Acceptance and commitment therapy for late-life treatment-resistant generalised anxiety disorder: a feasibility study.
acceptance and commitment therapy
feasibility
generalised anxiety disorder
older people
treatment-resistant
Journal
Age and ageing
ISSN: 1468-2834
Titre abrégé: Age Ageing
Pays: England
ID NLM: 0375655
Informations de publication
Date de publication:
11 09 2021
11 09 2021
Historique:
received:
08
11
2020
revised:
31
01
2021
accepted:
04
02
2021
pubmed:
15
4
2021
medline:
24
9
2021
entrez:
14
4
2021
Statut:
ppublish
Résumé
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. To examine the acceptability, feasibility and preliminary estimates of the effectiveness of acceptance and commitment therapy (ACT) for older people with TR-GAD. 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. Participants received up to 16 one-to-one sessions of ACT, developed specifically for older people with TR-GAD, in addition to usual care. 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). 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 33852722
pii: 6225090
doi: 10.1093/ageing/afab059
pmc: PMC8437065
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1751-1761Subventions
Organisme : Department of Health
ID : 15/161/05
Pays : United Kingdom
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society.
Références
Depress Anxiety. 2010 Feb;27(2):190-211
pubmed: 20099273
Am J Geriatr Psychiatry. 2008 Mar;16(3):201-8
pubmed: 18310551
Behav Res Ther. 1990;28(6):487-95
pubmed: 2076086
BMC Psychiatry. 2019 Nov 6;19(1):345
pubmed: 31694603
Psychiatry Res. 1992 Mar;41(3):237-48
pubmed: 1594710
Am J Psychiatry. 1991 Jan;148(1):102-5
pubmed: 1984692
Pain Med. 2012 Jul;13(7):860-7
pubmed: 22680627
Pain Med. 2016 Feb;17(2):264-77
pubmed: 26304771
Arch Gen Psychiatry. 2005 Nov;62(11):1249-57
pubmed: 16275812
Int Psychogeriatr. 2007 Feb;19(1):103-14
pubmed: 16805925
Trials. 2014 Jul 03;15:264
pubmed: 24993581
Behav Ther. 2011 Mar;42(1):127-34
pubmed: 21292059
Arch Intern Med. 2006 May 22;166(10):1092-7
pubmed: 16717171
Behav Ther. 2011 Dec;42(4):676-88
pubmed: 22035996
J Clin Psychiatry. 1998;59 Suppl 20:22-33;quiz 34-57
pubmed: 9881538
Am J Geriatr Psychiatry. 2009 Jun;17(6):455-64
pubmed: 19472431
Am J Geriatr Psychiatry. 2005 Jan;13(1):77-80
pubmed: 15653943
Aging Ment Health. 2017 Jul;21(7):766-773
pubmed: 26942691
J Behav Ther Exp Psychiatry. 2000 Jun;31(2):73-86
pubmed: 11132119
Psychiatr Clin North Am. 2001 Mar;24(1):41-55
pubmed: 11225508
Am J Geriatr Psychiatry. 2005 Jan;13(1):23-30
pubmed: 15653937
Health Technol Assess. 2014 Aug;18(50):1-59, v-vi
pubmed: 25110830
Aging Ment Health. 2013;17(5):555-63
pubmed: 23607328
Am J Geriatr Psychiatry. 2009 Jun;17(6):473-82
pubmed: 19472438
Psychother Psychosom. 2015;84(1):30-6
pubmed: 25547522
J Anxiety Disord. 2017 Aug;50:47-51
pubmed: 28554154
J Psychiatr Res. 1982-1983;17(1):37-49
pubmed: 7183759
Age Ageing. 2019 Sep 1;48(5):741-750
pubmed: 31297539
Int J Aging Hum Dev. 2002;54(3):233-53
pubmed: 12148688
Mol Psychiatry. 2006 Sep;11(9):805-14
pubmed: 16847460
Psychol Med. 2007 Mar;37(3):431-40
pubmed: 17109776
Clin Psychol Rev. 2017 Mar;52:124-136
pubmed: 28119196
Pain. 2011 Sep;152(9):2098-2107
pubmed: 21683527
Eval Program Plann. 2013 Apr;37:58-63
pubmed: 23434724