Acceptance and Commitment Therapy, Dementia
Conditions
Keywords
Dementia, Psychological distress, Psychological therapy, ACT, Acceptability, HSCED
Brief summary
Introduction: People with dementia have a high prevalence of psychological distress but are under-served with evidence-based psychological interventions. To promote choice and improve clinical outcomes, there is a necessity to test different psychological intervention options for this population. Purpose: To investigate the effectiveness and acceptability of Acceptance and Commitment Therapy (ACT) for people with dementia, considering carer-supported, remote delivery and necessary therapy adaptations. Methods: A hermeneutic single case efficacy design (HSCED) series was used to analyse therapy process and change for three clients with dementia and psychological distress. Quantitative and qualitative data was collated ('rich case records') and analysed by three independent psychotherapy experts ('judges') who determined the outcome for each client. Results: Over the course of therapy, it was concluded that one client with dementia made positive changes, specifically reliable reductions in psychological distress, which were largely attributable to Acceptance and Commitment Therapy (ACT). Two clients remained unchanged. Discussion/Conclusion: Where change was achieved, the ACT-specific processes of values, committed action and acceptance, in combination with non-specific therapy factors including a strong client-carer relationship, existing client interests and individualised therapy adaptations, were facilitative of change. Hence, ACT may be feasible and effective by helping carers to better meet the needs of their loved ones with dementia. Future research to optimise ACT delivery in this population may be beneficial. Furthermore, the assessment of carer factors (e.g., their psychological flexibility, the client-carer relationship) may strengthen the evidence-base for systemic ACT-use.
Interventions
OTHERAcceptance and Commitment Therapy
There is no specific protocol for ACT with dementia, therefore a published ACT protocol, 'Better Living with Illness' (Brassington et al., 2016), will be used flexibly to guide the intervention.
Sponsors
Nottinghamshire Healthcare NHS Trust
University of Nottingham
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Hermeneutic single case efficacy design (HSCED) series
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Inclusion criteria for people with dementia Participants were included in the study if they had: * A clinical diagnosis of dementia (any type) * A clinically significant level of psychological distress (a score of ≥8 on the GAD-7 and ≥10 on the PHQ-9). * Ability to give informed consent Inclusion criteria for caregiver of person with dementia Participants were included in the study if they: * Cared for someone with a clinical diagnosis of dementia (any type) * Were paid or unpaid and regularly supported them with activities of daily living * Aged 18+ (no maximum age limit) * Able to give informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in anxiety | Through study completion, up to 24 weeks | Generalised anxiety disorder questionnaire (GAD-7), scored 0-21, where higher scores indicate a greater severity of anxiety. |
| Change in depression | Through study completion, up to 24 weeks | Patient health questionnaire (PHQ-9), scored 0-27, where higher scores indicate a greater severity of depression. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in psychological flexibility | Through study completion, up to 24 weeks | Comprehensive assessment of Acceptance & Commitment Therapy (CompACT-SF), scored 0-48, where higher scores indicate increased psychological flexibility. |
| Change in wellbeing | Through study completion, up to 24 weeks | Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWS), scored 7-35, where higher scores indicate higher mental wellbeing. |
| Change in client problems | Through study completion, up to 24 weeks | Personal questionnaire (PQ), where higher scores indicate greater severity of problems. |
| Change in therapeutic alliance | Through study completion, up to 12 weeks | Session rating scale (SRS), does not involve numerical values but asks clients to mark on a line nearest to the description that best fits their experience (marks further towards the right indicate better therapeutic alliance). |
Countries
United Kingdom
Outcome results
None listed