An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: Study protocol for a cluster randomized controlled trial

Maartje Witlox* (Corresponding Author), Vivivan Kraaij, Nadia Garnefski, Margot W.M. De Waal, Filip Smit, Erik Hoencamp, Jacobijn Gussekloo, Ernst T. Bohlmeijer, Philip Spinhoven

*Corresponding author for this work

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Background: Anxiety is among the most prevalent and disabling mental health problems in older adults. Few older adults with mild to moderately severe anxiety symptoms receive adequate interventions, putting them at risk for developing anxiety disorders, depression, and various somatic problems. Effective, low-threshold interventions should be developed. Blended care, in which a web-based intervention is combined with a limited amount of face-to-face contacts with a mental healthcare counselor at the general practice, is a promising option. The online self-help intervention "Living to the Full" - an Acceptance and Commitment Therapy (ACT) intervention - has been proven to reduce depression and anxiety in several patient groups, but has not yet been investigated in older adults. The aim of this study is to evaluate the (cost-)effectiveness of a blended form of "Living to the Full" in reducing anxiety symptoms in adults aged 55 to 75 years. Furthermore, moderators and mediators of the treatment effect are investigated. Methods/design: The (cost-)effectiveness of the ACT intervention will be investigated in a cluster single-blind randomized controlled trial (RCT). The blended intervention will be compared to treatment-as-usual. Thirty-six mental health counselors working at general practices in the Netherlands will be randomized to deliver blended care or treatment as usual. A total of 240 participants (aged 55-75 years) with mild to moderately severe anxiety complaints (defined as a total score of 5-15 on the GAD-7) will be recruited. There are four measurements consisting of online questionnaires (primary outcome: GAD-7) and a telephone interview: before the start of the intervention; directly following the intervention (14 weeks after baseline); and six and twelve months after baseline. Possible mediator variables will be assessed multiple times basis during the intervention. Discussion: This RCT will evaluate the effectiveness of a blended ACT intervention for older adults with anxiety symptoms. If the intervention is shown to be effective, it will be implemented, thereby improving the accessibility and quality of preventive interventions for older adults with anxiety problems. Trial registration: Netherlands Trial Register, NTR6270. Registered on 21 March 2017.

Original languageEnglish
Article number502
Issue number1
Publication statusPublished - 17 Sep 2018



  • Anxiety
  • Anxiety complaints
  • Blended care
  • Internet
  • Older adults
  • Randomized controlled trial
  • Subclinical anxiety
  • Acceptance and commitment therapy

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