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Optimising the acceptability and feasibility of Acceptance and Commitment Therapy for treatment-resistant generalised anxiety disorder in older adults

Lawrence, V; Kimona, K; Howard, R; Serfaty, M; Wetherell, J; Livingston, G; Wilkinson, P; ... Gould, R; + view all (2019) Optimising the acceptability and feasibility of Acceptance and Commitment Therapy for treatment-resistant generalised anxiety disorder in older adults. Age and Ageing , 48 (5) pp. 741-750. 10.1093/ageing/afz082. Green open access

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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.

Type: Article
Title: Optimising the acceptability and feasibility of Acceptance and Commitment Therapy for treatment-resistant generalised anxiety disorder in older adults
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/ageing/afz082
Publisher version: https://doi.org/10.1093/ageing/afz082
Language: English
Additional information: Copyright © The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial reuse, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10073328
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