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A Pilot Trial Of Transdiagnostic Cognitive Behavioural Therapy (tCBT) For Depression And Anxiety In Older People

Primary Purpose

Depression, Anxiety

Status
Unknown status
Phase
Not Applicable
Locations
United Kingdom
Study Type
Interventional
Intervention
tCBT treatment
Sponsored by
King's College London
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Depression

Eligibility Criteria

60 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • 60 years of age or older;
  • Primary diagnosis of mild to severe depression or anxiety, together with clinical symptoms of another mood disorder (e.g. anxiety or depression respectively), or a diagnosis of mixed anxiety and depressive disorder;
  • Scores between 8 to 30 (mild to severe range) on the Hamilton Anxiety Rating Scale (HARS) or between 8 to 22 (mild to severe range) on the Hamilton Depression Rating Scale (HDRS) for the primary diagnosis;
  • Fluent in English;
  • Sufficient literacy skills and sensory abilities to cope with the demands of the psychological intervention (e.g reading handouts, completing questionnaires etc).

Exclusion Criteria:

  • Current diagnosis of Post Traumatic Stress Disorder (PTSD) or Complicated Grief;
  • Presence of a severe and enduring mental health disorder (e.g. Schizophrenia);
  • Presence of a developmental intellectual disability or cognitive impairment (e.g. a score below 26 on the Mini Mental State Examination);
  • Presence of a personality disorder;
  • Presence of a severe sensory impairment;
  • Presence of a neurodegenerative disease (e.g. dementia) or neurological condition (e.g stroke);
  • Current alcohol/substance abuse or dependence;
  • Current suicidal risk;
  • Receiving concurrent psychotherapy;
  • Receiving concurrent pharmacotherapy where stabilisation of dosages has not occurred (e.g. where pharmacotherapy has been introduced or changed less than 8-weeks prior to recruitment).

Sites / Locations

  • South London and Maudsley NHS TrustRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

tCBT treatment

7-week delayed tCBT treatment

Arm Description

Participants randomised to the tCBT treatment arm will receive 12 individual, 1-hour tCBT sessions based upon Barlow et al.'s (2011) Unifed Protocol for emotional disorders (UP).

Participants randomised to the delayed-treatment arm will receive a brief telephone call and complete the Hospital Anxiety and Depression Scale (HADS) in order to monitor risk and symptom deterioration during the 7-week delayed treatment phase. They will also receive TAU (e.g. Community Mental Health Team appointments, case reviews, etc) during this time. At the end of 7 weeks, participants in the delayed-treatment arm will crossover into the treatment arm and receive the tCBT intervention. This arm will serve as a control condition in order to enable between-group comparisons.

Outcomes

Primary Outcome Measures

Hospital Anxiety and Depression Scale (HADS). This will assess symptom change over time in order to evaluate the efficacy of the tCBT intervention.
Self-report questionnaire. The HADS will be used to measure changes in anxiety and depression symptoms on a weekly basis over the course of the tCBT intervention (from week 0 to week 14), and once again at 7-week follow-up (week 21) to establish whether any treatment gains have been maintained. For those participants allocated to the delayed-intervention arm of the trial the HADS will be also be completed each week during the 7-week delay period (week 0 to week 7) to monitor changes in symptoms and suicidal ideation. After the delay period these participants will crossover to the intervention arm and be evaluated accordingly (e.g. throughout the tCBT intervention; week 7 to week 21, and at 7-week follow-up; week 28).
Hamilton Anxiety Rating Scale (HARS). This will assess symptom change over time in order to evaluate the efficacy of the tCBT intervention.
This is a clinician-rated assessment, which will be completed by a blind outcome assessor.
Hamilton Depression Rating Scale (HDRS). This will assess symptom change over time in order to evaluate the efficacy of the tCBT intervention.
This is a clinician-rated assessment, which will be completed by a blind outcome assessor.

