Aging, Loneliness
Conditions
Keywords
Aging, Loneliness, Schemas, Mental Time Travel, Imagery Rescripting, Reminiscence therapy, Future Prospection
Brief summary
The goal of this clinical trial is to examine whether updating fundamental beliefs about self, others and the world using a mental time-travel group program can reduce loneliness and improve well-being in older adults when combined with multimodal social engagement opportunities. Over the span of eight sessions, participants within the experimental group will be guided to complete autobiographical simulations grounded in therapeutic techniques including reminiscence, imagery rescripting and positive future thinking. Participants within the active control group will be instructed to continue with their usual social group activities.
Detailed description
Older adults (≥65 years) from the Kimel Family Centre registry will be recruited based on a pre-specified score of loneliness. Recruitment will occur on a rolling basis through email and telephone contact, in-person booths, and information sessions. Kimel members who express interest in participating will then be emailed to schedule a time to be screened for eligibility via telephone. Prior to the telephone screening, consent forms will be sent via email for participants to review. The details of the study will be explained at the beginning of a telephone screening process. Participants will be given the opportunity to ask questions and to indicate whether they wish to continue, whereupon the screening questions will be administered to those who agree. Those who meet the eligibility criteria and provide informed consent will be scheduled for randomization into one of the two groups. Randomization will be computer-generated, stratified by baseline loneliness severity, number of other social groups taken at Kimel Family Centre, sex and gender. Participants will be randomly assigned to either: (1) Experimental condition: mental time travel protocol (reminiscence induction + imagery rescripting + positive prospection) or (2) a time-matched control condition: Kimel Centre group activities (see Arms and Interventions). Both groups will be encouraged to continue engaging with existing Kimel Centre programming throughout the study period. Both groups will complete the scheduled outcome assessments at baseline, 1-month post-baseline, 3-month follow-up, and 6-month follow-up. The experimental group will complete additional assessments throughout the experimental sessions (see Outcome measures). After completion of the main study, participants assigned to the time-matched control may be offered an opportunity to receive the structured experimental protocol, provided that the study remains active and the investigators determine that offering the protocol is appropriate.
Interventions
BEHAVIORALMental Time Travel Group
12 groups of six participants each. Groups will attend two 90- minute therapeutic sessions per week over a four-week period. A structured protocol session format will be used, including a short check-in, brief-assessment (i.e., PANAS and BCSS), the core session activity, a second brief-assessment (i.e., PANAS and BCSS), and a closing reflection. The primary session activities will consist of reminiscence induction, imagery rescripting, and positive prospection. In all these sessions, participants will be asked to write down their thoughts in response to the session prompts/exercises which they will not be required to share with the rest of the group. In addition to these sessions, participants will continue their usual weekly social group programming at the Kimel Centre.
BEHAVIORALSocial Engagement Group Activities
Participants in this condition will continue engaging in their usual weekly social group programming provided at the Kimel Centre. The Kimel Centre offers over 300 group-based programs across multiple categories, including Fitness \& Aquatics, Lectures \& Continued Education, Mind, Body, and Soul Wellness, Performing Arts, Nutrition \& Cooking, and Fine Arts \& Crafts, with offerings varying seasonally.
Sponsors
Baycrest
Mitacs
University of Waterloo
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥65 * Elevated loneliness based on a pre-specified cutoff of 44 on the UCLA version 3 Loneliness Scale (Russell, 1997) * Capacity to provide informed consent * Ability to participate in group sessions twice a week for four weeks
Exclusion criteria
* A diagnosis of dementia, mild cognitive impairment, stroke, other neurodegenerative disorders, schizophrenia, bipolar disorder, personality disorders * Any condition that would limit participants' capacity to benefit from or safely and comfortably complete the protocol. Given the nature of the protocol, which involves autobiographical memory recall in a group setting, individuals with a history of trauma-related diagnoses (e.g., PTSD or acute stress disorder) and/or those who score in the severe or extremely severe range on any of the depression (≥ 21), anxiety (≥ 15), or stress (≥ 26) subscales of the DASS-21, will be excluded in order to minimize the risk of significant distress during sessions * Participants who are unable to complete short questionnaires at each session and online at follow-up will be excluded
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Brief Core Schema Scale (BCSS) | Baseline, twice at each of the eight experimental group sessions, 1 month post-baseline, 3-month follow-up, 6-month follow-up | Four subscales measure: (1) negative self-belief ("I am bad"), (2) negative other-belief ("Others are bad/hostile"), (3) positive self-belief ("I am good"), and (4) positive other-belief ("Others are good/trustworthy"). Items rated on 5-point Likert scale. Higher scores indicate greater endorsement within the subscale. |
