Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 16, 2020
Date Accepted: Jan 20, 2021
Blended acceptance and commitment therapy versus face-to-face cognitive behavioral therapy for older adults with anxiety symptoms in primary care: a pragmatic single-blind cluster-randomized trial
ABSTRACT
Background:
Anxiety symptoms in older adults are highly prevalent and disabling, but often go untreated. Most trials on psychological interventions for late-life anxiety have examined face-to-face cognitive behavioral therapy (CBT). To bridge the current treatment gap, other treatment approaches and delivery formats should also be evaluated.
Objective:
This study was the first to examine a blended acceptance and commitment therapy (ACT) intervention for older adults with anxiety symptoms, comparing it to face-to-face CBT.
Methods:
Adults aged 55-75 (n=314) with mild to moderately severe anxiety symptoms were recruited from general practices and cluster-randomized to either blended ACT or face-to-face CBT. Assessments took place at baseline (T0), posttreatment (T1) and 6- and 12-month follow-up (T2, T3). Anxiety symptom severity (GAD-7) was the primary outcome. Secondary outcomes were positive mental health, depression symptom severity, functional impairment, presence of (a) DSM-V anxiety disorder(s) and treatment satisfaction.
Results:
Conditions did not differ significantly regarding change of anxiety symptom severity during the study period (T0-T1: b=0.18, P=.73; T1-T2: b=-0.63, P=.26; T1-T3: b=-0.33, P=.59). Large reductions in anxiety symptom severity (d ≥0.96) were found in both conditions at posttreatment and these were maintained at twelve-month follow-up. Rates of clinically significant change in anxiety symptoms were also not different for blended ACT and CBT (χ2=0.17, P=.68). Regarding secondary outcomes, long-term effects on positive mental health were significantly stronger in the blended ACT-group (b=0.27, P=.03, d=0.29) and treatment satisfaction was significantly higher for blended ACT than CBT (b=3.19, p <.001, d=0.78). No other differences between the conditions were found on the secondary outcomes.
Conclusions:
The results show that blended ACT is a valuable treatment alternative to CBT for late-life anxiety. Clinical Trial: Netherlands Trial Register: TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131
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