Secondary Outcome Measures

Clinical Outcomes of Routine Evaluation - 10 (CORE-10). This will assess symptom change over time in order to evaluate the efficacy of the tCBT intervention.
Self-report questionnaire.
Discharge Satisfaction Questionnaire (DSQ)
Self-report questionnaire

Full Information

First Posted
December 2, 2012
Last Updated
January 22, 2013
Sponsor
King's College London
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1. Study Identification

Unique Protocol Identification Number
NCT01744548
Brief Title
A Pilot Trial Of Transdiagnostic Cognitive Behavioural Therapy (tCBT) For Depression And Anxiety In Older People
Official Title
A Pilot Randomised Controlled Trial (RCT) Examining The Feasibility, Acceptability And Efficacy Of Transdiagnostic Cognitive Behavioural Therapy (tCBT) For Depression And Anxiety In Older People.
Study Type
Interventional

2. Study Status

Record Verification Date
January 2013
Overall Recruitment Status
Unknown status
Study Start Date
December 2012 (undefined)
Primary Completion Date
December 2013 (Anticipated)
Study Completion Date
May 2014 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
King's College London

4. Oversight

5. Study Description

Brief Summary
This study aims to evaluate the feasibility, acceptability and efficacy of transdiagnostic Cognitive Behavioural Therapy (tCBT) in comparison to delayed-treatment for depression and anxiety in older people. CBT is a form of 'talking therapy' that has been recommended by the National Institute of Clinical Excellence for the treatment of mood disorders. While traditional disorder-specific CBT has been found to be effective at alleviating individual mood disorders, it may be less effective when multiple mood disorders are present (i.e. when there is psychological comorbidity). tCBT is a form of CBT that targets cognitive and behavioural processes common to a range of mood disorders. Consequently, it may be better placed to address comorbidity than traditional CBT, both in terms of clinical and cost-effectiveness. There is growing evidence that tCBT has beneficial effects on both depression and anxiety in working-age people. However, the potential benefits of this approach have not yet been examined in older people (in whom psychological comorbidity is a frequent problem). Therefore, this study will aim to recruit 22 older people who are experiencing symptoms of depression and anxiety from community mental health teams within the South London and Maudsley National Health Service Trust. Participants will be randomly allocated to receive either tCBT plus treatment-as-usual (TAU) or 7-week delayed tCBT plus TAU. tCBT will be delivered on an individual basis in 12 sessions, each lasting 1 hour, over 14 weeks. It will be delivered in outpatient clinics or within the participants residence, depending on mobility issues. A number of outcome measures will be used to evaluate the feasibility, acceptability and efficacy of tCBT, including ratings on mood questionnaires, rates of dropout and reasons for dropout. Outcome measures will be collected before the tCBT intervention starts (week 0/baseline), midway through the intervention (after the 6th tCBT session/week 7), at the end of the intervention (after the final tCBT session/week 14) and at 7-week follow-up (week 21) . The main hypotheses are: i. It will be feasible to adapt and establish a tCBT intervention for older people with comorbid depressive and anxiety disorders. ii. The tCBT intervention will be acceptable to older people with comorbid depressive and anxiety disorders. iii. The tCBT intervention will significantly reduce depression and anxiety symptoms relative to a delayed-treatment control condition.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Depression, Anxiety

