Blended Acceptance and Commitment Therapy Versus Face-to-face Cognitive Behavioral Therapy for Older Adults With Anxiety Symptoms in Primary Care: Pragmatic Single-blind Cluster Randomized Trial

被引:15
|
作者
Witlox, Maartje [1 ]
Garnefski, Nadia [1 ]
Kraaij, Vivian [1 ]
de Waal, Margot W. M. [2 ]
Smit, Filip [3 ,4 ,5 ]
Bohlmeijer, Ernst [6 ]
Spinhoven, Philip [1 ]
机构
[1] Leiden Univ, Fac Social & Behav Sci, Inst Psychol, Sect Clin Psychol, Wassenaarseweg 52, NL-2333 AK Leiden, Netherlands
[2] Leiden Univ, Dept Publ Hlth & Primary Care, Med Ctr, Leiden, Netherlands
[3] Netherlands Inst Mental Hlth & Addict, Dept Mental Hlth & Prevent, Utrecht, Netherlands
[4] Vrije Univ, Dept Clin Neuro & Dev Psychol, Amsterdam, Netherlands
[5] Vrije Univ Amsterdam, Amsterdam Univ Med Ctr, Dept Epidemiol & Biostat, Med Ctr, Amsterdam, Netherlands
[6] Univ Twente, Dept Psychol Hlth & Technol, Enschede, Netherlands
关键词
acceptance and commitment therapy; anxiety; older adults; internet interventions; cognitive behavioral therapy; MENTAL-HEALTH; INTERVENTION; DISORDERS; PEOPLE; AGE; METAANALYSIS; PREVALENCE; DISABILITY; DEPRESSION; EFFICACY;
D O I
10.2196/24366
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Anxiety symptoms in older adults are prevalent and disabling but often go untreated. Most trials on psychological interventions for anxiety in later life have examined the effectiveness of 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 is the first to examine the effectiveness of a brief blended acceptance and commitment therapy (ACT) intervention for older adults with anxiety symptoms, compared with a face-to-face CBT intervention. Methods: Adults aged between 55-75 years (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 were performed at baseline (T0), posttreatment (T1), and at 6- and 12-month follow-ups (T2 and T3, respectively). The primary outcome was anxiety symptom severity (Generalized Anxiety Disorder-7). Secondary outcomes were positive mental health, depression symptom severity, functional impairment, presence of Diagnostic and Statistical Manual of Mental Disorders V anxiety disorders, and treatment satisfaction. Results: Conditions did not differ significantly regarding changes in anxiety symptom severity during the study period (T0-T1: B=.18, P=.73; T1-T2: B=-.63, P=.26; T1-T3: B=-.33, P=.59). Large reductions in anxiety symptom severity (Cohen d >= 0.96) were found in both conditions post treatment, and these were maintained at the 12-month follow-up. The rates of clinically significant changes in anxiety symptoms were also not different for the blended ACT group and CBT group (chi(2)(1)=0.2, P=.68). Regarding secondary outcomes, long-term effects on positive mental health were significantly stronger in the blended ACT group (B=.27, P=.03, Cohen d=0.29), and treatment satisfaction was significantly higher for blended ACT than CBT (B=3.19, P<.001, Cohen d=0.78). No other differences between the conditions were observed in the secondary outcomes. Conclusions: The results show that blended ACT is a valuable treatment alternative to CBT for anxiety in later life.
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页数:17
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