Optimising the acceptability and feasibility of acceptance and commitment therapy for treatment-resistant generalised anxiety disorder in older adults

Vanessa Lawrence*, Kate Kimona, Robert J. Howard, Marc A. Serfaty, Julie Loebach Wetherell, Gill Livingston, Philip Wilkinson, Kate Walters, Rebecca Jones, Viviana M. Wuthrich, Rebecca L. Gould

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
7 Downloads (Pure)


Background: generalised anxiety disorder (GAD) is common in later life with a prevalence of 3–12%. Many only partially respond to cognitive behavioural therapy or pharmacotherapy and can be classified as treatment resistant. These patients experience poor quality of life, and are at increased risk of comorbid depression, falls and loneliness. Acceptance and commitment therapy (ACT) is an emerging therapy, which may be particularly suited to this population, but has not been tailored to their needs.Objectives: to optimise the acceptability and feasibility of ACT for older adults with treatment-resistant GAD.Design: a person-based approach to ground the adapted ACT intervention in the perspectives and lives of those who will use it.Methods: first, we conducted qualitative interviews with 15 older adults with GAD and 36 healthcare professionals to develop guiding principles to inform the intervention. Second, we consulted service users and clinical experts and interviewed the same 15 older adults using ‘think aloud’ techniques to enhance its acceptability and feasibility.Results: in Stage 1, older adults’ concerns and needs were categorised in four themes: ‘Expert in one’s own condition’, ‘Deep seated coping strategies’, ‘Expert in therapy’ and ‘Support with implementation’. In Stage 2, implications for therapy were identified that included an early focus on values and ACT as a collaborative partnership, examining beliefs around ‘self as worrier’ and the role of avoidance, validating and accommodating individuals’ knowledge and experience and compensating for age-related cognitive changes.Discussion: Our systematic approach combined rigour and transparency to develop a therapeutic intervention tailored to the specific needs of older adults with treatment-resistant GAD.
Original languageEnglish
Pages (from-to)735-744
Number of pages10
JournalAge and Ageing
Issue number5
Publication statusPublished - Sep 2019

Bibliographical note

Copyright the Author(s) 2019. 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.


  • anxiety
  • qualitative
  • co-morbidity
  • acceptance and commitment therapy
  • intervention development
  • older people


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