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
22 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
tCBT treatment
Arm Type
Experimental
Arm Description
Participants randomised to the tCBT treatment arm will receive 12 individual, 1-hour tCBT sessions based upon Barlow et al.'s (2011) Unifed Protocol for emotional disorders (UP).
Arm Title
7-week delayed tCBT treatment
Arm Type
No Intervention
Arm Description
Participants randomised to the delayed-treatment arm will receive a brief telephone call and complete the Hospital Anxiety and Depression Scale (HADS) in order to monitor risk and symptom deterioration during the 7-week delayed treatment phase. They will also receive TAU (e.g. Community Mental Health Team appointments, case reviews, etc) during this time. At the end of 7 weeks, participants in the delayed-treatment arm will crossover into the treatment arm and receive the tCBT intervention. This arm will serve as a control condition in order to enable between-group comparisons.
Intervention Type
Behavioral
Intervention Name(s)
tCBT treatment
Other Intervention Name(s)
transdiagnostic Cognitive Behavioural Therapy (tCBT)
Intervention Description
The UP comprises 4 main treatment components: 1) psychoeducation about emotions and behaviour; 2) changing misappraisals about probabilities and consequences of negative experiences; 3) preventing avoidance of negative emotion triggers; and 4) modifying emotion-driven behaviours (e.g. hypervigilance, withdrawal). The manualised tCBT intervention will be adapted in order to account for a United Kingdom (UK) audience (as the manual was developed in the United States) and older people (as the manual was developed for working-age people).
Primary Outcome Measure Information:
Title
Hospital Anxiety and Depression Scale (HADS). This will assess symptom change over time in order to evaluate the efficacy of the tCBT intervention.
Description
Self-report questionnaire. The HADS will be used to measure changes in anxiety and depression symptoms on a weekly basis over the course of the tCBT intervention (from week 0 to week 14), and once again at 7-week follow-up (week 21) to establish whether any treatment gains have been maintained. For those participants allocated to the delayed-intervention arm of the trial the HADS will be also be completed each week during the 7-week delay period (week 0 to week 7) to monitor changes in symptoms and suicidal ideation. After the delay period these participants will crossover to the intervention arm and be evaluated accordingly (e.g. throughout the tCBT intervention; week 7 to week 21, and at 7-week follow-up; week 28).
Time Frame
The HADS will be completed on a weekly basis throughout the tCBT intervention (from week 0 to week 14) and once again at 7-week follow-up (week 21).
Title
Hamilton Anxiety Rating Scale (HARS). This will assess symptom change over time in order to evaluate the efficacy of the tCBT intervention.
Description
This is a clinician-rated assessment, which will be completed by a blind outcome assessor.
Time Frame
The HARS will be completed before the tCBT intervention starts (week 0/7), mid-way through the intervention (week 7/14), after the final tCBT session (week 14/21), and at 7-week follow-up (week 21/28).
Title
Hamilton Depression Rating Scale (HDRS). This will assess symptom change over time in order to evaluate the efficacy of the tCBT intervention.
Description
This is a clinician-rated assessment, which will be completed by a blind outcome assessor.
Time Frame
The HDRS will be completed before the tCBT intervention starts (week 0/7), mid-way through the intervention (week 7/14), after the final tCBT session (week 14/21), and at 7-week follow-up (week 21/28).
Secondary Outcome Measure Information:
Title
Clinical Outcomes of Routine Evaluation - 10 (CORE-10). This will assess symptom change over time in order to evaluate the efficacy of the tCBT intervention.
Description
Self-report questionnaire.
Time Frame
The CORE-10 will be completed before the tCBT intervention begins (week 0/7), after the final tCBT session (week 14/21), and at 7-week follow-up (week 21/28).
Title
Discharge Satisfaction Questionnaire (DSQ)
Description
Self-report questionnaire
Time Frame
After the final tCBT session (week 14/21)
Other Pre-specified Outcome Measures:
Title
Acceptability of tCBT
Description
Acceptability will be evaluated using the DSQ and based on attrition rates due to dissatisfaction with the intervention.
Time Frame
After the the final tCBT session (week 14/21)
Title
Feasibility of tCBT
Description
The feasibility of the tCBT intervention will be assessed based on attrition rates due to practical reasons (e.g. difficulty in attending due to mobility issues or physical health problems, etc) and clinician-rated judgments of the intervention (e.g. ease of delivery, etc).
Time Frame
After the final tCBT session (week 14/21)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 60 years of age or older; Primary diagnosis of mild to severe depression or anxiety, together with clinical symptoms of another mood disorder (e.g. anxiety or depression respectively), or a diagnosis of mixed anxiety and depressive disorder; Scores between 8 to 30 (mild to severe range) on the Hamilton Anxiety Rating Scale (HARS) or between 8 to 22 (mild to severe range) on the Hamilton Depression Rating Scale (HDRS) for the primary diagnosis; Fluent in English; Sufficient literacy skills and sensory abilities to cope with the demands of the psychological intervention (e.g reading handouts, completing questionnaires etc). Exclusion Criteria: Current diagnosis of Post Traumatic Stress Disorder (PTSD) or Complicated Grief; Presence of a severe and enduring mental health disorder (e.g. Schizophrenia); Presence of a developmental intellectual disability or cognitive impairment (e.g. a score below 26 on the Mini Mental State Examination); Presence of a personality disorder; Presence of a severe sensory impairment; Presence of a neurodegenerative disease (e.g. dementia) or neurological condition (e.g stroke); Current alcohol/substance abuse or dependence; Current suicidal risk; Receiving concurrent psychotherapy; Receiving concurrent pharmacotherapy where stabilisation of dosages has not occurred (e.g. where pharmacotherapy has been introduced or changed less than 8-weeks prior to recruitment).
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Siobhan Commins
Phone
02078480346
Email
siobhan.commins@kcl.ac.uk
First Name & Middle Initial & Last Name or Official Title & Degree
Rebecca Gould
Phone
02078480346
Email
rebecca.gould@kcl.ac.uk
Facility Information:
Facility Name
South London and Maudsley NHS Trust
City
South London
State/Province
London
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Debbie Walker
Email
debbie.walker@slam.nhs.uk
First Name & Middle Initial & Last Name & Degree
Siobhan Commins

12. IPD Sharing Statement

Learn more about this trial

A Pilot Trial Of Transdiagnostic Cognitive Behavioural Therapy (tCBT) For Depression And Anxiety In Older People

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