Group-based Acceptance and Commitment Therapy (ACT) for Older Veterans: Findings from a Quality Improvement Project

Psychometric Properties of the Acceptance and Action Questionnaire-II (AAQ-II) in Older Adult Primary Care Patients

OBJECTIVES

Considering that the examination of psychological flexibility measures among older adults is scant, this study explores the psychometric properties of the Acceptance and Action Questionnaire-II (AAQ-II) among outpatient geriatrics primary care clinic patients in a university-affiliated medical center in the Deep South.

METHODS

On average, patients who consented to participate in research (N = 119) were 75.42 (SD = 9.14) years old. Approximately 74% were women, 91% were non-Hispanic white, and 86% lived in urban areas. Measures included psychological inflexibility, subjective health literacy, depression, anxiety, and global cognitive functioning.

RESULTS

The AAQ-II demonstrated adequate internal reliability, Cronbach's α = 0.79, and good test-retest reliability, r(28) = .84, p < .001. With the removal of item 4, confirmatory factor analysis demonstrated adequate construct validity for the use of AAQ-II with older adults. As predicted, the AAQ-II exhibited concurrent, predictive, discriminant, and incremental validity within this older adult sample.

CONCLUSIONS

These results demonstrate meaningful scientific and clinical implications. This is the first study to examine the psychometric properties of the Acceptance and Action Questionnaire-II (AAQ-II) in an older adult sample.

CLINICAL IMPLICATIONS

The AAQ-II is a psychometrically sound measurement that can be clinically used on older adults.

Acceptance and commitment therapy for enhancing mental health in military personnel: A comprehensive review and meta-analysis

BACKGROUND

Military personnel frequently face unique psychological challenges due to high-stress environments, which increase the risk of mental health issues like anxiety and depression. Acceptance and commitment therapy (ACT) has shown potential in addressing these issues by enhancing psychological flexibility and resilience.

AIM

To systematically evaluate the effectiveness of ACT in improving the mental health of military personnel. Through a scoping review and meta-analysis, we quantitatively assess the impact of ACT on psychological outcomes, guiding future research and clinical practice.

METHODS

Relevant literature was searched systematically from database inception to June 30, 2023, across multiple databases, including PubMed, Web of Science, Cochrane Library, and Embase. The Joanna Briggs Institute's (JBI) scoping review guidelines were used as the methodological framework. Meta-analysis was performed using a random-effects model, and publication bias was assessed through Egger's regression test and Begg's funnel plot.

RESULTS

Twenty-six studies were included, highlighting the application of ACT in addressing PTSD, chronic pain, anxiety, and depression among military personnel. The meta-analysis of eight studies demonstrated a significant positive effect of ACT on mental health, with a pooled mean difference of -4.99 (95%CI: -6.53 to -3.45). Despite high heterogeneity (I² = 63%), sensitivity analyses confirmed the robustness of the findings.

CONCLUSION

This study underscores the potential of ACT as an effective intervention for improving the mental health of military personnel. Future research should focus on large-scale, multi-center RCTs to further validate these findings, particularly within diverse military populations.

Evaluation of a psychosocial group program for older adults: The Healthy Ageing Service Wellbeing Skills Group

ObjectiveTo conduct a quality assurance study assessing the implementation of the Healthy Ageing Service Wellbeing Skills Group Program (HAS-WSGP), a novel psychosocial skills group designed to support older adults' mental health.MethodsEligible participants were aged 65 years or older, presenting with mild-moderate mental health symptoms or interested in learning skills to enhance their emotional wellbeing, and living in community and residential aged care settings. Sessions were conducted weekly and facilitated by mental health clinicians and a peer support worker. Data collection involved a combination of demographic variables, outcome measures, and feedback surveys.ResultsA total of 40 consumers participated in the HAS-WSGP during the study period. Overall, participants demonstrated improvements in psychiatric, social, and occupational functioning, however no improvements in depressive and anxiety symptoms were observed. Improvements in self-reported knowledge of group program topics were observed, and participants endorsed the program as relevant, supportive, and helpful for improving their overall wellbeing.ConclusionsIt is feasible to run a psychosocial group program with older adults, and older adults report good benefits from this form of service provision. Further research will be needed to determine the efficacy of these programs on improving older adults' mental health.

Effect of group-based acceptance and commitment therapy on older stroke survivors: study protocol for a randomized controlled trial

INTRODUCTION

Older stroke survivors usually experience various psychology disorders, such as post-stroke depression (PSD), which may be associated with high experiential avoidance (EA) and can seriously affect their quality of life. To date, the efficacy of group-based acceptance and commitment therapy (ACT) for older stroke survivors has not been established. The aim of this study is to investigate the effectiveness of group-based ACT on EA, PSD, psychological distress, and quality of life in older stroke survivors after group-based ACT.

METHODS AND ANALYSIS

This study is a randomized, single-blind, wait-list controlled, parallel-arm trial. A total of 66 stroke survivors will be randomly assigned to wait-list control group or intervention group. Participants in wait-list control group will receive treatment as usual (TAU), while the intervention group will receive group-based ACT once a week for eight weeks. The primary outcome measure being EA, and the secondary outcome measures being PSD, psychological distress, and quality of life. Results of the two groups will be blindly assessed by professional evaluators at baseline (T0), post-treatment (T1), and one-month follow up (T2).

