estimate). Only two studies compared CBT to other psychological therapies, both of which only included participants with post-traumatic stress disorder. Low-certainty evidence showed no difference in anxiety severity post-treatment and at four to six months post-treatment, symptoms of depression post-treatment, and dropout rates post-treatment. Other outcomes and time points are reported in the results section of the manuscript. AUTHORS' CONCLUSIONS CBT may be more effective than minimal management in reducing anxiety and symptoms of worry and depression post-treatment in older adults with anxiety disorders. The evidence is less certain longer-term and for other outcomes including clinical recovery/improvement. There is not enough evidence to determine whether CBT is more effective than alternative psychological therapies for anxiety in older adults.
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Affiliation(s)
- Gert-Jan Hendriks
- "Overwaal" Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institute for Integrated Mental Health Care "Pro Persona, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Noortje Janssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | | | - Anton J van Balkom
- Department of Psychiatry, Amsterdam University Medical Centre Vrije Universiteit, Amsterdam Public Health Institute and GGZ inGeest, Amsterdam, Netherlands
| | - Willeke H van Zelst
- Department of Psychiatry, University Medical Centre Groningen, Groningen, Netherlands
| | - Samantha Wolfe
- Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | | | - Eleonora Uphoff
- Centre for Reviews and Dissemination, University of York, York, UK
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Maynard H, Gregory JD, Davies A, Fox J. Psychological Factors Protecting Against Suicidality in Older Adults: A Systematic Review. Clin Psychol Psychother 2024; 31:e3029. [PMID: 39138589 DOI: 10.1002/cpp.3029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/15/2024] [Accepted: 06/27/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE Suicide rates in older adults are often the highest of any age group, particularly among high income countries. However, there is a limited understanding of the factors that could protect against suicidality in older age. This systematic review aimed to identify and evaluate the psychological factors that protect against suicidality in older age. METHOD An a priori protocol was established and registered on PROSPERO (CRD42022343694). EMBASE, MEDLINE, PsycINFO, Web of Science and Scopus were searched. Papers were quality assessed using the Quality Assessment with Diverse Studies (QuADSs) tool. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Seventeen papers were included and narratively synthesised. RESULTS The initial searches identified 10,673 records, resulting in the screening of 5441 records after the removal of duplicates. The protective factors identified were (1) meaning/purpose in life, (2) reasons for living, (3) coping styles, (4) psychological wellbeing, (5) life satisfaction, (6) personality factors, (7) cognitive functioning, and (8) sense of belonging. The factors with the most empirical support were meaning in life, followed by psychological wellbeing and coping responses, such as primary control strategies, and personality traits, such as positive affect and agency. There was also evidence to suggest that the influence of some protective factors, for example meaning in life, may depend upon stage in older life and gender. CONCLUSION This review identified several psychological factors that have been found to protect against suicidal ideation in older adults, representing potential treatment targets for reducing suicide in older adults. Recommendations for future research includes greater use of longitudinal and case-control designs, measuring outcomes across the continuum of suicidality and using samples that allow comparison between younger and older adults and within the spectrum of old age.
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Affiliation(s)
| | | | - Andrea Davies
- Psychology, Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - John Fox
- Department of Psychology, University of Sheffield, Sheffield, UK
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Zarling A, Kim J, Russell D, Cutrona C. Increasing Older Adults' Social Connectedness: Development and Implementation of a Web-Assisted Acceptance and Commitment Therapy-Based Intervention. JMIR Aging 2024; 7:e47943. [PMID: 38647321 PMCID: PMC11058557 DOI: 10.2196/47943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 04/25/2024] Open
Abstract
In this article, we will provide a rationale for a web-assisted acceptance and commitment therapy (ACT) approach to loneliness among older adults, drawing upon theories from the literature on adult development and aging, emotion regulation, and loneliness. The intervention program was developed using the principles of ACT, which is a cognitive behavioral approach and unified model of human behavior change and psychological growth. The ACT intervention focuses on developing nonjudgmental present-focused awareness of internal experiences (thoughts, emotions, and memories) through strategies such as acceptance and mindfulness rather than directly modifying or removing them per se. The ACT intervention appears well-suited to assist older adults in coping with the challenges of aging, as the focus is on an individual’s willingness to sit with internal experiences out of one’s control (ie, acceptance), stepping back from negative or critical thoughts and developing greater kindness toward oneself (ie, defusion), discerning what is most important to one’s true self (ie, values), and building larger patterns of effective action based on such values (ie, committed action). The ACT intervention was developed as a resource for older adults who are socially isolated or having difficulty with social connectedness. Eight modules comprise the web-assisted ACT intervention program, which includes reading materials, video clips, and activities. Each module is followed by a summary, a homework assignment, a short quiz to assess learning, and a moderated discussion with a coach. The intervention program begins with reconnecting participants with their values. The goal of the ACT intervention program is to foster flexibility in a participant’s behavior so they can behave consistently with their chosen values, rather than becoming locked into a pattern of behavior that is driven by avoiding distress or discomfort. The ACT intervention approach is both novel and innovative, as it is based on ACT and leverages a behavioral health web platform that is flexible and inclusive in its design. The ACT intervention aims to help older adults become more socially connected, less lonely, and more satisfied with their relationships with other people. The emphasis that ACT places on values and living life in accordance with one’s values renders it an approach ideally suited to older adults. Finally, recommendations for future research regarding this approach to addressing loneliness among older adults is addressed.
