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

2021 ◽  
Vol 25 (54) ◽  
pp. 1-150
Author(s):  
Rebecca L Gould ◽  
Julie Loebach Wetherell ◽  
Marc A Serfaty ◽  
Kate Kimona ◽  
Vanessa Lawrence ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Older People ◽  
Outcome Measures ◽  
Acceptance And Commitment Therapy ◽  
Feasibility Study ◽  
Phase 2 ◽  
Generalised Anxiety Disorder ◽  
Treatment Resistant ◽  
Commitment Therapy ◽  
Acceptance And Commitment

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.

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

2019 ◽  
Vol 48 (5) ◽  
pp. 741-750
Author(s):  
Vanessa Lawrence ◽  
Kate Kimona ◽  
Robert J Howard ◽  
Marc A Serfaty ◽  
Julie Loebach Wetherell ◽  
...  
Keyword(s):  
Older Adults ◽  
Anxiety Disorder ◽  
Acceptance And Commitment Therapy ◽  
Generalised Anxiety Disorder ◽  
Treatment Resistant ◽  
Cognitive Changes ◽  
Commitment Therapy ◽  
Age Related ◽  
Acceptance And Commitment ◽  
Increased Risk

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.

scholarly journals Development and feasibility of a digital Acceptance and Commitment Therapy-based Intervention for Generalised Anxiety Disorder: Pilot study (Preprint)

2020 ◽  
Author(s):  
Nicola R Hemmings ◽  
Jamie M Kawadler ◽  
Rachel Whatmough ◽  
Sonia Ponzo ◽  
Alessio Rossi ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Acceptance And Commitment Therapy ◽  
Feasibility Study ◽  
Psychological Flexibility ◽  
Post Treatment ◽  
Self Report ◽  
Generalised Anxiety Disorder ◽  
Commitment Therapy ◽  
Digital Intervention ◽  
Acceptance And Commitment

BACKGROUND Generalised anxiety disorder (GAD) is characterised by excessive worry that is difficult to control and has high comorbidity with mood disorders including depression. Individuals experience long wait times for diagnosis and often face accessibility barriers to treatment. There is a need for a digital solution that is accessible and acceptable to those with GAD. OBJECTIVE This paper aims to describe the development of a digital intervention prototype of acceptance and commitment therapy (ACT) for GAD that sits within an existing wellbeing app platform, BioBase. A pilot feasibility study evaluating acceptability, usability and efficacy study is conducted in a sample of adults with a diagnosis of GAD, self-referred to the study. METHODS Phase 1 applied the person-based approach (creation of guiding principles, intervention design objectives and the key intervention features). In Phase 2 participants received the app-based therapeutic and paired wearable for two weeks. Self-report questionnaires were obtained at baseline and post-treatment. The primary outcome was psychological flexibility (AAQ-II) as this is the aim of ACT. Mental wellbeing (WEMWBS) and symptoms of anxiety (GAD-7) and depression (PHQ-9) were also assessed. Post-treatment usability was assessed via self-report measures (SUS) in addition to interviews that further explored feasibility of the digital intervention in this sample. RESULTS The app-based therapeutic was well received. Of 13 participants, 10 (77%) completed the treatment. Results show a high usability rating (83.5). Participants found the digital intervention to be relevant, useful and helpful in managing their anxiety. Participants had lower anxiety (d=0.69) and depression (d=0.84) scores at exit, and these differences were significantly different from baseline. Participants had higher psychological flexibility and wellbeing scores at exit, although these were not significantly different from baseline. CONCLUSIONS This ACT prototype within BioBase is an acceptable and feasible digital intervention, with evidence of preliminary efficacy in reducing symptoms of anxiety and depression. This study suggests this intervention warrants a larger feasibility study in adults with GAD.

scholarly journals A Randomised Controlled Trial of Acceptance and Commitment Therapy and Cognitive-Behaviour Therapy for Generalised Anxiety Disorder

