Generalized Anxiety Disorder Clinical Trial
Official title:
Generalized Anxiety Disorder in Older Adults : Efficacy of a Self-help Treatment Guided by Trained Lay Providers
Verified date | October 2023 |
Source | Laval University |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Few older adults receive treatment for Generalized Anxiety Disorder (GAD) despite a high prevalence in this population and significant associated health care costs. Although older adults generally prefer psychotherapy to medication for help with anxiety, face-to-face psychotherapy is difficult to access for many of them. Psychological guided self-help (GSH), which patients use by themselves at home under the supervision of a licensed mental health provider (e.g., psychologist), has been shown to be effective. However, the capacity of our health care system to respond adequately to the mental health needs of seniors has been questioned and cost-effective solutions are required. Because the therapist's role in GSH is limited to supporting the patient, it is conceivable that this role could be assumed by trained and supervised lay providers (LP) instead of licensed providers. If this approach is effective, it could help provide many older adults with much needed mental health treatment at a lower cost. The main objective of this project is to evaluate the effectiveness of GSH guided by LP for GAD in older adults. Participants will be assigned randomly to an experimental group, which will receive treatment immediately, or to a control group whose treatment will be delayed. Data will be obtained through clinician evaluations and self-assessment questionnaires. They will include socio-demographic characteristics, symptoms of GAD, variables related to anxiety, such as depression and sleep difficulties, and participants' perception of treatment. For the experimental group, data collection will take place at four different times: before treatment begins, after treatment ends, and at 6 and 12 months after the end of treatment. Control group participants will be assessed on three occasions: before and after the waiting period and after receiving treatment. The efficacy of GSH will be established by comparing the change in the two groups on the main variables. We will also identify the characteristics of patients associated with improvement during treatment and document their perception of treatment.
Status | Completed |
Enrollment | 150 |
Est. completion date | February 24, 2023 |
Est. primary completion date | February 24, 2023 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 60 Years and older |
Eligibility | Inclusion Criteria: - 60 years of age or older - meet at least criteria for subthreshold GAD at screening based on items of the Worry and Anxiety Questionnaire - meet DSM-5 criteria for primary threshold or subthreshold GAD - be able to read and speak French and to use the telephone without difficulty - if an anxiety medication is used, commit to maintaining the type of medication or dose during eight weeks prior to treatment and during the protocol. Exclusion Criteria: - a disabling physical disorder that is not adequately controlled (e.g., acute heart disease, recent stroke) - the presence of a substance use disorder - presenting a bipolar disorder or symptoms of a psychotic disorder - having significant cognitive impairment (score of less than 22 on the Telephone version of the Mini-Mental State Examination) - currently receiving or having received psychotherapy for anxiety over the last six months. |
Country | Name | City | State |
---|---|---|---|
Canada | Centre de recherche de l'Institut universitaire de gériatrie de Montréal | Montréal | Quebec |
Canada | École de psychologie, Université Laval | Québec | Quebec |
Canada | Département de psychologie, Université de Sherbrooke | Sherbrooke | Quebec |
Lead Sponsor | Collaborator |
---|---|
Laval University | Canadian Institutes of Health Research (CIHR), CIUSSS du Centre-Sud-de-l'Île-Montréal, Estrie University Integrated Health and Social Services Center - University Hospital of Sherbrooke, Integrated University Health and Social Services Center of the Capitale-Nationale |
Canada,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Evaluation of treatment by participants | Measures participant's perception of treatment. 19 statements covering various aspects of treatment (modules, readings, exercises, telephone sessions, workload, organization and duration of treatment, and its usefulness). Each statement is evaluated on a four-point scale ranging from "strongly agree" to "absolutely disagree". A fifth possible answer, 'does not apply', is also provided. | Post treatment (15 weeks) | |
Other | Questionnaire of behavioral manifestations linked to anxiety | Twenty-four items evaluating six behaviors related to generalized anxiety, namely reassurance seeking, avoidance, control, procrastination, overplanning and checking. Items are rated on a five point Likert scale | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. | |
Other | Nine items relating to COVID-19 | These items were added to describe the reality of the participants while considering the effects of the pandemic on their anxiety. Five questions are framed as "yes or no" with an open-ended description of their answer choice whereas four items are rated on a five-point Likert scale. | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. | |
Primary | Change in Penn State Worry Questionnaire | 16 items rated on a scale ranging from 1 to 5. A higher total score indicates a greater tendency to worry. | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. | |
Primary | Change in GAD-7 | 7 items answered on a scale ranging from 0 to 3. A higher total score suggests greater severity. | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. | |
Secondary | Change in Intolerance to Uncertainty Inventory | 27 items rated on a scale ranging from 1 to 5. A higher total score suggests higher intolerance to uncertainty. | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. | |
Secondary | Change in Negative Problem Orientation Questionnaire | 12 items rated on a scale ranging from 1 to 5. A higher total score suggests more negative attitudes toward problems. | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. | |
Secondary | Change in Cognitive Avoidance Questionnaire | 25 items rated on a scale ranging from 1 to 5. A higher total score suggests more likely use of cognitive avoidance. | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. | |
Secondary | Change in Why Worry Questionnaire | 25 items rated on a scale ranging from 1 to 5. A higher total score suggests a greater belief that worrying is useful. | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. | |
Secondary | Change in Geriatric Anxiety Inventory | 20 items rated as "agree" or "disagree". Minimum score = 0; Maximum score = 20. A higher total score is indicative of greater severity of symptoms. | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. | |
Secondary | Change in Geriatric Depression Scale | 30 items rated as "yes" or "no". Minimum score = 0; Maximum score = 30.A higher total score is indicative of greater severity of symptoms. | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. | |
Secondary | Change in Insomnia Severity Index | 7 items rated on a scale ranging from 1 to 4. A higher total score suggests more severe insomnia. | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. | |
Secondary | Change in Sheehan Disability Scale | Three self-rated items of family, work, and social impairment rated on a scale ranging from 0 to 10. | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. | |
Secondary | Change in Mini-Mental State Examination, telephone version | Items on orientation to time and place, registration, attention, recall, and language. Scores vary between 0 and 26 with higher scores indicating better cognitive functioning. | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. | |
Secondary | Change in GAD diagnosis | The Anxiety and Related Disorders Interview Schedule for DSM-5 is a validated structured interview used to confirm the presence or absence of anxiety disorders and associated psychiatric diagnoses. | Baseline, post treatment (15 weeks), 6 months and 12 months follow-up. |
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