JMIR Publications

ABSTRACT

Background:

Older Veterans with anxiety disorders encounter barriers to receiving mental health services such as transportation difficulties, physical limitations, and limited access to mental health providers trained to work with older persons. To address both accessibility and the shortage of available providers, evidence-based treatments that can be delivered via guided self-management are a potential solution.

Objective:

This study aimed to assess to compare the treatment effects of guided self-management interventions of relaxation versus health psychoeducation on anxiety symptom severity and functioning in older Veterans with anxiety disorders.

Methods:

Older Veterans with anxiety disorders participated in this pilot randomized controlled trial (RCT). They were randomized to one of two video-delivered interventions: (1) BREATHE–breathing and progressive relaxation to manage anxiety; or (2) Healthy Living for Reduced Anxiety– psychoeducation about lifestyle changes. Telephone coaching calls were conducted weekly during the intervention. Measures of anxiety, depression, and functioning were obtained at baseline, week 4 (end of treatment), week 8, and week 12. Participants completed a qualitative interview at week 12. Analyses included descriptive statistics to characterize measures of intervention engagement, mixed effects models to characterize symptom change, and qualitative analyses.

Results:

Fifty-six participants (85.7% men; 41% ethnic or racial minority; M age = 71.36, SD = 6.19) were randomized. No significant difference for retention was found. The Healthy Living group completed significantly more lessons (M =3.68, SD = 0.86) than the BREATHE group (M = 2.85, SD = 1.43), t(53) = 2.60, p = .01. With regard to daily practices in the BREATHE group, greater baseline anxiety scores (r = -.41, p = .03) and greater severity of medical comorbidity (r = -.50, p = .009) were associated with fewer completed practices. There were no effects of either intervention on change in total anxiety scores or functioning over time. However, for specific anxiety subtypes, the Healthy Living group had a greater decline in somatic anxiety over time compared with BREATHE. Qualitative analyses investigated participants’ perceptions of the BREATHE intervention. Participants described adapting their practice routine to fit their daily lives. Some also discussed how they used relaxation skills in everyday situations. Barriers to practicing identified included difficulty setting time aside to practice, forgetting, or having other activities that interfered with practice.

Conclusions:

The present findings suggest that guided self-management approaches to treating late-life anxiety may be generally acceptable to older Veterans, but maintaining home practices was less acceptable. While progressive relaxation was reported to be enjoyable for most older participants, those with milder anxiety severity and fewer health problems were better able to adhere to recommended practices. Our findings differ from previous studies in our implementation of self-guided relaxation in a mostly male sample with substantial ethnic and racial minority representation. Clinical Trial: ClinicalTrials.gov NCT02400723