2014 ◽  
Vol 31 (2) ◽  
pp. 110-130 ◽  
Author(s):  
Elbina Avdagic ◽  
Shirley A. Morrissey ◽  
Mark J. Boschen
Keyword(s):  
Anxiety Disorder ◽  
Acceptance And Commitment Therapy ◽  
Treatment Completion ◽  
Generalised Anxiety Disorder ◽  
Reliable Change ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Treatment Gains ◽  
Post Assessment

The study examined the relative efficacy of group acceptance and commitment therapy (ACT) for generalised anxiety disorder (GAD) compared to group cognitive-behavioural therapy (CBT). Fifty-one individuals with GAD were randomly allocated to a 6-week intervention, either ACT or CBT. Participants were assessed at pre-treatment, post-treatment, and 3-month follow-up on symptom measures, quality of life, and process measures. Data from 38 participants (19 in each group) were available at post-assessment, indicating significant improvements on all measures for both treatment conditions. Treatment gains were maintained at follow-up, with significant further improvements in anxiety, depression and stress symptoms for both groups. While no between-group differences were found at treatment completion, a significant interaction indicating steeper reduction in worrying symptoms (d = .79) from pre- to post-assessment was found for the ACT group compared to the CBT group. Furthermore, in relation to worrying, at treatment completion 78.9% of participants in the ACT group achieved reliable change compared to 47.4% of participants in the CBT group. However, both groups showed equivalent reliable change rates of 60% at the follow-up assessment. The results suggest that group ACT was as efficacious as group CBT. While participants in the ACT group maintained treatment gains at follow-up, participants in the CBT group continued to improve between post-assessment and follow-up.

scholarly journals Development and feasibility of a digital Acceptance and Commitment Therapy-based Intervention for Generalised Anxiety Disorder: Pilot study (Preprint)

10.2196/21737 ◽  
2020 ◽  
Author(s):  
Nicola R Hemmings ◽  
Jamie M Kawadler ◽  
Rachel Whatmough ◽  
Sonia Ponzo ◽  
Alessio Rossi ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Pilot Study ◽  
Acceptance And Commitment Therapy ◽  
Generalised Anxiety Disorder ◽  
Commitment Therapy ◽  
Acceptance And Commitment

scholarly journals Cognitive Mediators of Treatment for Social Anxiety Disorder: Comparing Acceptance and Commitment Therapy and Cognitive-Behavioral Therapy

2014 ◽  
Vol 45 (5) ◽  
pp. 664-677 ◽  
Author(s):  
Andrea N. Niles ◽  
Lisa J. Burklund ◽  
Joanna J. Arch ◽  
Matthew D. Lieberman ◽  
Darby Saxbe ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Cognitive Behavioral Therapy ◽  
Acceptance And Commitment Therapy ◽  
Social Anxiety Disorder ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Cognitive Mediators

scholarly journals Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review (Preprint)

2018 ◽  
Author(s):  
Joshua Kelson ◽  
Audrey Rollin ◽  
Brad Ridout ◽  
Andrew Campbell
Keyword(s):  
Systematic Review ◽  
Anxiety Disorder ◽  
Acceptance And Commitment Therapy ◽  
Treatment Satisfaction ◽  
Behavioral Therapy ◽  
Anxiety Symptoms ◽  
General Anxiety ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
The Impact