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Affiliation(s)
- Amie Zarling
- Department of Human Development and Family Studies, Iowa State University, Ames, IA, United States
| | - Joseph Kim
- Department of Human Development and Family Studies, Iowa State University, Ames, IA, United States
| | - Daniel Russell
- Department of Human Development and Family Studies, Iowa State University, Ames, IA, United States
| | - Carolyn Cutrona
- Department of Human Development and Family Studies, Iowa State University, Ames, IA, United States
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Apolinário-Hagen J, Drüge M, Guthardt L, Haller E. Acceptance and Commitment Therapy for Major Depressive Disorder: Navigating Depression Treatment in Traditional and Digital Settings with Insights from Current Research. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1456:227-256. [PMID: 39261432 DOI: 10.1007/978-981-97-4402-2_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Given the shortcomings of a mechanistic assumption of traditional cognitive behavioral therapy (CBT), a newer generation of CBT-grounded interventions focusing on process-orientated emotional and motivational aspects has emerged. These so-called third-wave CBTs emphasize function and context of inner experience over form and content, and have become evidence-based practice in the past four decades. Among these approaches, acceptance and commitment therapy (ACT) has both a large body of research for various (mental) health conditions, including major depressive disorder (MDD) in particular. ACT is a transdiagnostic approach that intends to increase psychological flexibility (PF) of clients as a universal mechanism of behavior change and a value-driven orientation in life. By focusing on present-moment awareness, acceptance, defusion, establishing a stable sense of self, clarifying personal valued life directions, and committing to behaviors consistent to these values, ACT targets the core processes of PF. Meta-analyses have indicated the efficacy and effectiveness of ACT in reducing depressive symptoms and increasing well-being, with mainly moderate effect sizes in clinical trials. ACT for MDD has been shown to be effective across different delivery modes (e.g., individual, group, digital). ACT can also be applied using self-help formats (e.g., mobile apps) and combined with features from compatible approaches like behavioral activation. There is also evidence for a high acceptability of ACT and adherence rates comparable to classic CBT. Moreover, process research has shown that ACT works specifically through the mediator of PF and by addressing its suggested core therapeutic processes. Given the essential role of offering a personalized therapeutic strategy in treatment outcomes and adherence, it is central to provide more effective options that match clients' needs and preferences. This chapter illustrates different applications of ACT for adults with MDD and the current evidence base to promote informed decisions on using ACT as additional or stand-alone therapeutic approach.
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Affiliation(s)
- Jennifer Apolinário-Hagen
- Faculty of Medicine, Centre for Health and Society, Institute for Occupational, Social and Environmental Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Marie Drüge
- Department of Clinical Psychology/Psychotherapy Research, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Lisa Guthardt
- Faculty of Medicine, Centre for Health and Society, Institute for Occupational, Social and Environmental Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Elisa Haller
- Faculty of Psychology, Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
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Effectiveness of ACT-based intervention in compliance with the model for sustainable mental health: A cluster randomized control trial in a group of older adults. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Zarling A, Kim J, Russell D, Cutrona C. Online acceptance and commitment therapy as treatment for loneliness among older adults: Report of a pilot study. J Am Geriatr Soc 2023. [PMID: 36970989 DOI: 10.1111/jgs.18345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Loneliness has been linked to cognitive decline, cardiovascular risk, and risk of mortality among older adults. Creative approaches are needed to increase access for older adults to evidence-based intervention programs. One possible approach is acceptance and commitment therapy (ACT). The aim of this study was to pilot test a novel ACT-based online intervention to decrease loneliness in older adults living in the community. METHODS A self-paced online ACT program consisting of eight interactive modules designed to teach participants skills to address common contributors to loneliness was evaluated. It was delivered to a sample of 529 men and women, aged 65 or over, who were assessed pre-intervention, postintervention, and at a one-month follow-up, with a short 10-item version of the UCLA Loneliness Scale. RESULTS For participants who completed all eight modules of the intervention, average levels of loneliness significantly decreased from pre- to posttreatment, b = -0.013, t (385) = -4.69, p < 0.001 (Cohen's d = 0.30). The improvement in loneliness was maintained at the one-month follow-up assessment. These improvements were particularly robust for individuals who were lonely at outset (Cohen's d = 0.73). The change in loneliness among these individuals was significantly greater than that observed in members of a "hold-out" group of lonely individuals that did not participate in the intervention (Cohen's d = 0.24). CONCLUSIONS This pilot investigation suggests the feasibility of this program for decreasing loneliness in older adults. Future controlled investigations with long-term follow-up assessments are needed to confirm the effectiveness and sustained benefits of the program.
