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Development of a video-delivered relaxation treatment of late-life anxiety for veterans

Published online by Cambridge University Press:  08 June 2017

Christine E. Gould ,
Aimee Marie L. Zapata ,
Janine Bruce ,
Sylvia Bereknyei Merrell ,
Julie Loebach Wetherell ,
Ruth O'Hara ,
Eric Kuhn ,
Mary K. Goldstein  and
Sherry A. Beaudreau
Christine E. Gould*
Affiliation:
Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
Aimee Marie L. Zapata
Affiliation:
Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, CA, USA
Janine Bruce
Affiliation:
Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
Sylvia Bereknyei Merrell
Affiliation:
Department of Medicine, Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, USA
Julie Loebach Wetherell
Affiliation:
Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA Department of Psychiatry, University of California, San Diego, CA, USA
Ruth O'Hara
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
Eric Kuhn
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA National Center for PSTD, VA Palo Alto Health Care System, Palo Alto, CA, USA
Mary K. Goldstein
Affiliation:
Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA Center for Primary Care and Outcomes Research (PCOR), Stanford University, Stanford, CA, USA
Sherry A. Beaudreau
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
*
Correspondence should be addressed to: Christine E. Gould, PhD, Veterans Affairs Palo Alto Health Care System, GRECC (182B), 3801 Miranda Ave., Palo Alto, CA, 94304, USA. Email: cegould@stanford.edu.
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Abstract

Background:

Behavioral treatments reduce anxiety, yet many older adults may not have access to these efficacious treatments. To address this need, we developed and evaluated the feasibility and acceptability of a video-delivered anxiety treatment for older Veterans. This treatment program, BREATHE (Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment), combines psychoeducation, diaphragmatic breathing, and progressive muscle relaxation training with engagement in activities.

Methods:

A mixed methods concurrent study design was used to examine the clarity of the treatment videos. We conducted semi-structured interviews with 20 Veterans (M age = 69.5, SD = 7.3 years; 55% White, Non-Hispanic) and collected ratings of video clarity.

Results:

Quantitative ratings revealed that 100% of participants generally or definitely could follow breathing and relaxation video instructions. Qualitative findings, however, demonstrated more variability in the extent to which each video segment was clear. Participants identified both immediate benefits and motivation challenges associated with a video-delivered treatment. Participants suggested that some patients may need encouragement, whereas others need face-to-face therapy.

Conclusions:

Quantitative ratings of video clarity and qualitative findings highlight the feasibility of a video-delivered treatment for older Veterans with anxiety. Our findings demonstrate the importance of ensuring patients can follow instructions provided in self-directed treatments and the role that an iterative testing process has in addressing these issues. Next steps include testing the treatment videos with older Veterans with anxiety disorders.

Keywords

anxietybehavioral therapypsychogeriatricsqualitative
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 10 , October 2017 , pp. 1633 - 1645
Copyright
Copyright © International Psychogeriatric Association 2017 

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Footnotes

Previous Presentation: These data were presented at the 2016 Gerontological Society of America Meeting in New Orleans, LA.

