| dc.description.abstract | Provisional Question for the thesis to address:
Indicated and selective prevention of common mental health problems in later life: Is there a
theoretical rationale for an Acceptance and Commitment Therapy approach?
Background
The burden of late life depression and anxiety is significant. Even subthreshold symptoms result in
great individual, community, economic and societal cost. However, common mental health
problems in later life are under‐recognised and under‐treated despite evidence in support of
pharmacological and psychological intervention. Previous research regarding psychological therapy
for late life mental health problems has been dominated by cognitive behavioural therapy.
However, the effectiveness of this approach has been questioned, leading researchers to explore
alternative approaches. Acceptance and Commitment Therapy has received increasing attention
from researchers keen to explore an alternative and some have argued that this approach is
particularly suited to older people. In the context of demographic change and a significant increase
in the proportion of community dwelling elderly there is a need to provide evidence to support the
use of alternative management strategies for late life mental health problems, for example, focusing
on prevention.
Methods
A systematic review will evaluate the current evidence for the use of ‘indicated’ and ‘selective’
prevention interventions for older people at risk of developing a major depressive or anxiety
disorder due to the experience of subsyndromal symptoms or the presence of significant physical,
socioeconomic, and psychosocial risk factors. This paper will be followed by an empirical article in
which the relationship between psychological processes and ageing will be explored. Specifically,
this study will explore psychological flexibility, the use of Selection, Optimisation and Compensation
strategies, and the presence of psychopathology in a non clinical sample of community dwelling
older people.
Results
Findings of the systematic review provide preliminary evidence for indicated and selective
prevention of late life depression, however there is no clear evidence of benefits of these
interventions in late life anxiety. The relationships between variables in the empirical study were explored using descriptive statistics, correlation analysis, and conditional process modelling.
Although the study did not find age to be a specific predictor of variance in psychological variables
explored, the study did provide empirical support for the potential to use Acceptance and
Commitment Therapy with older people.
Discussion
The systematic review article provided preliminary evidence for the efficacy of selective and
indicated prevention interventions for late life depression. However, further research is required to
consolidate these findings. The empirical paper found significant relationships between the
perception of positive health, reduced psychopathology and theoretical variables including cognitive
fusion, engagement in valued living, and the use of Selection, Optimisation, and Compensation
strategies. Cognitive fusion was found to mediate these relationships and as such, findings provide
support for the use of an Acceptance and Commitment Therapy approach with older people. The
theoretical and clinical implications of these findings are discussed in detail. | en |
