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

Abstract

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.

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

“…We used systematic, qualitative methods to develop and optimise the relevance, acceptability and feasibility of a manualised intervention for older people with TR-GAD [ 6 ]. The intervention comprised up to 16 one-to-one, face-to-face sessions of ACT, with each session lasting up to 1 hour.…”

“…However, many older people with GAD find these treatments ineffective, lacking acceptability (e.g. due to side effects) or unable to produce a sustained benefit [ 6 ], leaving clinicians uncertain as to how best to manage this condition. At present, there is a lack of evidence to guide the management of GAD that has not responded adequately to first-line pharmacological and psychological interventions (i.e.…”

“…their values); and (iii) identify ways to best live their lives in accordance with their values, alongside their uncomfortable experiences. With its focus on increasing adaptive functioning and how best to live with uncomfortable thoughts, emotions and sensations (as opposed to challenging, changing or trying to eliminate them), ACT may be particularly appropriate for older people with TR-GAD who have not derived benefit from interventions focused directly on controlling such experiences [ 6 ]. Evidence that control-orientated strategies (e.g.…”

Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: the FACTOID feasibility study

“…Consequently, the first phase of the current study used qualitative methods to optimise the relevance, acceptability and feasibility of ACT for older people with TR-GAD, in accordance with MRC guidelines. 61 This has been reported in Lawrence et al 62 The objectives were to use:…”

New horizons and new opportunities for qualitative research to understand and improve mental health in later life

“…Parallel to this, we consider qualitative research vital in grounding the development of remote methods of assessment and support, which have arisen in response to the disruption of normal service provision, in the lives of the people who will use them 3 . Person‐centred approaches that use iterative qualitative designs can play an important role in optimising the feasibility and acceptability of new psychosocial interventions and services for older adults 5,6 . Applied qualitative research also affords valuable insight into the messiness of daily practice, helping to unravel the successes and failures of complex interventions in pragmatic trials and explicating the contextual factors that are necessary to implement and sustain changes in routine healthcare settings 7‐9 .…”