References

Bandura, A. (1971). Social Learning Theory. New York, NY: General Learning Press.Google Scholar
Bernstein, D. A., Borkovec, T. D. and Hazlett-Stevens, H. (2000). New Directions in Progressive Relaxation Training. A Guidebook for Helping Professionals. Westport, CT: Praeger Publishers.Google Scholar
Charlson, M. E., Pompei, P, Ales, K. L. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Disease, 40, 373–383. doi: 10.1016/0021-9681(87)90171-8.Google Scholar
Chou, K.-L. (2009). Age at onset of generalized anxiety disorder in older adults. The American Journal of Geriatric Psychiatry, 17, 455–464. doi: 10.1097/JGP.0b013e31818f3a93.Google Scholar
Creswell, J. W. and Plano Clark, V. L. (2011). Designing and Conducting Mixed Methods Research, 2nd ed. Los Angeles: Sage Publications, Inc.Google Scholar
Cuijpers, P., Donker, T., van Straten, A., Li, J. and Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine, 40, 1943–1957. doi: 10.1017/S0033291710000772.Google Scholar
Czaja, S. J. and Sharit, J. (2013). Designing Training and Instructional Programs for Older Adults. Boca Raton, FL: CRC Press.Google Scholar
de Gage, B. S. et al. (2014). Benzodiazepine use and risk of Alzheimer's disease: case-control study. BMJ (Clinical Research Ed.), 349, 1–10. doi: 10.1136/bmj.g5205.Google Scholar
de Shazer, S. and Dolan, Y. (2007). More than Miracles: The State of the Art of Solution-Focused Brief Therapy. London: Routledge.Google Scholar
Gould, C. E., Rideaux, T., Spira, A. P. and Beaudreau, S. A. (2015). Depression and anxiety symptoms in male veterans and non-veterans: the Health and Retirement Study. International Journal of Geriatric Psychiatry, 30, 623–630. doi: 10.1002/gps.4193.Google Scholar
Gould, C. E., Segal, D. L., Yochim, B. P., Pachana, N. A., Byrne, G. J. and Beaudreau, S. A. (2014). Measuring anxiety in late life: a psychometric examination of the geriatric anxiety inventory and geriatric anxiety scale. Journal of Anxiety Disorders, 28, 804–811. doi: 10.1016/j.janxdis.2014.08.001.CrossRefGoogle ScholarPubMed
Gould, R. L., Coulson, M. C. and Howard, R. J. (2012). Efficacy of cognitive behavioral therapy for anxiety disorders in older people: a meta-analysis and meta-regression of randomized controlled trials. Journal of the American Geriatrics Society, 60, 218–229. doi: 10.1111/j.1532-5415.2011.03824.x.Google Scholar
Guest, G., Bunce, A. and Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18, 59–82. doi: 10.1177/1525822X05279903.Google Scholar
Gum, A. M., Iser, L. and Petkus, A. (2010). Behavioral health service utilization and preferences of older adults receiving home-based aging services. The American Journal of Geriatric Psychiatry, 18, 491–501. doi: 10.1097/JGP.0b013e3181c29495.Google Scholar
Haaga, D. A. F. (2000). Introduction to the special section on stepped care models in psychotherapy. Journal of Consulting and Clinical Psychology, 68, 547–548. doi: 10.1037/0022-006X.68.4.547.Google Scholar
Hall, J., Kellett, S., Berrios, R. E., Bains, M. K. and Scott, S. (2016). Efficacy of cognitive behavioral therapy for generalized anxiety disorder in older adults: systematic review, meta-analysis and meta-regression. The American Journal of Geriatric Psychiatry, 24, 1063–1073. doi: 10.1016/j.jagp.2016.06.006.Google Scholar
Karlin, B. E. and Cross, G. (2014). Enhancing access, fidelity, and outcomes in the national dissemination of evidence-based psychotherapies. The American Psychologist, 69, 709–711. doi: 10.1037/a0037384.Google Scholar
Katz, J. N., Chang, L. C., Sangha, O., Fossel, A. H. and Bates, D. W. (1996). Can comorbidity be measured by questionnaire rather than medical record review? Medical Care, 34, 73–84.Google Scholar
Katzman, R., Brown, T., Fuld, P., Peck, A., Schechter, R. and Schimmel, H. (1983). Validation of a short orientation-memory-concentration test of cognitive impairment. The American Journal of Psychiatry, 140, 734–739. doi: 10.1176/ajp.140.6.734.Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.Google Scholar
