Category: Aging and Older Adults
Keywords: Anxiety | Technology / Mobile Health | Aging / Older Adults
Presentation Type: Symposium
Objective: To address the need for more accessible late-life anxiety treatments, we developed and tested a guided self-help treatment with progressive muscle relaxation (PMR) as the main component. The guided self-help treatment program called BREATHE (Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment) consists of four weekly video-lessons, daily practice sessions, and telephone coaching. The videos provide psychoeducation, teach diaphragmatic breathing and progressive relaxation training, and encourage engagement in activities. The aim of the present study was to examine the feasibility of BREATHE in a pilot randomized controlled trial (RCT).
Methods: We conducted a pilot RCT of BREATHE compared with a wait list control condition with equal assignment to both conditions (n=20). Eligible participants were 60 years or older, without major cognitive impairment, met DSM-5 criteria for an anxiety disorder (Generalized Anxiety Disorder [GAD], Social Anxiety Disorder [SAD], Panic Disorder, Agoraphobia, Anxiety Disorder Unspecified), and were not receiving any other psychotherapy. The primary outcome was anxiety severity measured by the Geriatric Anxiety Scale (GAS). Participants were monitored for eight weeks, and both groups completed the GAS at baseline, week-4 and week-8. The BREATHE participants completed the video-based intervention during the first 4-weeks; afterward, they were asked to continue practicing relaxation on their own for the remainder of the study (4 weeks). Weekly telephone calls during the first month provided the BREATHE group with technical assistance, addressed treatment-related issues, and were used to discuss practice adherence. Participants assigned to the wait list were offered the BREATHE treatment at the end of the study.
Results: Seventy-one older adults were screened by phone (n=15 excluded, n=8 did not complete a baseline assessment). Forty-eight completed a baseline assessment; 40 met inclusion/exclusion criteria and were randomized. Participants ranged in age from 60 to 88 years (M=68.93, SD=7.13) and 60% were female. The presence of current anxiety disorders was determined using the Structured Clinical Interview for DSM-5. The prevalence of anxiety disorders in the sample was as follows: GAD (58%), anxiety disorder unspecified (38%), SAD (28%), agoraphobia (8%), and panic disorder (3%). Thirty percent of participants had a comorbid depressive disorder. Mean baseline GAS scores were 22.15 (SD=9.72) and baseline depression scores on the PHQ-9 were 7.60 (SD=5.50). Our main interim finding was differential drop-out rates for the BREATHE condition (n = 6) compared with the wait list control (n = 0). Drop-outs were due to returning to work (n = 1), family/caregiving duties (n = 2), treatment-related factors such as wanting a different treatment (n = 2), and lost to follow-up (n = 1). Data collection is 95% complete; intent-to-treat analysis results will be presented.
Conclusion: In the presentation we will discuss study design, homework adherence, preliminary outcomes, and lessons learned about conducting guided self-help treatments with older adults with anxiety disorders.
VA Palo Alto Health Care System/Stanford
Friday, November 17
10:15 AM – 11:45 AM
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