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BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering

A Randomized Controlled Trial of CBT vs MCT in the Treatment of Generalized Anxiety Disorder and Depression in Older Adults

Awarded: NOK 0.30 mill.

The project is a three-partied project with the overarching goal of informing the status of anxiety and depression in elderly between 60 and 80 years of age in the municipality of Trondheim. The three pre-project are: 1. Estimate the prevalence of late-life anxiety and depression in Trondheim Municipality and describe this population in detail, which will inform the main study with regard to feasibility and characteristics of potential participants. Method: Cross-sectional survey using a representative sample. In all 1069 elderly participated in the survey, with a response rate of 35.62%. The study has given us an indication of the prevalence of anxiety and depression among elderly in the municipality of Trondheim, and if the participants have received treatment for their anxiety and depression and by which profession. 2. Describe the experiences and suggestions of people with late-life anxiety and depression using focus group interviews, which may influence the interventions chosen in the main study. Method: Focus group interviews. Focus group interviews were undertaken with both users and treatment personnel. The goal of the focus group interviews was to explore how users had experienced having anxiety and depression, which treatment they have been offered and to have examples of how the disorder driving transdiagnostic processes of rumination and worry were expressed in an elderly sample. In addition, the users informed the work on their views of the major barriers for help seeking in their age group. The treatment personnel gave information on difficulties with diagnosing anxiety and depression in the relevant age group, which treatment options were most commonly used in their view and to what extent the disorder driving processes of worry and rumination were prevalent in this age group. In addition, the treatment personnel gave their suggestions on how to improve treatments of anxiety and depression in elderly along with possible treatment barriers. 3. Conduct a literature review on treatments for late-life anxiety and depression, which will inform the status of treatment approaches tested among elderly as well as suggest needed improvements in this research field. The literature review focused on the latest publications of high quality publications with large samples and stringent designs like RCTs to give an updated summary of findings. The findings concluded that anxiety and depression are not necessarily two separate disorders, but they may share underlying mechanisms that include negative repetitive thinking such as rumination and worry. For this reason, it would be relevant to use a transdiagnostic treatment approach that addresses these processes. The review compared treatment results from cognitive behavioral therapy (CBT) with metacognitive therapy (MCT) for depression and generalized anxiety disorder. The results indicate that MCT is more effective than CBT. However, MCT has not been tested among elderly. The review recommend that these two treatments should be tested in a sample of elderly with anxiety and/or depression in a randomized controlled trial.

The observed inflated prevalence estimates of anxiety and depression in the elderly group, and the high healthcare costs associated with it, suggest that this is a very important field for research. The current first line psychological treatment for depression and anxiety is cognitive behaviour therapy (CBT). However, despite the success of CBT only 30% remain recovered at follow-up. A new treatment approach to depression and anxiety is metacognitive therapy (MCT) which has reported very promising treatment results with recovery rates ranging from 65-90%. The primary aim of the main research project is therefore to conduct the first randomized controlled trial on group based MCT and CBT for 150 elderly patients with depression and/or anxiety. Close collaboration between the Norwegian University of Science and Technology, the international scientific advisory board, Trondheim Municipality, and the service user organization will ensure the quality and integration of the project. As we are laying the groundwork for this main project we first propose to conduct a pre-project which will be used for three main activities: 1. A survey registering the prevalence and characteristics of our population (late-life anxiety and depression) in Trondheim municipality, which gives an estimation of the prevalence of late-life anxiety and depression in Trondheim which will inform the main study with regard to feasibility and characteristics of potential participants 2. Conduct focus group interviews with elderly suffering from these problems, describing the experiences and suggestions of people with late-life anxiety and depression which may influence the interventions chosen in the main study 3. Conduct meta-analysis summarizing research findings on treatments for this population, which will inform the main study regarding needed improvements in the research field

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BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering