Reducing Anxiety and Improving Functioning in Older Veterans

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 DESCRIPTION: The proposed CDA-2 will provide Dr. Christine Gould, a Clinical Psychologist at the VA Palo Alto Geriatric Research Education and Clinical Center (GRECC) and recently graduated VA Advanced Fellow in Geriatrics, with research training to foster her career aimed at slowing functional decline in older Veterans with anxiety and depression. Her mentor team includes Drs. Ruth O'Hara, Sherry A. Beaudreau, Mary Goldstein, and Julie Wetherell. Consultants include Drs. Helena Kraemer, Joung Won (Terri) Huh, and Eric Kuhn. In this CDA-2 award, Dr. Gould will obtain training in 1) clinical trials and longitudinal methods, 2) technology and eHealth, 3) medical comorbidity and functioning, and 4) grant and scientific writing. In the CDA-2 research plan, Dr. Gould aims test whether a brief psychosocial intervention for anxiety improves functioning in older Veterans with anxiety disorders. Anxiety is pervasive, costly, and leads to behavioral avoidance, disability, and poor quality of life. The proposed CDA-2 is expected to benefit older Veterans (= 60 years) by reducing anxiety and avoidance and thereby increasing their engagement in activities and improving overall functioning. This project is aligned with older adults' preference of psychotherapy to pharmacotherapy for treating anxiety. The first aim of the proposed project is to adapt progressive muscle relaxation (PMR), an efficacious treatment for late-life anxiety, for administration at home using DVD videos. Self-directed PMR will increase older Veterans' access to this brief treatment. The program, BREATHE (Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment), was developed by Dr. Gould with her mentors' input and includes age-appropriate vignettes of anxiety-evoking situations (e.g., health related worries, financial concerns, attending medical visits). Two studie will address the first aim. In study 1a, qualitative feedback from 20 older Veterans on the video modules will be obtained via semi- structured interviews. In study 1b, the feasibility of BREATHE will be piloted in 10 older Veterans with anxiety disorders, specifically, Generalized Anxiety Disorder (GAD), Panic Disorder (PD), Agoraphobia, Social Anxiety Disorder (SAD), and Anxiety Disorder NOS. Functioning will be assessed using the modified Activity Card Sort. The second aim of the CDA-2 is to assess Veterans' preferences, access to, and perceptions of technology platform that can be used to deliver brief psychosocial treatments. Study 2 will address this aim in 75 older Veterans by obtaining feedback via interview and questionnaires about telephone, web-based, mobile app, telehealth, and DVD-based platforms for interventions. The third aim of the CDA-2 is to determine whether BREATHE has a greater impact on anxiety and functioning compared with an active control (psychoeducation). Study 3 will address this aim with a randomized control trial of DVD-based BREATHE compared with psychoeducation in 60 older Veterans with anxiety disorders (GAD, PD, Agoraphobia, SAD, and unspecified anxiety disorder). It is hypothesized that BREATHE will result in a statistically and clinically significant reduction of anxiety symptoms as measured with the Geriatric Anxiety Scale compared with psychoeducation. Improvements in functioning (Activity Card Sort) are expected for participants randomized to the BREATHE condition compared with those randomized to psychoeducation. Hypotheses in study 3 will be addressed with mixed effects models. This CDA-2 is an essential step towards Dr. Gould's long term goal of becoming a VA leader in research on interventions aimed toward improving older Veteran's functioning via the treatment of mental health symptoms. This CDA-2 also aligns with Dr. Gould's aim of developing these interventions for dissemination via different technology platforms as part of the implementation and outreach process in her future independent VA research career.