Landreville, P., Gosselin, P., Grenier, S., Hudon, C. and Lorrain, D. (2016). Guided self-help for generalized anxiety disorder in older adults. Aging and Mental Health, 20, 1070–1083. doi: 10.1080/13607863.2015. 1060945.Google Scholar
Malterud, K. (2001). Qualitative research: standards, challenges, and guidelines. Lancet, 358, 483–488. doi: 10.1016/S0140-6736(01)05627-6.Google Scholar
Mohlman, J. (2012). A community based survey of older adults’ preferences for treatment of anxiety. Psychology and Aging, 27, 1182–1190. doi: 10.1037/a0023126.Google Scholar
Neild, M. A., Soo Hoo, G. W., Roper, J. M. and Santiago, S. (2007). Efficacy of pursed-lips breathing: a breathing retraining strategy for dyspnea reduction. Journal of Cardiopulmonary Rehabilitation and Prevention, 27, 237–244. doi: 10.1097/01.HCR.0000281770. 82652.cb.Google Scholar
Newman, M. G. and Fisher, A. J. (2013). Mediated moderation in combined cognitive behavioral therapy versus component treatments for generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 81, 405–414. doi: 10.1037/a0031690.Google Scholar
Patton, M. Q. (1999). Enhancing the quality and credibility of qualitative analysis. Health Services Research, 34, 1189–1208.Google Scholar
Petkus, A. J., Reynolds, C. A., Wetherell, J. L., Kremen, W. S., Pedersen, N. L. and Gatz, M. (2016). Anxiety is associated with increased risk of dementia in older Swedish twins. Alzheimer's and Dementia: The Journal of the Alzheimer's Association, 12, 399–406. doi: 10.1016/j.jalz.2015.09.008.CrossRefGoogle ScholarPubMed
Porensky, E. K. et al. (2009). The burden of late-life generalized anxiety disorder: effects on disability, health-related quality of life, and healthcare utilization. The American Journal of Geriatric Psychiatry, 17, 473–482. doi: 10.1097/JGP.0b013e31819b87b2.Google Scholar
Rollnick, S., Miller, W. R. and Butler, C. C. (2008). Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, NY: Guilford Press.Google Scholar
Scogin, F., Rickard, H. C., Keith, S., Wilson, J. and McElreath, L. (1992). Progressive and imaginal relaxation training for elderly persons with subjective anxiety. Psychology and Aging, 7, 419–424. doi: 10.1037/0882-7974.7.3.419.Google Scholar
Segal, D. L., June, A., Payne, M., Coolidge, F. L. and Yochim, B. (2010). Development and initial validation of a self-report assessment tool for anxiety among older adults: the geriatric anxiety scale. Journal of Anxiety Disorders, 24, 709–714. doi: 10.1016/j.janxdis.2010.05.002.Google Scholar
Thorp, S. R., Ayers, C. R., Nuevo, R., Stoddard, J. A., Sorrell, J. T. and Wetherell, J. L. (2009). Meta-analysis comparing different behavioral treatments for late-life anxiety. The American Journal of Geriatric Psychiatry, 17, 105–115. doi: 10.1097/JGP.0b013e31818b3f7e.Google Scholar
Vaismoradi, M., Turunen, H. and Bondas, T. (2013). Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nursing and Health Sciences, 15, 398–405. doi: 10.1111/nhs.12048.Google Scholar
van't Veer-Tazelaar, P. J. et al. (2009). Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial. Archives of General Psychiatry, 66, 297–304. doi: 10.1001/archgenpsychiatry.2008.555.Google Scholar
Wetherell, J. L., Thorp, S. R., Patterson, T. L., Golshan, S., Jeste, D. V. and Gatz, M. (2004). Quality of life in geriatric generalized anxiety disorder: a preliminary investigation. Journal of Psychiatric Research, 38, 305–312. doi: 10.1016/j.jpsychires.2003.09.003.Google Scholar
Zou, J. B. et al. (2012). Brief internet-delivered cognitive behavioral therapy for anxiety in older adults: a feasibility trial. Journal of Anxiety Disorders, 26, 650–655. doi: 10.1016/j.janxdis.2012.04.002.Google Scholar
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