Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Division of Psychiatry, University College London, London, UK.
Age Ageing. 2019 Sep 1;48(5):741-750. doi: 10.1093/ageing/afz082.
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.
to optimise the acceptability and feasibility of ACT for older adults with treatment-resistant GAD.
a person-based approach to ground the adapted ACT intervention in the perspectives and lives of those who will use it.
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.
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.
Our systematic approach combined rigour and transparency to develop a therapeutic intervention tailored to the specific needs of older adults with treatment-resistant GAD.
广泛性焦虑障碍（GAD）在晚年很常见，患病率为 3-12%。许多人对认知行为疗法或药物治疗仅部分反应，可被归类为治疗抵抗。这些患者生活质量较差，且患有共病抑郁、跌倒和孤独的风险增加。接纳与承诺疗法（ACT）是一种新兴的疗法，可能特别适合这一人群，但尚未针对他们的需求进行调整。
优化针对治疗抵抗性 GAD 老年患者的 ACT 的可接受性和可行性。
采用基于个体的方法，使改编后的 ACT 干预措施根植于使用它的人的观点和生活中。
首先，我们对 15 名患有 GAD 的老年患者和 36 名医疗保健专业人员进行了定性访谈，以制定指导原则为干预措施提供信息。其次，我们咨询了服务使用者和临床专家，并使用“出声思考”技术对相同的 15 名老年患者进行了访谈，以提高其可接受性和可行性。
在第 1 阶段，老年患者的关注点和需求分为四个主题：“自身状况的专家”、“根深蒂固的应对策略”、“治疗专家”和“实施支持”。在第 2 阶段，确定了对治疗的影响，包括早期关注价值观和 ACT 作为合作伙伴关系，检查围绕“自我为忧虑者”的信念和回避的作用，验证和适应个人的知识和经验，并补偿与年龄相关的认知变化。
我们的系统方法结合了严谨性和透明度，开发了一种针对治疗抵抗性 GAD 老年患者特定需求的治疗干预措施。