BACKGROUND Anxiety conditions are debilitating and prevalent throughout the world. Acceptance and Commitment Therapy (ACT) is an effective, acceptance-based behavioral therapy for anxiety. However, there are treatment barriers (eg, financial, geographical, and attitudinal), which prevent people from accessing it. To overcome these barriers, internet-delivered ACT (iACT) interventions have been developed in recent years. These interventions use websites to deliver ACT information and skill training exercises on the Web, either as pure self-help or with therapist guidance. OBJECTIVE This systematic review aimed to examine the therapeutic impact of iACT on all anxiety conditions. METHODS The EMBASE, MEDLINE, ProQuest Central, PsycINFO, Scopus, and Web of Science databases were searched up to September 2018. The titles and abstracts of remaining records after deduplication were screened by 2 authors with a total of 36 full-text articles being retained for closer inspection next to eligibility criteria. Empirical studies of all designs, population types, and comparator groups were included if they appraised the impact of iACT treatment on any standardized measure of anxiety. Included studies were appraised on methodological quality and had their data extracted into a standardized coding sheet. Findings were then tabulated, and a narrative synthesis was performed because of the heterogeneity found between studies. RESULTS A total of 20 studies met inclusion criteria. There were 11 randomized controlled trials (RCTs) and 9 uncontrolled pilot studies. Participants across all studies were adults. The anxiety conditions treated were as follows: generalized anxiety disorder (GAD), social anxiety disorder (SAD), illness anxiety disorder (IAD), and general anxiety symptoms, with or without comorbid physical and mental health problems. A total of 18 studies reported significant anxiety reduction after iACT treatment. This was observed in studies that delivered iACT with (n=13) or without (n=5) therapist guidance. The average attrition rate across all included studies during the active iACT treatment phase was 19.19%. In the 13 studies that assessed treatment satisfaction, participants on average rated their iACT experience with above average to high treatment satisfaction. CONCLUSIONS These findings indicate that iACT can be an efficacious and acceptable treatment for adults with GAD and general anxiety symptoms. More RCT studies are needed to corroborate these early iACT findings using empirical treatments in active control groups (eg, internet-delivered cognitive behavioral therapy). This would potentially validate the promising results found for SAD and IAD as well as address the full spectrum of anxiety disorders.

scholarly journals Process and outcome measures used in acceptance and commitment therapy research, with adults with acquired neurological conditions: a systematic review

2021 ◽  
Author(s):  
Hannah Foote ◽  
Audrey Bowen ◽  
Sarah Cotterill ◽  
Geoff Hill ◽  
Matilde Pieri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Acceptance And Commitment Therapy ◽  
Anxiety And Depression ◽  
Core Outcome ◽  
Process Of Change ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Health Related ◽  
Neurological Conditions

Background: Acceptance and Commitment Therapy (ACT) interventions may promote wellbeing in neurological populations, but there is a lack of evidence to inform measure selection in research. Purpose: To identify and classify the measures used in ACT with adults with acquired neurological conditions.Methods: PRISMA guided systematic review. MEDLINE, PsycInfo and CINAHL databases searched (27/05/2020) with forward and backward searching. All study types included. Extraction of ACT process-of-change and health-related outcome measures. Outcomes coded using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy.Results: 204 papers screened. 34 studies included. Conditions included multiple sclerosis (n=17), traumatic brain injury (n=9) and stroke (n=8). 25 process-of-change measures extracted. Psychological flexibility was the most common process measured (AAQ-II most commonly used, n=14 studies). 76 health-related outcome measures extracted. Measures exploring quality of life, health status, anxiety and depression occurred most frequently. The Hospital Anxiety and Depression Scale was the most commonly used measure (n=8 studies). Conclusions: Future studies should follow reporting guidelines and consider the consistent use of measures to support synthesis of results. This could be achieved through the development of a Core Outcome Set – a standardised set of measures to be used across trials of ACT with adults with neurological conditions.

scholarly journals The effectiveness of acceptance and commitment therapy for social anxiety disorder: a randomized clinical trial

2020 ◽  
Vol 42 (1) ◽  
pp. 30-38
Author(s):  
Samad Khoramnia ◽  
Amir Bavafa ◽  
Nasrin Jaberghaderi ◽  
Aliakbar Parvizifard ◽  
Aliakbar Foroughi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Anxiety Disorder ◽  
Social Anxiety ◽  
Randomized Clinical Trial ◽  
Acceptance And Commitment Therapy ◽  
Social Anxiety Disorder ◽  
Commitment Therapy ◽  
Acceptance And Commitment
Sign in / Sign up

Export Citation Format

Share Document