Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: the FACTOID feasibility study

BACKGROUND: Generalised anxiety disorder, characterised by excessive anxiety and worry, is the most common anxiety disorder among older people. It is a condition that may persist for decades and is associated with numerous negative outcomes. Front-line treatments include pharmacological and psychological therapy, but many older people do not find these treatments effective. Guidance on managing treatment-resistant generalised anxiety disorder in older people is lacking. OBJECTIVES: To assess whether or not a study to examine the clinical effectiveness and cost-effectiveness of acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder is feasible, we developed an intervention based on acceptance and commitment therapy for this population, assessed its acceptability and feasibility in an uncontrolled feasibility study and clarified key study design parameters. DESIGN: Phase 1 involved qualitative interviews to develop and optimise an intervention as well as a survey of service users and clinicians to clarify usual care. Phase 2 involved an uncontrolled feasibility study and qualitative interviews to refine the intervention. SETTING: Participants were recruited from general practices, Improving Access to Psychological Therapies services, Community Mental Health Teams and the community. PARTICIPANTS: Participants were people aged ≥ 65 years with treatment-resistant generalised anxiety disorder. INTERVENTION: Participants received up to 16 one-to-one sessions of acceptance and commitment therapy, adapted for older people with treatment-resistant generalised anxiety disorder, in addition to usual care. Sessions were delivered by therapists based in primary and secondary care services, either in the clinic or at participants’ homes. Sessions were weekly for the first 14 sessions and fortnightly thereafter. MAIN OUTCOME MEASURES: The co-primary outcome measures for phase 2 were acceptability (session attendance and satisfaction with therapy) and feasibility (recruitment and retention). Secondary outcome measures included additional measures of acceptability and feasibility and self-reported measures of anxiety, worry, depression and psychological flexibility. Self-reported outcomes were assessed at 0 weeks (baseline) and 20 weeks (follow-up). Health economic outcomes included intervention and resource use costs and health-related quality of life. RESULTS: Fifteen older people with treatment-resistant generalised anxiety disorder participated in phase 1 and 37 participated in phase 2. A high level of feasibility was demonstrated by a recruitment rate of 93% and a retention rate of 81%. A high level of acceptability was found with respect to session attendance (70% of participants attended ≥ 10 sessions) and satisfaction with therapy was adequate (60% of participants scored ≥ 21 out of 30 points on the Satisfaction with Therapy subscale of the Satisfaction with Therapy and Therapist Scale-Revised, although 80% of participants had not finished receiving therapy at the time of rating). Secondary outcome measures and qualitative data further supported the feasibility and acceptability of the intervention. Health economic data supported the feasibility of examining cost-effectiveness in a future randomised controlled trial. Although the study was not powered to examine clinical effectiveness, there was indicative evidence of improvements in scores for anxiety, depression and psychological flexibility. LIMITATIONS: Non-specific therapeutic factors were not controlled for, and recruitment in phase 2 was limited to London. CONCLUSIONS: There was evidence of high levels of feasibility and acceptability and indicative evidence of improvements in symptoms of anxiety, depression and psychological flexibility. The results of this study suggest that a larger-scale randomised controlled trial would be feasible to conduct and is warranted. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12268776. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 54. See the NIHR Journals Library website for further project information

Musical preferences predict personality: evidence from active listening and Facebook likes

Research over the past decade has shown that various personality traits are communicated through musical preferences. One limitation of that research is external validity, as most studies have assessed individual differences in musical preferences using self-reports of music-genre preferences. Are personality traits communicated through behavioral manifestations of musical preferences? We addressed this question in two large-scale online studies with demographically diverse populations. Study 1 (N = 22,252) shows that reactions to unfamiliar musical excerpts predicted individual differences in personality—most notably, openness and extraversion—above and beyond demographic characteristics. Moreover, these personality traits were differentially associated with particular music-preference dimensions. The results from Study 2 (N = 21,929) replicated and extended these findings by showing that an active measure of naturally occurring behavior, Facebook Likes for musical artists, also predicted individual differences in personality. In general, our findings establish the robustness and external validity of the links between musical preferences and personality

The Use of Social Media in Enterprises for Communication, Collaboration, and Knowledge Management