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Affiliation(s)
- Amie Zarling
- Human Development and Family Studies, Iowa State University, Ames, Iowa, USA
| | - Joseph Kim
- Human Development and Family Studies, Iowa State University, Ames, Iowa, USA
| | - Dan Russell
- Human Development and Family Studies, Iowa State University, Ames, Iowa, USA
| | - Carolyn Cutrona
- Human Development and Family Studies, Iowa State University, Ames, Iowa, USA
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Hungerford C, Hills S, Richards C, Robinson T, Hills D. Facilitating Mindfulness-Based Interventions for Anxiety in Older People: History, Effectiveness, and Future Possibilities. Issues Ment Health Nurs 2022; 43:1014-1021. [PMID: 36053887 DOI: 10.1080/01612840.2022.2116510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The origins of mindfulness go back some 25 centuries to Eastern teachings, including Buddhism and Hinduism. Mindfulness-based interventions gained credence in Western mental health settings in the late 1970s through the work of medical researcher Kabat-Zinn, whose interest in Eastern meditation led him to develop a program for stress reduction. Since then, mindfulness-based interventions have been utilized for various populations, including older people with anxiety. Group mindfulness-based interventions have demonstrated benefits for older people with anxiety living in residential aged care and the community. In primary care settings, innovative delivery models for group mindfulness-based interventions could be facilitated by nurses to support older people with anxiety to age in place with dignity. The benefits of mindfulness-based interventions suggest the value of integrating ancient Eastern techniques with modern Western strategies to achieve better health outcomes for older people with mental health concerns.
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Affiliation(s)
- Catherine Hungerford
- Faculty of Health, Federation University Australia, Ballarat, Victoria, Australia.,Central Queensland University, Sydney, New South Wales, Australia
| | - Sharon Hills
- Faculty of Health, Federation University Australia, Ballarat, Victoria, Australia
| | - Catelyn Richards
- Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Tracy Robinson
- Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia
| | - Danny Hills
- Faculty of Health, Federation University Australia, Ballarat, Victoria, Australia.,Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
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Lappalainen P, Pakkala I, Lappalainen R, Nikander R. Supported Web-Based Acceptance and Commitment Therapy for Older Family Caregivers (CareACT) Compared to Usual Care. Clin Gerontol 2022; 45:939-955. [PMID: 33856279 DOI: 10.1080/07317115.2021.1912239] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The objective of the present study was to investigate whether an acceptance and commitment therapy (ACT)-based web-intervention (Group 1, CareACT), or a standardized rehabilitation in a rehabilitation center (Group 2) was effective in enhancing the psychological well-being of family caregivers aged 60 and over compared to support provided by voluntary caregiver associations (Group 3). METHODS Altogether, 149 family caregivers participated in this quasi-experimental study. Primary outcome measure was depression. Secondary outcomes included anxiety, sense of coherence, quality of life, psychological flexibility, experiential avoidance, and thought suppression. The questionnaires were administered at baseline, and four, and 10 months post-measurement. We investigated differences in the changes between the groups using Mplus modeling techniques. RESULTS Regarding the main outcome of depression, the results suggest that the CareACT intervention was superior to standardized rehabilitation and to the support given by caregiver associations at four months, both showing a medium-sized difference between the groups. However, the change from four to 10 months post-intervention was not significantly different between these groups (d = 0.32-0.36). Thought suppression showed a significantly different change between the three groups from baseline to four months and to 10 months post-measurement (p = .038). CONCLUSIONS Web-based ACT may have beneficial effects on depressive symptoms and thought suppression in older caregivers. CLINICAL IMPLICATIONS Web-based ACT could be a feasible alternative to institutional rehabilitation and support provided by voluntary caregiver associations. Web-based ACT responds flexibly to the needs of caregivers and provides them an opportunity for learning new skills to promote well-being.
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Affiliation(s)
- Päivi Lappalainen
- The Gerocenter Foundation for Research and Development, Jyväskylä, Finland.,Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Inka Pakkala
- The Gerocenter Foundation for Research and Development, Jyväskylä, Finland
| | - Raimo Lappalainen
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Riku Nikander
- The Gerocenter Foundation for Research and Development, Jyväskylä, Finland.,Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.,Department of Research & Education, Central Hospital of Central Finland, Jyväskylä, Finland.,Faculty of Sport Sciences, University of Jyväskylä, Jyväskylä, Finland
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Orgeta V, Leung P, Del-Pino-Casado R, Qazi A, Orrell M, Spector AE, Methley AM. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev 2022; 4:CD009125. [PMID: 35466396 PMCID: PMC9035877 DOI: 10.1002/14651858.cd009125.pub3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Experiencing anxiety and depression is very common in people living with dementia and mild cognitive impairment (MCI). There is uncertainty about the best treatment approach. Drug treatments may be ineffective and associated with adverse effects. Guidelines recommend psychological treatments. In this updated systematic review, we investigated the effectiveness of different psychological treatment approaches. OBJECTIVES Primary objective To assess the clinical effectiveness of psychological interventions in reducing depression and anxiety in people with dementia or MCI. Secondary objectives To determine whether psychological interventions improve individuals' quality of life, cognition, activities of daily living (ADL), and reduce behavioural and psychological symptoms of dementia, and whether they improve caregiver quality of life or reduce caregiver burden. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE, Embase, four other databases, and three trials registers on 18 February 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared a psychological intervention for depression or anxiety with treatment as usual (TAU) or another control intervention in people with dementia or MCI. DATA COLLECTION AND ANALYSIS A minimum of two authors worked independently to select trials, extract data, and assess studies for risk of bias. We classified the included psychological interventions as cognitive behavioural therapies (cognitive behavioural therapy (CBT), behavioural activation (BA), problem-solving therapy (PST)); 'third-wave' therapies (such as mindfulness-based cognitive therapy (MBCT)); supportive and counselling therapies; and interpersonal therapies. We compared each class of intervention with control. We expressed treatment effects as standardised mean differences or risk ratios. Where possible, we pooled data using a fixed-effects model. We used GRADE methods to assess the certainty of the evidence behind each result. MAIN RESULTS We included 29 studies with 2599 participants. They were all published between 1997 and 2020. There were 15 trials of cognitive behavioural therapies (4 CBT, 8 BA, 3 PST), 11 trials of supportive and counselling therapies, three trials of MBCT, and one of interpersonal therapy. The comparison groups received either usual care, attention-control education, or enhanced usual care incorporating an active control condition that was not a specific psychological treatment. There were 24 trials of people with a diagnosis of dementia, and five trials of people with MCI. Most studies were conducted in community settings. We considered none of the studies to be at low risk of bias in all domains. Cognitive behavioural therapies (CBT, BA, PST) Cognitive behavioural therapies are probably slightly better than treatment as usual or active control conditions for reducing depressive symptoms (standardised mean difference (SMD) -0.23, 95% CI -0.37 to -0.10; 13 trials, 893 participants; moderate-certainty evidence). They may also increase rates of depression remission at the end of treatment (risk ratio (RR) 1.84, 95% CI 1.18 to 2.88; 2 studies, with one study contributing 2 independent comparisons, 146 participants; low-certainty evidence). We were very uncertain about the effect of cognitive behavioural therapies on anxiety at the end of treatment (SMD -0.03, 95% CI -0.36 to 0.30; 3 trials, 143 participants; very low-certainty evidence). Cognitive behavioural therapies probably improve patient quality of life (SMD 0.31, 95% CI 0.13 to 0.50; 7 trials, 459 participants; moderate-certainty evidence) and activities of daily living at end of treatment compared to treatment as usual or active control (SMD -0.25, 95% CI -0.40 to -0.09; 7 trials, 680 participants; moderate-certainty evidence). Supportive and counselling interventions Meta-analysis showed that supportive and counselling interventions may have little or no effect on depressive symptoms in people with dementia compared to usual care at end of treatment (SMD -0.05, 95% CI -0.18 to 0.07; 9 trials, 994 participants; low-certainty evidence). We were very uncertain about the effects of these treatments on anxiety, which was assessed only in one small pilot study. Other interventions There were very few data and very low-certainty evidence on MBCT and interpersonal therapy, so we were unable to draw any conclusions about the effectiveness of these interventions. AUTHORS' CONCLUSIONS CBT-based treatments added to usual care probably slightly reduce symptoms of depression for people with dementia and MCI and may increase rates of remission of depression. There may be important effect modifiers (degree of baseline depression, cognitive diagnosis, or content of the intervention). CBT-based treatments probably also have a small positive effect on quality of life and activities of daily living. Supportive and counselling interventions may not improve symptoms of depression in people with dementia. Effects of both types of treatment on anxiety symptoms are very uncertain. We are also uncertain about the effects of other types of psychological treatments, and about persistence of effects over time. To inform clinical guidelines, future studies should assess detailed components of these interventions and their implementation in different patient populations and in different settings.
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Affiliation(s)
- Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Phuong Leung
- Division of Psychiatry, University College London, London, UK
| | | | - Afifa Qazi
- Old Age Psychiatry, Kent and Medway NHS Partnership Trust, Maidstone, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Aimee E Spector
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Abigail M Methley
- Clinical Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK
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Goetz DB, Hirschhorn EW. An Evaluation of an ACT-Based "Aging Resiliently" Group. Clin Gerontol 2022; 45:430-436. [PMID: 34102959 DOI: 10.1080/07317115.2021.1932001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES There were two quality improvement aims in this project: (1) to evaluate the outcomes of a six-week closed geriatric focused Acceptance and Commitment Therapy (ACT)-based group called "Aging Resiliently" offered in a primary care setting, and (2) to obtain feedback from group members in order to make relevant modifications to future groups. METHODS Four cohorts of veterans ages 58 and older participated in the group (N = 17). Paired samples t-tests were computed to determine the significance of changes on pre- and post- self-report measures of depression, experiential avoidance, and life satisfaction. Veterans also provided feedback in the form of an open-ended feedback questionnaire. RESULTS There were statistically significant improvements in depressive symptoms and satisfaction with life, but not in experiential avoidance. Two major themes emerged from the feedback questionnaire about what group members found to be the most helpful: (1) self-reflection/values, and (2) the social process of the group. CONCLUSIONS At our institution, the Aging Resiliently group yielded meaningful outcomes for older veterans presenting with different problems related to aging. CLINICAL IMPLICATIONS This Aging Resiliently group proved to be a potential effective, feasible, and acceptable psychotherapy for older veterans in our established local primary care setting.
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Affiliation(s)
- Dana B Goetz
- American Lake Division, VA Puget Sound Health Care System, Tacoma, Washington, USA
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Arias-Casais N, Amuthavalli Thiyagarajan J, Rodrigues Perracini M, Park E, Van den Block L, Sumi Y, Sadana R, Banerjee A, Han ZA. What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world. BMJ Open 2022; 12:e054492. [PMID: 35105637 PMCID: PMC8808408 DOI: 10.1136/bmjopen-2021-054492] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/20/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing. DESIGN Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community. INCLUSION CRITERIA Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French. RESULTS 305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13). CONCLUSION The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Global Observatory for Palliative Care, University of Navarra, Pamplona, Spain
| | | | | | - Eunok Park
- College of Nursing, Jeju National University, Jeju, Republic of Korea
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yuka Sumi
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Ritu Sadana
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Zee-A Han
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Delhom I, Mateu-Mollá J, Lacomba-Trejo L. Is acceptance and commitment therapy helpful in reducing anxiety symptomatology in people aged 65 or over? A systematic review. Front Psychiatry 2022; 13:976363. [PMID: 36311522 PMCID: PMC9614026 DOI: 10.3389/fpsyt.2022.976363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/23/2022] [Indexed: 11/19/2022] Open
Abstract
Anxiety-related mental health problems constitute a health challenge, especially in the elderly population. At present, there are few psychological treatments to reduce anxiety adapted to this group. The aim of this study was to conduct a systematic review of the literature to determine the therapeutic effects of Acceptance and Commitment Therapy (ACT) on anxiety in older adults, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Two blinded reviewers participated in the search, selection and methodological quality assessment processes; reaching satisfactory levels of agreement between reviewers (κ > 0.70). The search was performed in PubMed, Proquest Central, Scopus and Web of Science; making use of standardized terms for the construction of the algorithm. In the general search 348 studies were found. After applying the eligibility criteria and excluding duplicates, seven articles were extracted for qualitative analysis. The total number of subjects was 633, with an average age of 68.89 years (68.94% women). The analysis of methodological rigor showed moderate indices on average. The publications focused primarily on samples with a diagnosis of generalized anxiety disorder, proposing a variety of assessment tests for related dependent variables, especially depressive symptoms and psychological flexibility. Critical analysis of the findings provides evidence for the efficacy of ACT in reducing anxious and depressive symptoms in older adults. This study proposes the use of this procedure as a non-pharmacological alternative for a group usually underrepresented in the scientific literature on this topic.
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Affiliation(s)
- Iraida Delhom
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
| | - Joaquín Mateu-Mollá
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
| | - Laura Lacomba-Trejo
- Departament of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, Universitat de València, Valencia, Spain
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13
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Gould RL, Wetherell JL, Serfaty MA, Kimona K, Lawrence V, Jones R, Livingston G, Wilkinson P, Walters K, Novere ML, Howard RJ. Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: the FACTOID feasibility study. Health Technol Assess 2021; 25:1-150. [PMID: 34542399 DOI: 10.3310/hta25540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Generalised anxiety disorder, characterised by excessive anxiety and worry, is the most common anxiety disorder among older people. It is a condition that may persist for decades and is associated with numerous negative outcomes. Front-line treatments include pharmacological and psychological therapy, but many older people do not find these treatments effective. Guidance on managing treatment-resistant generalised anxiety disorder in older people is lacking. OBJECTIVES To assess whether or not a study to examine the clinical effectiveness and cost-effectiveness of acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder is feasible, we developed an intervention based on acceptance and commitment therapy for this population, assessed its acceptability and feasibility in an uncontrolled feasibility study and clarified key study design parameters. DESIGN Phase 1 involved qualitative interviews to develop and optimise an intervention as well as a survey of service users and clinicians to clarify usual care. Phase 2 involved an uncontrolled feasibility study and qualitative interviews to refine the intervention. SETTING Participants were recruited from general practices, Improving Access to Psychological Therapies services, Community Mental Health Teams and the community. PARTICIPANTS Participants were people aged ≥ 65 years with treatment-resistant generalised anxiety disorder. INTERVENTION Participants received up to 16 one-to-one sessions of acceptance and commitment therapy, adapted for older people with treatment-resistant generalised anxiety disorder, in addition to usual care. Sessions were delivered by therapists based in primary and secondary care services, either in the clinic or at participants' homes. Sessions were weekly for the first 14 sessions and fortnightly thereafter. MAIN OUTCOME MEASURES The co-primary outcome measures for phase 2 were acceptability (session attendance and satisfaction with therapy) and feasibility (recruitment and retention). Secondary outcome measures included additional measures of acceptability and feasibility and self-reported measures of anxiety, worry, depression and psychological flexibility. Self-reported outcomes were assessed at 0 weeks (baseline) and 20 weeks (follow-up). Health economic outcomes included intervention and resource use costs and health-related quality of life. RESULTS Fifteen older people with treatment-resistant generalised anxiety disorder participated in phase 1 and 37 participated in phase 2. A high level of feasibility was demonstrated by a recruitment rate of 93% and a retention rate of 81%. A high level of acceptability was found with respect to session attendance (70% of participants attended ≥ 10 sessions) and satisfaction with therapy was adequate (60% of participants scored ≥ 21 out of 30 points on the Satisfaction with Therapy subscale of the Satisfaction with Therapy and Therapist Scale-Revised, although 80% of participants had not finished receiving therapy at the time of rating). Secondary outcome measures and qualitative data further supported the feasibility and acceptability of the intervention. Health economic data supported the feasibility of examining cost-effectiveness in a future randomised controlled trial. Although the study was not powered to examine clinical effectiveness, there was indicative evidence of improvements in scores for anxiety, depression and psychological flexibility. LIMITATIONS Non-specific therapeutic factors were not controlled for, and recruitment in phase 2 was limited to London. CONCLUSIONS There was evidence of high levels of feasibility and acceptability and indicative evidence of improvements in symptoms of anxiety, depression and psychological flexibility. The results of this study suggest that a larger-scale randomised controlled trial would be feasible to conduct and is warranted. TRIAL REGISTRATION Current Controlled Trials ISRCTN12268776. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 54. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rebecca L Gould
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Julie Loebach Wetherell
- Department of Psychiatry, VA San Diego Healthcare System, University of California San Diego, La Jolla, CA, USA
| | - Marc A Serfaty
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Kate Kimona
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Vanessa Lawrence
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Jones
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | | | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Marie Le Novere
- Department of Primary Care and Population Health, University College London, London, UK
| | - Robert J Howard
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
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14
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Gould RL, Wetherell JL, Kimona K, Serfaty MA, Jones R, Graham CD, Lawrence V, Livingston G, Wilkinson P, Walters K, Le Novere M, Leroi I, Barber R, Lee E, Cook J, Wuthrich VM, Howard RJ. Acceptance and commitment therapy for late-life treatment-resistant generalised anxiety disorder: a feasibility study. Age Ageing 2021; 50:1751-1761. [PMID: 33852722 PMCID: PMC8437065 DOI: 10.1093/ageing/afab059] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 11/18/2022] Open
Abstract
Background Generalised anxiety disorder (GAD) is the most common anxiety disorder in older people. First-line management includes pharmacological and psychological therapies, but many do not find these effective or acceptable. Little is known about how to manage treatment-resistant generalised anxiety disorder (TR-GAD) in older people. Objectives To examine the acceptability, feasibility and preliminary estimates of the effectiveness of acceptance and commitment therapy (ACT) for older people with TR-GAD. Participants People aged ≥65 years with TR-GAD (defined as not responding to GAD treatment, tolerate it or refused treatment) recruited from primary and secondary care services and the community. Intervention Participants received up to 16 one-to-one sessions of ACT, developed specifically for older people with TR-GAD, in addition to usual care. Measurements Co-primary outcomes were feasibility (defined as recruitment of ≥32 participants and retention of ≥60% at follow-up) and acceptability (defined as participants attending ≥10 sessions and scoring ≥21/30 on the satisfaction with therapy subscale). Secondary outcomes included measures of anxiety, worry, depression and psychological flexibility (assessed at 0 and 20 weeks). Results Thirty-seven participants were recruited, 30 (81%) were retained and 26 (70%) attended ≥10 sessions. A total of 18/30 (60%) participants scored ≥21/30 on the satisfaction with therapy subscale. There was preliminary evidence suggesting that ACT may improve anxiety, depression and psychological flexibility. Conclusions There was evidence of good feasibility and acceptability, although satisfaction with therapy scores suggested that further refinement of the intervention may be necessary. Results indicate that a larger-scale randomised controlled trial of ACT for TR-GAD is feasible and warranted.
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Affiliation(s)
- Rebecca L Gould
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Julie Loebach Wetherell
- Mental Health Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Kate Kimona
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Marc A Serfaty
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
- Priory Hospital North London, London, UK
| | - Rebecca Jones
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | | | - Vanessa Lawrence
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | | | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Marie Le Novere
- Department of Primary Care and Population Health, University College London, London, UK
| | - Iracema Leroi
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Robert Barber
- Centre for Health of the Elderly, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Ellen Lee
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jo Cook
- The Bexleyheath Centre, Oxleas NHS Foundation Trust, Bexleyheath, UK
| | - Viviana M Wuthrich
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
- Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Robert J Howard
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
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15
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Witlox M, Garnefski N, Kraaij V, de Waal MWM, Smit F, Bohlmeijer E, Spinhoven P. Blended Acceptance and Commitment Therapy Versus Face-to-face Cognitive Behavioral Therapy for Older Adults With Anxiety Symptoms in Primary Care: Pragmatic Single-blind Cluster Randomized Trial. J Med Internet Res 2021; 23:e24366. [PMID: 33769293 PMCID: PMC8088844 DOI: 10.2196/24366] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/23/2020] [Accepted: 01/20/2021] [Indexed: 01/16/2023] Open
Abstract
