N/A N=3 Treatment

Acceptance and Commitment Therapy for Older Adults

Psychological Distress · Anxiety · Depression

Bottom Line

View on ClinicalTrials.gov: NCT04280445 ↗

Enrolled (actual)

Serious AEs

0.0%

Results posted

Nov 2021

Primary outcome: Primary: Change in Quality of Life Assessed Using the Older People's Quality of Life Questionnaire (OPQOL-brief). — 43.33 score on a scale

Study Design & Population

Study type: Interventional
Phase: N/A
Interventions: Psychological therapy (Other)
Age: Older Adult · 65+ yrs
Sex: All
Sponsor: University of Lincoln
Primary completion: Nov 2020

Outcome Measures

Outcome	Result	p-value
PRIMARY Change in Quality of Life Assessed Using the Older People's Quality of Life Questionnaire (OPQOL-brief).	43.33	—
SECONDARY Client's Level of Cognitive Functioning Assessed Using the Montreal Cognitive Assessment (MoCA).	—	—
SECONDARY Symptoms of Anxiety and Depression Assessed With the Hospital Anxiety and Depression Scale (HADS).	—	—
SECONDARY Change in/Progress on Client's Goals Assessed Using the Simplified Personal Questionnaire (PQ).	—	—
SECONDARY Change in Client's Weekly Level of Quality of Life Assessed Using the Outcome Rating Scale (ORS).	—	—
SECONDARY Change in Therapeutic Alliance Assessed With the Session Rating Scale (SRS).	—	—
SECONDARY Client's (Qualitative) Views on Individual Therapy Sessions Assessed With the Helpful Aspects of Therapy Form (HAT).	—	—
SECONDARY Change in Psychological Flexibility Assessed Using the CompACT	—	—
SECONDARY Client's Attribution of Change and View on Therapy Assessed With the Change Interview	—	—
SECONDARY Adherence to ACT Related Processes Assessed With the ACT Fidelity Measure (ACT-FM).	—	—

Summary

Title: Acceptance and Commitment Therapy for older adults experiencing psychological distress: A hermeneutic single case efficacy design (HSCED) series. Anxiety and depression in older age is associated with increased level of disability and lower quality of life (OAs). Unfortunately, pharmacological treatments are disproportionality relied upon to manage the mental health of OAs. Despite cognitive behaviour therapy (CBT) being the recommended psychotherapy, there is evidence that CBT is less effective for OAs than younger populations. An alternative treatment, Acceptance and Commitment Therapy (ACT), has been shown to be effective in reducing distress for OAs experiencing physical health difficulties. Several case studies have also indicated that ACT can be effective for OAs with psychological difficulties. ACT aims to change how a person interacts with their thoughts/feelings; to reduce avoidance; and to promote value-focused living. The study aims to use an adjudicated HSCED to answer the following questions: i) Is ACT an effective intervention for older adult clients experiencing psychological distress. ii) Do meaningful changes occur for client-participants over the course of ACT intervention? iii) What specific factors (ACT-specific, non-specific, extra-therapeutic) contribute to observed changes? iv) Are observed changes broadly attributable to the ACT intervention? v) What adaptations may facilitate change when using ACT with older adult clients. For the study, up to four participants will be recruited from an OA community mental health team, each receiving up to 12 individual sessions of ACT. Participants will be required to complete a number of questionnaires throughout the study, including before/after sessions. Post-treatment, there will be a semi-structured 1:1 interview to explore any changes participants experienced, before a six-week follow-up is employed to check stability of change.

Eligibility Criteria

Inclusion Criteria

Be at least 65 years of age.
Score at least 8 on the Hospital Anxiety and Depression Scale (HADS; ZIgmond & Snaith, 1983) on either the anxiety or depression sub-scale. The HADS is an outcome measure already used by the MHSOP.
Be referred to the MHSOP for psychological support.
Have capacity to give informed consent.
Be willing to engage in one-to-one psychotherapy.
Be able to travel to the service (either independently or with support).

Exclusion Criteria

A score lower than 22-24 on the MoCA. This is to screen for a level of cognitive deficit, which cannot be accommodated for in the current study, due to the adaptations which will be required (e.g. review sessions, carer enrolment to support memory consolidation). Cut-off limit is dependent on the individual's age and education history. The MoCA is administered by the MHSOP as standard practice.
Not rated higher than Cluster 8 (Mental Health Clustering Booklet 2013/14, Department of Health), a categorisation based on the Health of the Nation Outcome Scale (HoNOS; Wing et al., 1998). Clusters higher than 8 are associated with clients presenting with symptoms of psychosis and it is felt that this level of mental health problem would cause serious heterogeneity between client cases. As standard practice, the MHSOP at Ling Bar Hospital will have rated the client prior to consideration for the study.
Inability to understand English to a level required to participate fully in the intervention. This is due to a lack of ability to benefit from the intervention without an interpreter, and the impact an interpreter would have on the non-therapeutic processes (e.g. alliance) being measured in this study.
Not currently undertaking any other psychological therapy, talking therapy or counselling. This is due to the potential impact the other therapy could have on change and the inability to fully account for this.

View full record on ClinicalTrials.gov →

Data sourced from ClinicalTrials.gov (NCT04280445). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.