ACT for Older Adults Who Hear Voices (HSCED)

Chief Investigator:

Dr Danielle De Boos

Objectives:

To investigate the efficacy of Acceptance and Commitment Therapy for older adults who hear voices in a Hermeneutic Single-Case Efficacy Design series.

Trial Configuration:

Case study series, recruited from multiple centres.

Settings:

Secondary care older adult mental health service and charity-based support groups.

Sample size estimate:

3

Number of participants:

Three participants. If a participant withdraws, a replacement participant will be sought.

Eligibility criteria:

Individuals who are 65+ years of age, experience moderate levels of distress (as defined by the Depression, Anxiety and Stress Scales-21), have capacity to provide informed consent, and express willingness to engage in the intervention are eligible to participate providing they do not have a diagnosis of dementia/cognitive impairment, are not currently receiving other psychological therapy and are able to independently communicate in English.

Description of interventions:

Acceptance and commitment therapy adapted to suit the needs of older adults. Twelve sessions are expected to take place, with a review at session six.

Duration of study:

Up to 20 months.

Outcome measures:

Personal Questionnaire (simplified) will be reviewed weekly.

At baseline, pre-therapy, mid-therapy, post-therapy, and follow-up (4-6 weeks) participants will complete the following outcome measures:

• Voices Acceptance and Action Scale-9,
• Beliefs about voices questionnaire-revised,
• Depression, Anxiety and Stress Scales-21,
• Comprehensive assessment of Acceptance and Commitment Therapy processes (short-form),
• Older People's Quality of Life questionnaire (brief version),
• Psychotic Symptom Rating Scale (Auditory Hallucination sub-scale).

Participants will also complete a change interview post-therapy with Trainee Clinical Psychologist (Jennifer Welch; University of Nottingham / University of Lincoln) who is independent to this study.

Statistical methods:

Reliable Change Index; adjudication panel; Framework Analysis; correlations; visual analysis

Inclusion criteria

• Currently experiences HV
• 65+ years of age
• Moderate levels of distress. This will be measured using recommended "Moderate" severity level cut-off scores on the Depression, Anxiety and Stress Scales-21 (Lovibond & Lovibond, 1995) following the completion of Informed Consent Forms.
• Having capacity to provide informed consent (in accordance with the Mental Capacity Act)
• Willingness to engage in the intervention

Exclusion criteria

• Diagnosis of cognitive impairment or dementia (based on self-report), as this indicates a degree of cognitive impairment that would be difficult to accommodate for.
• Current engagement with another psychological therapy
• Unable to independently communicate in English without an interpreter (based on researcher's discretion at recruitment).