Background Anxiety symptoms in older adults are prevalent and disabling but often go untreated. Most trials on psychological interventions for anxiety in later life have examined the effectiveness of face-to-face cognitive behavioral therapy (CBT). To bridge the current treatment gap, other treatment approaches and delivery formats should also be evaluated. Objective This study is the first to examine the effectiveness of a brief blended acceptance and commitment therapy (ACT) intervention for older adults with anxiety symptoms, compared with a face-to-face CBT intervention. Methods Adults aged between 55-75 years (n=314) with mild to moderately severe anxiety symptoms were recruited from general practices and cluster randomized to either blended ACT or face-to-face CBT. Assessments were performed at baseline (T0), posttreatment (T1), and at 6- and 12-month follow-ups (T2 and T3, respectively). The primary outcome was anxiety symptom severity (Generalized Anxiety Disorder-7). Secondary outcomes were positive mental health, depression symptom severity, functional impairment, presence of Diagnostic and Statistical Manual of Mental Disorders V anxiety disorders, and treatment satisfaction. Results Conditions did not differ significantly regarding changes in anxiety symptom severity during the study period (T0-T1: B=.18, P=.73; T1-T2: B=−.63, P=.26; T1-T3: B=−.33, P=.59). Large reductions in anxiety symptom severity (Cohen d≥0.96) were found in both conditions post treatment, and these were maintained at the 12-month follow-up. The rates of clinically significant changes in anxiety symptoms were also not different for the blended ACT group and CBT group (χ21=0.2, P=.68). Regarding secondary outcomes, long-term effects on positive mental health were significantly stronger in the blended ACT group (B=.27, P=.03, Cohen d=0.29), and treatment satisfaction was significantly higher for blended ACT than CBT (B=3.19, P<.001, Cohen d=0.78). No other differences between the conditions were observed in the secondary outcomes. Conclusions The results show that blended ACT is a valuable treatment alternative to CBT for anxiety in later life. Trial Registration Netherlands Trial Register TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131
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Affiliation(s)
- Maartje Witlox
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Nadia Garnefski
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Vivian Kraaij
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Margot W M de Waal
- Department Public Health & Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Filip Smit
- Department of Mental Health & Prevention, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.,Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Philip Spinhoven
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
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16
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Apolinário-Hagen J, Drüge M, Hennemann S, Breil B. Acceptance and Commitment Therapy for Major Depressive Disorder: Insights into a New Generation of Face-to-Face Treatment and Digital Self-Help Approaches. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1305:311-332. [PMID: 33834407 DOI: 10.1007/978-981-33-6044-0_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Major depressive disorder (MDD) represents a key contributor to the global burden of mental illness given its relatively high lifetime prevalence, frequent comorbidity, and disability rates. Evidence-based treatment options for depression include pharmacotherapy and psychotherapy, such as cognitive behavioral therapy (CBT). Beyond traditional CBT, over 15 years ago, Hayes proclaimed a new generation of contextualistic and process-orientated so-called third wave of CBT interventions, including acceptance and commitment therapy (ACT). Using mindfulness and acceptance as well as commitment and behavior change processes, the transdiagnostic ACT approach aims to increase psychological flexibility as universal mechanism of behavior change and to build a value-driven orientation in life. ACT for MDD can be provided as either stand-alone individual, group, or self-help formats (e.g., apps) or combined with other approaches like behavioral activation. To date, a steadily growing empirical support from outcome and process research suggests the efficacy of ACT, which appears to work specifically through the six proposed core processes involved in psychological flexibility, such as defusion. In view of an ongoing interest of clinicians in "third-wave" CBTs and the important role of clients' preferences in providing therapy choices that work, the purpose of this chapter is to give a brief overview on the application of ACT in the treatment of MDD in adults.
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Affiliation(s)
- Jennifer Apolinário-Hagen
- Faculty of Medicine, Institute of Occupational, Social and Environmental Medicine, Centre of Health and Society (chs), Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- Centre of Health and Society (chs), University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Marie Drüge
- Institute of Psychology, Department of Clinical Psychology/Psychotherapy Research, University of Zurich, Zurich, Switzerland
| | - Severin Hennemann
- Institute of Psychology, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Bernhard Breil
- Faculty of Healthcare, Niederrhein University of Applied Sciences, Krefeld, Germany
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17
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Omissions of Care in Nursing Home Settings: A Narrative Review. J Am Med Dir Assoc 2020; 21:604-614.e6. [DOI: 10.1016/j.jamda.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
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18
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Davison TE, McCabe MP, Busija L, O'Connor DW, Costa VC, Byers J. A cluster randomised trial of the program to enhance adjustment to residential living (PEARL): a novel psychological intervention to reduce depression in newly admitted aged care residents. BMC Geriatr 2020; 20:98. [PMID: 32164587 PMCID: PMC7068981 DOI: 10.1186/s12877-020-1492-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background Depression rates are high in residential aged care (RAC) facilities, with newly admitted residents at particular risk. New approaches to address depression in this population are urgently required, particularly psychological interventions suitable for widespread use across the RAC sector. The Program to Enhance Adjustment to Residential Living (PEARL) is a brief intervention, designed to provide individually tailored care approaches to meet the psychological needs of newly admitted residents, delivered in collaboration with facility staff. Methods PEARL will be evaluated using a cluster randomised controlled design, comparing outcomes for residents who participate in the intervention with those residing in care as usual control facilities. Participants are RAC residents aged 60 years or above, with normal cognition or mild-moderate cognitive impairment, who relocated to the facility within the previous 4 weeks. The primary outcomes are depressive symptoms and disorders, with secondary outcomes including anxiety, stress, quality of life, adjustment to RAC, and functional dependence, analysed on an intention to treat basis using multilevel modelling. Discussion PEARL is an intervention based on self-determination theory, designed to reduce depression in newly admitted residents by tailoring day to day care to meet their psychological needs. This simple psychological approach offers an alternative care model to the current over-reliance of antidepressant medications. Trial registration ACTRN12616001726448; Registered 16 December 2016 with the Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- Tanya E Davison
- Health and Ageing Research Group, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, H95 PO Box 218, Hawthorn, VIC, 3122, Australia.
