Background: Research identified psychological characteristics underlying a ‘need for psychological control’ as treatment attrition moderators for anxiety disorders in Cognitive Behavioural Therapy ...Show moreBackground: Research identified psychological characteristics underlying a ‘need for psychological control’ as treatment attrition moderators for anxiety disorders in Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT). It has not yet been examined if these characteristics moderate treatment attrition for older adults with anxiety, as this age population experience greater barriers in seeking therapy. Objective: This study evaluated whether the psychological characteristics of experiential avoidance and cognitive reappraisal moderated the observed attrition in CBT, and if mindfulness and positive mental health moderated the observed attrition in ACT. Method: Dutch speaking adults, aged 55-75 (N=314) with mild to moderate anxiety, were randomized into a four session CBT or ACT protocol. In the primary analysis, treatment attrition was defined as attending at least one treatment session but not completing all four sessions. In the secondary analysis, treatment attendance was defined as the total number of completed treatment sessions Results: The observed attrition rates were significantly different between the CBT and ACT condition (ꭓ2=6.58, p=.01). The four psychological characteristics did not significantly predict treatment attrition nor the number of completed treatment sessions in CBT and ACT. Conclusions: This study found no moderation in the examined psychological characteristics on the observed ACT and CBT attrition for older adults with anxiety. These findings may be explained by age related reorientations in the need for control and methodological issues in defining treatment attrition. Methods for developing a multi-layered definition of treatment attrition are discussed, and future directions for treatment attrition moderator research are proposed.Show less
Anxiety symptoms and disorders in older adults are both prevalent and disabling. At the moment little is known about how age of onset of anxiety problems is related to the clinical characteristics...Show moreAnxiety symptoms and disorders in older adults are both prevalent and disabling. At the moment little is known about how age of onset of anxiety problems is related to the clinical characteristics of older adults. The current study aimed to explore clinical differences between older adults with early-onset (before the age of 50) anxiety problems and later-life onset (after the age of 50) anxiety problems. Differences in the severity and type of anxiety were assessed, as well as differences in health care use, quality of life, functional impairment, comorbid depressive complaints, comorbid somatic problems and positive mental health. This crosssectional study included 161 participants that experienced anxiety problems (aged 55-75). Multiple one-way ANOVAs were used to compare the early- and late-onset groups regarding clinical factors. A chi-square test, followed by a post-hoc z-test was performed to examine if certain types of anxiety more often had a late-onset. Results showed no significant differences in clinical factors between the early- and late-onset group. Generalized anxiety was significantly more often reported with a late-onset than early-onset (χ2 = 14.516, p = <.001) This finding underscores the need for further research on late-onset types of anxiety. Older adults with early vs. late-onset anxiety might differ on other clinical factors than those studied in the current article. Therefore, further research into potential similarities and differences between early- and late-onset groups should include a wide variety of clinical factors.Show less
Background: Emotion regulation difficulties and impulsive aggression are common occurrences in Borderline Personality Disorder (BPD) and Attention-Deficit/Hyperactivity Disorder (ADHD) patients,...Show moreBackground: Emotion regulation difficulties and impulsive aggression are common occurrences in Borderline Personality Disorder (BPD) and Attention-Deficit/Hyperactivity Disorder (ADHD) patients, often leading to interpersonal problems. Traumatic childhood experiences may further negatively affect adaptive functioning and quality of life in these populations in various ways. The current study aimed to elucidate the relationships between these three factors, specifically investigating if emotion regulation difficulties predict impulsive aggression and if childhood trauma severity moderates this relationship. Methods: A total of 87 all-female participants aged 18-50, divided into healthy control (HC) (n = 30), BPD (n = 29), and ADHD (n = 28) groups, completed two self-report questionnaires; the Difficulties in Emotion Regulation Scale (DERS), and Childhood Trauma Questionnaire (CTQ). Additionally, the Point Subtraction Aggression Paradigm (PSAP) was applied, which assesses impulsive aggressive behaviors in response to provocation. Results: Neither patient group scored higher on measures of impulsive aggression than controls, and emotion regulation difficulties did not predict impulsive aggression. A model where childhood trauma severity moderates the relationship between emotion regulation difficulties and impulsive aggression was also insignificant. Unexpectedly, childhood trauma severity did positively predict impulsive aggression on its own. Conclusions: The fact that these results partially contradict previous research calls for replications of this study with more representative samples and in-depth analyses of the factors involved (e.g. taking into account differences between various types of aggression, emotion regulation skills, or abuse/neglect). The finding that childhood trauma severity predicts impulsive aggression appears to be a relative novelty, and should be investigated further.Show less