Der Erfolg von Social Media im Internet hat dazu geführt, dass diese Technologie zunehmend auch in Unternehmen eingesetzt, oder über deren Implementierung nachgedacht wird. Durch die erwartete Verbesserung der Kommunikation und Interaktion zwischen Mitarbeitern auf der einen Seite und des Wissensmanagements auf der anderen Seite er-hoffen sich Entscheidungsträger in Unternehmen einen erheblichen betriebswirtschaftlichen Nutzen. Obwohl es einige Beispiele erfolgreicher Enterprise-Social-Media(ESM)-Implementierungen gibt und mehr als 90% der Fortune 500 Unternehmen ESM eingeführt haben oder dies planen, verfehlen 80% der ESM-Projekte die eingangs definierten Ziele. Während die Entscheidung, die Software einzukaufen, zentral getroffen wird, hängt deren Erfolg von der aktiven Partizipation der Mitarbeiter ab – wie sich anhand der genannten Statistiken zeigt, ist beides nicht zwangsläufig korreliert. Im Gegensatz zu organischem Wachstum, wie es in Social-Media-Anwendungen im Internet in den vergangenen Jahren beobachtet werden konnte (z.B. bei Facebook), ist die Nutzungsrate von internen ESM oft zu gering, um den Fortbestand der Community zu sichern. Es zeigt sich dabei verstärkt, dass passive Roll-Out-Strategien, die darauf vertrauen, dass es ein vergleichbares organisches Wachstum auch bei ESM gibt, zum Scheitern verurteilt sind. Viel-mehr müssen Analysen im Vorhinein das für einen spezifischen Anwendungsbereich geeignete Tool identifizieren, und Strategien entwickelt werden, wie Mitarbeiter für die Interaktion über die neuen Anwendungen gewonnen werden können. Da Ausgaben für Informationstechnologien bei einem geringen Nutzungsgrad nicht zu-rechtfertigen sind, trägt die vorliegende Dissertation in acht Essays dazu bei, verschiedene Facetten der ESM-Nutzung näher beleuchten und so zu einem besseren Verständnis des Themas und damit einhergehend einer effektiveren und effizienteren Implementierung von ESM beitragen. Sowohl die Analyse von Einflussfaktoren auf verschiedene Nutzungstypen von ESM, die Optimierung von Enterprise-Suchalgorithmen als auch die Neuinterpretation von Online-Produkt-Ratings können dabei helfen, die Veränderungen der internen und externen Kommunikation, Kollaboration und des Wissensmanagements, die sich durch den Einsatz von ESM ergeben, besser zu erklären und bedarfs-gerechter einzusetzen. Die theoretischen und praktischen Implikationen, welche sich konkret aus den einzelnen Essays ergeben, werden in den entsprechenden Abschnitten der jeweiligen Papiere erläutert

Assessment, Implication, and Analysis of Online Consumer Reviews: A Literature Review

The onset of e-marketplace, virtual communities and social networking has appreciated the influential capability of online consumer reviews (OCR) and therefore necessitate conglomeration of the body of knowledge. This article attempts to conceptually cluster academic literature in both management and technical domain. The study follows a framework which broadly clusters management research under two heads: OCR Assessment and OCR Implication (business implication). Parallel technical literature has been reviewed to reconcile methodologies adopted in the analysis of text content on the web, majorly reviews. Text mining through automated tools, algorithmic contribution (dominant majorly in technical stream literature) and manual assessment (derived from the stream of content analysis) has been studied in this review article. Literature survey of both the domains is analyzed to propose possible area for further research. Usage of text analysis methods along with statistical and data mining techniques to analyze review text and utilize the knowledge creation for solving managerial issues can possibly constitute further work. Available at: https://aisel.aisnet.org/pajais/vol9/iss2/4

Food, Health and Safety in Cross Cultural Consumer Contexts

The concept of cross-cultural perspectives in research in food is important in general and particularly so in relation to human perception in food and health. Food concepts are very different across different jurisdictions. Different markets and cultures have varying perspectives on what is considered a palatable, acceptable, or useful food or food product; in simple terms, one size does not at all in the majority of cases. Specific markets thus need targeted food design, to be successful from a myriad of perspectives. In this Special Issue anthology "Food, Health and Safety in Cross-Cultural Consumer Contexts", we bring together articles that show the wide range of studies from fundamental to market applicability currently in focus in sensory and consumer science in food, health, and safety cross-cultural contexts. From the included perspectives, it is abundantly clear that there is a need for much knowledge related to future food design linked to cross-cultural contexts and that this will continue to be critical to the success of food transfer in global food markets

AESOPS: a randomised controlled trial of the clinical effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care

BACKGROUND: There is clear evidence of the detrimental impact of hazardous alcohol consumption on the physical and mental health of the population. Estimates suggest that hazardous alcohol consumption annually accounts for 150,000 hospital admissions and between 15,000 and 22,000 deaths in the UK. In the older population, hazardous alcohol consumption is associated with a wide range of physical, psychological and social problems. There is evidence of an association between increased alcohol consumption and increased risk of coronary heart disease, hypertension and haemorrhagic and ischaemic stroke, increased rates of alcohol-related liver disease and increased risk of a range of cancers. Alcohol is identified as one of the three main risk factors for falls. Excessive alcohol consumption in older age can also contribute to the onset of dementia and other age-related cognitive deficits and is implicated in one-third of all suicides in the older population. OBJECTIVE: To compare the clinical effectiveness and cost-effectiveness of a stepped care intervention against a minimal intervention in the treatment of older hazardous alcohol users in primary care. DESIGN: A multicentre, pragmatic, two-armed randomised controlled trial with an economic evaluation. SETTING: General practices in primary care in England and Scotland between April 2008 and October 2010. PARTICIPANTS: Adults aged ≥ 55 years scoring ≥ 8 on the Alcohol Use Disorders Identification Test (10-item) (AUDIT) were eligible. In total, 529 patients were randomised in the study. INTERVENTIONS: The minimal intervention group received a 5-minute brief advice intervention with the practice or research nurse involving feedback of the screening results and discussion regarding the health consequences of continued hazardous alcohol consumption. Those in the stepped care arm initially received a 20-minute session of behavioural change counselling, with referral to step 2 (motivational enhancement therapy) and step 3 (local specialist alcohol services) if indicated. Sessions were recorded and rated to ensure treatment fidelity. MAIN OUTCOME MEASURES: The primary outcome was average drinks per day (ADD) derived from extended AUDIT--Consumption (3-item) (AUDIT-C) at 12 months. Secondary outcomes were AUDIT-C score at 6 and 12 months; alcohol-related problems assessed using the Drinking Problems Index (DPI) at 6 and 12 months; health-related quality of life assessed using the Short Form Questionnaire-12 items (SF-12) at 6 and 12 months; ADD at 6 months; quality-adjusted life-years (QALYs) (for cost-utility analysis derived from European Quality of Life-5 Dimensions); and health and social care resource use associated with the two groups. RESULTS: Both groups reduced alcohol consumption between baseline and 12 months. The difference between groups in log-transformed ADD at 12 months was very small, at 0.025 [95% confidence interval (CI)--0.060 to 0.119], and not statistically significant. At month 6 the stepped care group had a lower ADD, but again the difference was not statistically significant. At months 6 and 12, the stepped care group had a lower DPI score, but this difference was not statistically significant at the 5% level. The stepped care group had a lower SF-12 mental component score and lower physical component score at month 6 and month 12, but these differences were not statistically significant at the 5% level. The overall average cost per patient, taking into account health and social care resource use, was £488 [standard deviation (SD) £826] in the stepped care group and £482 (SD £826) in the minimal intervention group at month 6. The mean QALY gains were slightly greater in the stepped care group than in the minimal intervention group, with a mean difference of 0.0058 (95% CI -0.0018 to 0.0133), generating an incremental cost-effectiveness ratio (ICER) of £1100 per QALY gained. At month 12, participants in the stepped care group incurred fewer costs, with a mean difference of -£194 (95% CI -£585 to £198), and had gained 0.0117 more QALYs (95% CI -0.0084 to 0.0318) than the control group. Therefore, from an economic perspective the minimal intervention was dominated by stepped care but, as would be expected given the effectiveness results, the difference was small and not statistically significant. CONCLUSIONS: Stepped care does not confer an advantage over minimal intervention in terms of reduction in alcohol consumption at 12 months post intervention when compared with a 5-minute brief (minimal) intervention. TRIAL REGISTRATION: This trial is registered as ISRCTN52557360. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 25. See the HTA programme website for further project information

Participation in environmental enhancement and conservation activities for health and well-being in adults: a review of quantitative and qualitative evidence

PUBHLT