| | - Marita P McCabe
- Health and Ageing Research Group, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, H95 PO Box 218, Hawthorn, VIC, 3122, Australia
| | - Lucy Busija
- Biostatistics Consulting Platform, Research Methodology Division, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | - Vera Camões Costa
- Health and Ageing Research Group, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, H95 PO Box 218, Hawthorn, VIC, 3122, Australia
| | - Jessica Byers
- Health and Ageing Research Group, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, H95 PO Box 218, Hawthorn, VIC, 3122, Australia
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19
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Moore C, Hill JF, Feinstein C, Pike C, Delaney KR. Implementation of Acceptance Commitment Therapy on a Mood Disorder Unit: A Quality Improvement Project. J Psychosoc Nurs Ment Health Serv 2019; 57:22-27. [DOI: 10.3928/02793695-20190627-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/31/2019] [Indexed: 02/03/2023]
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Jacobs ML, Luci K, Hagemann L. Group-based Acceptance and Commitment Therapy (ACT) for Older Veterans: Findings from a Quality Improvement Project. Clin Gerontol 2018; 41:458-467. [PMID: 29236623 DOI: 10.1080/07317115.2017.1391917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purpose of this project was to develop, implement, and evaluate a 12-session Acceptance and Commitment Therapy (ACT) for Older Veterans group protocol. METHODS The Plan-Do-Study-Act (PDSA) quality improvement model was the foundational process for this project. Veterans age 55 years and older participated in an ACT for Older Veterans group in an outpatient geropsychology clinic at a Veterans Affairs Medical Center. Study methods included analysis of participant feedback gathered in a focus group, process measures (i.e., number of sessions attended and number of early terminations), and outcome measures (i.e., depressive symptoms, anxiety symptoms, and psychological flexibility). RESULTS Seventeen participants completed an average of ten sessions. Less than 25% of participants terminated early. Depressive symptoms improved, though there were no statistically significant changes in anxiety symptoms and psychological flexibility. The focus group yielded several recommendations that were implemented in subsequent groups. CONCLUSIONS The PDSA model helped in the development of a group therapy intervention that is both relevant and beneficial to older Veterans presenting with a variety of biopsychosocial issues. Results provide support for further research investigation of ACT for Older Veterans Group. CLINICAL IMPLICATIONS ACT used in a group format is a feasible and acceptable psychotherapy for older Veterans.
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21
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Renn BN, Areán PA. Psychosocial Treatment Options for Major Depressive Disorder in Older Adults. ACTA ACUST UNITED AC 2017; 4:1-12. [PMID: 28932652 DOI: 10.1007/s40501-017-0100-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Late-life depression (LLD) is a public health concern with deleterious effects on overall health, cognition, quality of life, and mortality. Although LLD is relatively common, it is not a normal part of aging and is often under-recognized in older adults. However, psychotherapy is an effective treatment for LLD that aligns with many patients' preferences and can improve health and functioning. This review synthesized the current literature on evidence-based psychotherapies for the treatment of depression in older adults. Findings suggest that active, skills-based psychotherapies (cognitive behavioral therapy [CBT] and problem-solving therapy [PST]) may be more effective for LLD than non-directive, supportive counseling. PST may be particularly relevant for offsetting skill deficit associated with LLD, such as in instances of cognitive impairment (especially executive dysfunction) and disability. Emerging treatments also consider contextual factors to improve treatment delivery, such as personalized care, access, and poverty. Tele-mental health represents one such exciting new way of improving access and uptake of treatment by older adults. Although these strategies hold promise, further investigation via randomized controlled trials and comparative effectiveness are necessary to advance our treatment of LLD. Priority should be given to recruiting and training the geriatric mental health workforce to deliver evidence-based psychosocial interventions for LLD.
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Affiliation(s)
- Brenna N Renn
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
| | - Patricia A Areán
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
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22
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Xu X, Liu X, Ou M, Xie C, Chen Y. Psychological Flexibility of Nurses in a Cancer Hospital: Preliminary Validation of a Chinese Version of the Work-related Acceptance and Action Questionnaire. Asia Pac J Oncol Nurs 2017; 5:83-90. [PMID: 29379839 PMCID: PMC5763445 DOI: 10.4103/apjon.apjon_62_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective To translate the English work-related acceptance and action questionnaire (WAAQ), make cross-cultural adaptations, and examine its psychometric properties when used by Chinese oncology nurses. Methods After translation, the psychometric properties of the Chinese WAAQ were analyzed among 417 nurses, and content validity was determined by six experts. Results Item-level content validity index (CVI) values were between 0.83 and 1.00; scale-level CVI/universal agreement (S-CVI/UA) and S-CVI/average were 0.86 and 0.98, respectively, which implicated a good content validity. The correlation of the Chinese WAAQ with AAQ-II (rs = -0.247, P < 0.001) suggested criterion validity, and those with General Health Questionnaire-12 (-0.250, <0.001) and general self-efficacy scale (0.491, <0.001) and Utrecht work engagement scale (UWES) (0.439, <0.001) suggested convergent validity. Exploratory factor analysis identified a seven-item, one-factor structure of WAAQ. The Chinese version of WAAQ had high internal consistency (Cronbach's α = 0.920), with an item-total correlation coefficient of 0.702-0.828 (P < 0.05), split-half reliability of 0.933, and test-retest reliability of 0.772. Conclusions The Chinese WAAQ is a reliable and valid tool for assessing psychological flexibility in Chinese oncology nurses.
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Affiliation(s)
- Xianghua Xu
- Department of Nursing, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Xiangyu Liu
- Department of Nursing, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Meijun Ou
- Department of Nursing, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Chanjuan Xie
- Department of Nursing, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Yongyi Chen
- Department of Nursing, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
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