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Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: the FACTOID feasibility study

Research output: Contribution to journalArticlepeer-review

Rebecca L. Gould, Julie Loebach Wetherell, Marc A. Serfaty, Kate Kimona, Vanessa Lawrence, Rebecca Jones, Gill Livingston, Philip Wilkinson, Kate Walters, Marie Le Novere, Robert J. Howard

Original languageEnglish
Pages (from-to)VII-127
Number of pages150
JournalHealth technology assessment (Winchester, England)
Volume25
Issue number54
DOIs
Published1 Sep 2021

Bibliographical note

Funding Information: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 54. See the NIHR Journals Library website for further project information.We would like to thank the National Institute for Health Research (NIHR) Health Technology Assessment Programme for funding this study. We would also like to thank the following NHS trusts for providing funding for excess treatment costs to cover therapist training, supervision and intervention delivery: South London and Maudsley NHS Foundation Trust; Barnet, Enfield and Haringey Mental Health NHS Trust; Camden and Islington NHS Foundation Trust; Whittington Health NHS Trust; and North East London NHS Foundation Trust. This research was supported by the NIHR Biomedical Research Centre at University College London and King?s College London. Funding Information: Declared competing interests of authors: Rebecca L Gould reports current funding from the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (16/155/01 and 16/81/01) and NIHR Research for Patient Benefit (RfPB) programme (PB-PG-0418-20001) and is an associate member of the NIHR HTA General Board (2018 to present). Marc A Serfaty reports current funding from the NIHR HTA programme (16/81/01) and the NIHR Public Health Research (PHR) programme (13/164/32) and is a member of the NIHR HTA General Board (2016 to present). Vanessa Lawrence reports current funding from the NIHR HTA programme (16/155/01, 16/81/01, 17/32/04 and 17/123/03) and NIHR Programme Grants for Applied Research (PGfAR) programme (NIHR200605). Rebecca Jones reports current funding from the NIHR HTA programme (NIHR129175). Gill Livingston reports current funding from the NIHR HTA programme (16/155/01, NIHR128761 and 13/115/76) and is a member of the NIHR Advanced Fellowship Board (2018 to present). Philip Wilkinson reports current funding from the NIHR HTA programme (16/155/01). Kate Walters reports current funding from the NIHR HTA programme (NIHR128334 and NIHR127905), NIHR PGfAR programme (RP-PG-1016-20001), the Economic and Social Research Council (ESRC)/NIHR (ES/S010408/1), NIHR School for Public Health Research (SPHR) programme, NIHR Applied Research Collaboration programme (North Thames and York Humber) and NIHR School for Public Health Research Public Mental Health (SPHR PMH) programme. Robert J Howard reports current funding from the NIHR HTA programme (16/155/01 and 16/81/01). Funding Information: The research reported in this issue of the journal was funded by the HTA programme as project number 15/161/05. The contractual start date was in May 2017. The draft report began editorial review in December 2019 and was accepted for publication in August 2020. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report. Funding Information: We would like to thank the National Institute for Health Research (NIHR) Health Technology Assessment Programme for funding this study. We would also like to thank the following NHS trusts for providing funding for excess treatment costs to cover therapist training, supervision and intervention delivery: South London and Maudsley NHS Foundation Trust; Barnet, Enfield and Haringey Mental Health NHS Trust; Camden and Islington NHS Foundation Trust; Whittington Health NHS Trust; and North East London NHS Foundation Trust. This research was supported by the NIHR Biomedical Research Centre at University College London and King’s College London. Funding Information: Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 54. See the NIHR Journals Library website for further project information. Funding Information: This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health and Social Care. Publisher Copyright: © 2021 Gould et al.

King's Authors

Abstract

Background: Generalised anxiety disorder, characterised by excessive anxiety and worry, is the most common anxiety disorder among older people. It is a condition that may persist for decades and is associated with numerous negative outcomes. Front-line treatments include pharmacological and psychological therapy, but many older people do not find these treatments effective. Guidance on managing treatment-resistant generalised anxiety disorder in older people is lacking. Objectives: To assess whether or not a study to examine the clinical effectiveness and cost-effectiveness of acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder is feasible, we developed an intervention based on acceptance and commitment therapy for this population, assessed its acceptability and feasibility in an uncontrolled feasibility study and clarified key study design parameters. Design: Phase 1 involved qualitative interviews to develop and optimise an intervention as well as a survey of service users and clinicians to clarify usual care. Phase 2 involved an uncontrolled feasibility study and qualitative interviews to refine the intervention. Setting: Participants were recruited from general practices, Improving Access to Psychological Therapies services, Community Mental Health Teams and the community. Participants: Participants were people aged ≥ 65 years with treatment-resistant generalised anxiety disorder. Intervention: Participants received up to 16 one-to-one sessions of acceptance and commitment therapy, adapted for older people with treatment-resistant generalised anxiety disorder, in addition to usual care. Sessions were delivered by therapists based in primary and secondary care services, either in the clinic or at participants’ homes. Sessions were weekly for the first 14 sessions and fortnightly thereafter. Main outcome measures: The co-primary outcome measures for phase 2 were acceptability (session attendance and satisfaction with therapy) and feasibility (recruitment and retention). Secondary outcome measures included additional measures of acceptability and feasibility and self-reported measures of anxiety, worry, depression and psychological flexibility. Self-reported outcomes were assessed at 0 weeks (baseline) and 20 weeks (follow-up). Health economic outcomes included intervention and resource use costs and health-related quality of life. Results: Fifteen older people with treatment-resistant generalised anxiety disorder participated in phase 1 and 37 participated in phase 2. A high level of feasibility was demonstrated by a recruitment rate of 93% and a retention rate of 81%. A high level of acceptability was found with respect to session attendance (70% of participants attended ≥ 10 sessions) and satisfaction with therapy was adequate (60% of participants scored ≥ 21 out of 30 points on the Satisfaction with Therapy subscale of the Satisfaction with Therapy and Therapist Scale-Revised, although 80% of participants had not finished receiving therapy at the time of rating). Secondary outcome measures and qualitative data further supported the feasibility and acceptability of the intervention. Health economic data supported the feasibility of examining cost-effectiveness in a future randomised controlled trial. Although the study was not powered to examine clinical effectiveness, there was indicative evidence of improvements in scores for anxiety, depression and psychological flexibility. Limitations: Non-specific therapeutic factors were not controlled for, and recruitment in phase 2 was limited to London. Conclusions: There was evidence of high levels of feasibility and acceptability and indicative evidence of improvements in symptoms of anxiety, depression and psychological flexibility. The results of this study suggest that a larger-scale randomised controlled trial would be feasible to conduct and is warranted.

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