Acceptance and commitment therapy for late-life treatment-resistant generalised anxiety disorder: a feasibility study

Rebecca L. Gould; Julie Loebach Wetherell; Kate Kimona; Marc A. Serfaty; Rebecca Jones; Christopher D. Graham; Vanessa Lawrence; Gill Livingston; Philip Wilkinson; Kate Walters; Marie Le Novere; Iracema Leroi; Robert Barber; Ellen Lee; Jo Cook; Viviana M. Wuthrich; Robert J. Howard; FACTOID group

doi:10.1093/ageing/afab059

Acceptance and commitment therapy for late-life treatment-resistant generalised anxiety disorder: a feasibility study

Rebecca L. Gould^*, Julie Loebach Wetherell, Kate Kimona, Marc A. Serfaty, Rebecca Jones, Christopher D. Graham, Vanessa Lawrence, Gill Livingston, Philip Wilkinson, Kate Walters, Marie Le Novere, Iracema Leroi, Robert Barber, Ellen Lee, Jo Cook, Viviana M. Wuthrich, Robert J. Howard, FACTOID group

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

24 Citations (Scopus)

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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.

Original language	English
Pages (from-to)	1751-1761
Number of pages	11
Journal	Age and Ageing
Volume	50
Issue number	5
DOIs	https://doi.org/10.1093/ageing/afab059
Publication status	Published - 11 Sept 2021

Bibliographical note

Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

acceptance and commitment therapy
feasibility
generalised anxiety disorder
older people
treatment-resistant

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10.1093/ageing/afab059Licence: CC BY-NC

Publisher version (open access)Final published version, 484 KBLicence: CC BY-NC

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Gould, R. L., Wetherell, J. L., Kimona, K., Serfaty, M. A., Jones, R., Graham, C. D., Lawrence, V., Livingston, G., Wilkinson, P., Walters, K., Le Novere, M., Leroi, I., Barber, R., Lee, E., Cook, J., Wuthrich, V. M., Howard, R. J., & FACTOID group (2021). Acceptance and commitment therapy for late-life treatment-resistant generalised anxiety disorder: a feasibility study. Age and Ageing, 50(5), 1751-1761. https://doi.org/10.1093/ageing/afab059

@article{51cbc3066426441c9cd12fe9fc45463f,

title = "Acceptance and commitment therapy for late-life treatment-resistant generalised anxiety disorder: a feasibility study",

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.",

keywords = "acceptance and commitment therapy, feasibility, generalised anxiety disorder, older people, treatment-resistant",

author = "Gould, {Rebecca L.} and Wetherell, {Julie Loebach} and Kate Kimona and Serfaty, {Marc A.} and Rebecca Jones and Graham, {Christopher D.} and Vanessa Lawrence and Gill Livingston and Philip Wilkinson and Kate Walters and {Le Novere}, Marie and Iracema Leroi and Robert Barber and Ellen Lee and Jo Cook and Wuthrich, {Viviana M.} and Howard, {Robert J.} and {FACTOID group} and Steve Boddington and Julia Brownlie and Rachel Butterfield and Lisa Carmody and Georgina Charlesworth and Charlotte Gardner and Danielle Gaynor and Rachel Holliss and Debbie Hunt and Joana Johnson and Maitri Khurana and Eva Klamerus and Gemma Knight and Victoria Lawson and Ruth Lukeman and Monique Maroney and Eleanor Martin and Aska Matsunaga and Alison Milton and Harry O{\textquoteright}Hayon and Meenaxi Patel and Dhriti Ratra and Simpson Catherine and Nicola Stanhope and Debbie Walker and Janet Wingrove and Grace Wong",

note = "Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2021",

month = sep,

day = "11",

doi = "10.1093/ageing/afab059",

language = "English",

volume = "50",

pages = "1751--1761",

journal = "Age and Ageing",

issn = "0002-0729",

publisher = "OXFORD UNIV PRESS INC",

number = "5",

}

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 & FACTOID group 2021, 'Acceptance and commitment therapy for late-life treatment-resistant generalised anxiety disorder: a feasibility study', Age and Ageing, vol. 50, no. 5, pp. 1751-1761. https://doi.org/10.1093/ageing/afab059

TY - JOUR

T1 - Acceptance and commitment therapy for late-life treatment-resistant generalised anxiety disorder

T2 - a feasibility study

AU - Gould, Rebecca L.

AU - Wetherell, Julie Loebach

AU - Kimona, Kate

AU - Serfaty, Marc A.

AU - Jones, Rebecca

AU - Graham, Christopher D.

AU - Lawrence, Vanessa

AU - Livingston, Gill

AU - Wilkinson, Philip

AU - Walters, Kate

AU - Le Novere, Marie

AU - Leroi, Iracema

AU - Barber, Robert

AU - Lee, Ellen

AU - Cook, Jo

AU - Wuthrich, Viviana M.

AU - Howard, Robert J.

AU - FACTOID group

AU - Boddington, Steve

AU - Brownlie, Julia

AU - Butterfield, Rachel

AU - Carmody, Lisa

AU - Charlesworth, Georgina

AU - Gardner, Charlotte

AU - Gaynor, Danielle

AU - Holliss, Rachel

AU - Hunt, Debbie

AU - Johnson, Joana

AU - Khurana, Maitri

AU - Klamerus, Eva

AU - Knight, Gemma

AU - Lawson, Victoria

AU - Lukeman, Ruth

AU - Maroney, Monique

AU - Martin, Eleanor

AU - Matsunaga, Aska

AU - Milton, Alison

AU - O’Hayon, Harry

AU - Patel, Meenaxi

AU - Ratra, Dhriti

AU - Catherine, Simpson

AU - Stanhope, Nicola

AU - Walker, Debbie

AU - Wingrove, Janet

AU - Wong, Grace

N1 - Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2021/9/11

Y1 - 2021/9/11

N2 - 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.

AB - 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.

KW - acceptance and commitment therapy

KW - feasibility

KW - generalised anxiety disorder

KW - older people

KW - treatment-resistant

UR - http://www.scopus.com/inward/record.url?scp=85116459490&partnerID=8YFLogxK

U2 - 10.1093/ageing/afab059

DO - 10.1093/ageing/afab059

M3 - Article

C2 - 33852722

AN - SCOPUS:85116459490

SN - 0002-0729

VL - 50

SP - 1751

EP - 1761

JO - Age and Ageing

JF - Age and Ageing

IS - 5

ER -

Acceptance and commitment therapy for late-life treatment-resistant generalised anxiety disorder: a feasibility study

Abstract

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Keywords

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