DISCUSSION

The results of this study will provide the first evidence for the effectiveness of a group-based ACT intervention in reducing EA, PSD, psychological stress, and improving quality of life for post-stroke survivors.

TRIAL REGISTRATION

ChiCTR2200066361.

A Preliminary Investigation into the Factor Structure of Two Psychological Flexibility Measures in a Sample of Community-Dwelling Older Adults

OBJECTIVES

Acceptance and Commitment Therapy (ACT) targets psychological flexibility and the ability to identify behavioral function in context. Properly measuring these constructs is imperative to understanding whether these processes are mechanisms of change in treatment. The current study examined the factor structure of the Comprehensive Assessment of ACT processes (CompACT) and Tacting of Function scale (TOF) in community-dwelling older adults.

METHODS

Factor structure was examined with CFA. Eighty community-dwelling older adults completed questionnaires prior to an intervention.

RESULTS

While the original 23-item, 3-factor structure of the CompACT demonstrated inadequate fit, a modified 15-item, 3-factor structure demonstrated adequate fit. The original 1-factor structure of the TOF demonstrated inadequate fit. A modified 2-factor structure of the TOF fit significantly better than the original 1-factor structure; however, this model also demonstrated inadequate fit.

CONCLUSIONS

Examining the factor structure of the CompACT and TOF in an older adult sample contributes to the field's understanding of the constructs of psychological flexibility and tacting ability and to the clinical utility of these measures in an understudied sample.

CLINICAL IMPLICATIONS

These findings provide preliminary support for the use of a short-form version of the CompACT to measure therapeutic processes of change in community-dwelling older adults.

Is acceptance and commitment therapy helpful in reducing anxiety symptomatology in people aged 65 or over? A systematic review

Anxiety-related mental health problems constitute a health challenge, especially in the elderly population. At present, there are few psychological treatments to reduce anxiety adapted to this group. The aim of this study was to conduct a systematic review of the literature to determine the therapeutic effects of Acceptance and Commitment Therapy (ACT) on anxiety in older adults, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Two blinded reviewers participated in the search, selection and methodological quality assessment processes; reaching satisfactory levels of agreement between reviewers (κ > 0.70). The search was performed in PubMed, Proquest Central, Scopus and Web of Science; making use of standardized terms for the construction of the algorithm. In the general search 348 studies were found. After applying the eligibility criteria and excluding duplicates, seven articles were extracted for qualitative analysis. The total number of subjects was 633, with an average age of 68.89 years (68.94% women). The analysis of methodological rigor showed moderate indices on average. The publications focused primarily on samples with a diagnosis of generalized anxiety disorder, proposing a variety of assessment tests for related dependent variables, especially depressive symptoms and psychological flexibility. Critical analysis of the findings provides evidence for the efficacy of ACT in reducing anxious and depressive symptoms in older adults. This study proposes the use of this procedure as a non-pharmacological alternative for a group usually underrepresented in the scientific literature on this topic.

ACT em Grupo para Manejo de Ansiedade entre Universitários: Ensaio Clínico Randomizado

Resumo Estima-se que um a cada cinco estudantes universitários ao redor do mundo apresenta algum tipo de transtorno psicológico, dentre os quais os transtornos de ansiedade são os mais prevalentes. Este estudo consiste em um ensaio clínico randomizado com o objetivo de avaliar a eficácia e efetividade de um protocolo semiestruturado de psicoterapia em grupo baseado nos princípios da Terapia de Aceitação e Compromisso (ACT) para o tratamento de ansiedade entre estudantes universitários. Os participantes foram alocados aleatoriamente entre os grupos intervenção e controle. Os níveis de ansiedade pré e pós-intervenção foram avaliados por meio do instrumento General Anxiety Disorders-7 (GAD-7). A amostra final do estudo foi composta por 15 pessoas, dentre as quais 10 foram alocadas no grupo intervenção e 5, no grupo controle. Os resultados foram analisados de duas formas: a) por protocolo (Per-protocol analysis); e b) por intenção de tratar (Intention-to-treat Analysis). Este tratamento reduziu a sintomatologia ansiosa em 39,7% entre os pacientes que completaram o tratamento (por protocolo, p=0,030) e em 30,8% entre todos alocados para o grupo intervenção (i.e., por intenção de tratar, incluindo os dropouts, p=0,035), enquanto os controles não tiveram redução significativa no mesmo período. Portanto, recomenda-se a utilização deste protocolo dentro do contexto universitário como uma alternativa viável ao acompanhamento individual em situações de transtornos de ansiedade. Pesquisas futuras com amostras maiores podem contribuir na consolidação deste protocolo.

Healthcare Quality Improvement Competency: A Clinical and Training Imperative for Geropsychology

Quality improvement (QI) work is increasingly necessary to ensure healthcare is delivered safely, efficiently, and equitably. As geropsychologists play an increasingly vital role in healthcare service delivery for older adults, it is imperative that they develop professional competence in QI, yet there is little formal QI training aimed at geropsychologists or to graduate students pursuing geropsychology. This article aims to elucidate the importance of QI education and training in geropsychology. In line with the Pikes Peak model for training in professional geropsychology, we outline QI knowledge and skills competencies for geropsychology training and suggest a rubric for integrating QI education into academic and clinical training from graduate school to professional practice. We provide recommended readings that geropsychology educators can read to become familiar with QI or use as part of a syllabus. Finally, we offer some recommendations for how current and future geropsychologists can be leaders in quality improvement work.