| Positive and Negative Affect Schedule (PANAS) | Baseline, twice at each of the eight experimental group sessions, 1 month post-baseline, 3-month follow-up, 6-month follow-up | Two 10-item subscales measure positive affect (e.g., interested, excited, proud) and negative affect (e.g., distressed, fearful, guilty). Items rated on 5-point Likert scale (1 = Very slightly or not at all; 5 = Extremely). Subscale scores range from 10-50, with higher scores indicating greater positive or negative affect. |
| UCLA Loneliness Scale (Version 3) | Baseline, 1-month post baseline, 3-month follow-up, and 6-month follow-up | Items are scored on a 4-point Likert scale (1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Always). Items 1, 5, 6, 9, 10, 15, 16, 19, and 20 are reverse scored. Total scores range from 20-80, with higher scores indicating greater levels of loneliness. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Health Questionnaire-9 (PHQ-9) | Baseline, 1-month post-baseline , 3-month follow-up, and 6-month follow-up | Items rated on 4-point Likert scale (0 = Not at all; 3 = Nearly every day). Total scores range from 0-27, with higher scores indicating greater depressive symptom severity. Severity categories: minimal (0-4), mild (5-9), moderate (10-14), moderately severe (15-19), and severe (20-27). |
| Overall Anxiety Severity and Impairment Scale (OASIS) | Baseline, 1-month post-baseline , 3-month follow-up, and 6-month follow-up | Each item is rated on a 5-point scale (0-4). Total scores range from 0-20, with higher scores indicating greater anxiety severity and impairment. A score of 8 or higher is recommended as a cut-off for clinically significant anxiety. |
| Difficulties in Emotion Regulation Scale (DERS) | Baseline, post-intervention, 3-month follow-up, 6-month follow-up | Items rated on 5-point Likert scale (1 = Almost never; 5 = Almost always). Six subscales measure: (1) non-acceptance of emotional responses, (2) difficulties engaging in goal-directed behavior, (3) impulse control difficulties, (4) lack of emotional awareness, (5) limited access to emotion regulation strategies, and (6) lack of emotional clarity. Higher scores indicate greater emotion regulation difficulties. |
| Social Connectedness Scale (SCS) | Baseline, 1 month post-baseline, 3-month follow-up, 6-month follow-up | Items rated on 6-point Likert scale (1 = Strongly disagree; 6 = Strongly agree). Total scores range from 20-120, with higher scores indicating greater social connectedness and sense of belonging. |
| Mini-Social Phobia Inventory (Mini-SPIN) | Baseline, 1 month post-baseline, 3-month follow-up, 6-month follow-up | Items rated on a 5-point Likert scale (0 = Not at all; 4 = Extremely). Total scores range from 0-12. A score of 6 or higher has been proposed as a screening cut-off for social anxiety disorder. |
| Relational Needs Satisfaction Scale | Baseline, 1 month post-baseline, 3-month follow-up, 6-month follow-up | Items rated on Likert scale reflecting degree of satisfaction with each relational domain. There are five domains each ranging from 4- 20. Higher scores indicate greater satisfaction of relational needs. |
| Object-Spatial Imagery Questionnaire (OSIQ) | Baseline | Items rated on a Likert scale reflecting the degree to which each imagery style describes the respondent. Scores on each subscale range from 15-75 with higher scores on each subscale indicate greater reliance on the corresponding imagery style (object or spatial). |
| Vividness of Visual Imagery Questionnaire (VVIQ) | Baseline, 1 month post-baseline, 3-month follow-up, 6-month follow-up | Items are measured on a 5-point scale with higher scores indicating greater imagery vividness. Scores can range from 4-20. |
| Brief 5-item "Core" Social Isolation Measure | Baseline, 1 month post-baseline, 3-month follow-up, 6-month follow-up | Items are measured on a 2- or 3-point scale with higher scores indicating greater social isolation. Scores can range from 0-8. |
| Healthcare Utilization Questionnaire | Baseline, 1 month post-baseline, 3-month follow-up, 6-month follow-up | Items are tabulated to produce counts or frequency data for each category, which can be aggregated to calculate total healthcare service utilization and associated costs if applicable. |
| Implicit Association Test (IAT) | Baseline, 1 month post-baseline, 3-month follow-up, 6-month follow-up | The IAT measures the strength of automatic associations between concepts (e.g., self vs. other) and evaluative attributes (e.g., positive vs. negative). D-scores quantify the magnitude of the implicit association, with positive values indicating stronger association of self with positive attributes or other with negative attributes, depending on the specific IAT variant administered. |
| Narrative Identity Self-Evaluation scale (NISE) | Baseline, twice at each of the eight experimental group sessions, 1 month post-baseline, 3-month follow-up, 6-month follow-up | Items are measured on a 7-point Likert scale. There are four subscale, autobiographical reasoning, desire for structure, positive themes and narrative disturbances. Higher scores indicate higher endorsement of the subscale. |
| Thinking About Life Experiences Scale (TALE) | Baseline, 1 month post-baseline, 3-month follow-up, 6-month follow-up | Items are measured on a 5-point Likert scale with higher scores indicating greater frequency of talking about their life |
Countries
Canada
Contacts
CONTACTBrian Levine, Ph.D
CONTACTDavid Moscovitch, Ph.D
PRINCIPAL_INVESTIGATORBrian Levine, Ph.D
Baycrest Academy for Research and Education
PRINCIPAL_INVESTIGATORDavid Moscovitch, Ph.D
University of Waterloo
Outcome results
None listed