Regular Research Article
The Peaceful Mind Program: A Pilot Test of a Cognitive–Behavioral Therapy–Based Intervention for Anxious Patients with Dementia

https://doi.org/10.1016/j.jagp.2013.01.007Get rights and content

Objectives

To assess feasibility and to conduct a preliminary evaluation of outcomes following Peaceful Mind, a cognitive-behavioral therapy-based intervention for anxiety in dementia, relative to usual care.

Design

Pilot randomized controlled trial including assessments at baseline and 3 and 6 months.

Setting

Houston, TX.

Participants

Thirty-two outpatients diagnosed with mild (47%) or moderate (53%) dementia receiving care through outpatient clinics at the Veterans Affairs medical center, Baylor College of Medicine, Harris County Hospital District, and community day centers for dementia, and their collaterals, who spent at least 8 hours a week with them.

Intervention

Peaceful Mind included up to 12 weekly in-home sessions (mean: 8.7, SD: 2.27) during the initial 3 months and up to eight brief telephone sessions (mean: 5.4, SD: 3.17) during months 3–6, involving self-monitoring for anxiety, deep breathing, and optional skills (coping self-statements, behavioral activation, and sleep management). Patients learned skills, and collaterals served as coaches. In usual care, patients received diagnostic feedback, and providers were informed of inclusion status.

Measurements

Neuropsychiatric Inventory-Anxiety subscale, Rating Anxiety in Dementia scale, Penn State Worry Questionnaire-Abbreviated, Geriatric Anxiety Inventory, Geriatric Depression Scale, Quality of Life in Alzheimer disease, Patient Health Questionnaire, and Client Satisfaction Questionnaire.

Results

Feasibility was demonstrated with regard to recruitment, attrition, and treatment characteristics. At 3 months, clinicians rated patients receiving Peaceful Mind as less anxious, and patients rated themselves as having higher quality of life; collaterals reported less distress related to loved ones' anxiety. Although significant positive effects were not noted in other outcomes or at 6-month follow-up, the pilot nature of the trial prohibits conclusions about efficacy.

Conclusions

Results support that Peaceful Mind is ready for future comparative clinical trials.

Section snippets

Participants

Participants were recruited from outpatient clinics at 1) the Veterans Affairs medical center (geriatrics, primary care, neurology, and psychiatry); 2) Baylor College of Medicine's affiliated geriatric, primary care and Alzheimer disease center; 3) the Harris County Hospital District's geriatric service; and 4) community day centers specializing in dementia care. Potential participants were identified, using three different recruitment strategies: 1) direct provider referral; 2) facilitated

Patient and Caregiver Characteristics

Sample characteristics are given in Table 1. Base-line scores suggested clinically significant anxiety on primary measures (NPI-A, RAID) and mild symptoms on secondary measures (PSWQ-A, GAI). The majority (65%) had at least one psychiatric diagnosis. GAD was the most frequent principal diagnosis, and comorbid anxiety and depressive disorders were common. Most patients (75%) were taking psychotropic medication, most frequently antidepressants (59%). Patients self-reported minimal depressive

Discussion

Feasibility of the Peaceful Mind intervention was demonstrated in a number of ways. First, the inclusion rate from direct provider referral (39%) was comparable to studies of depression treatment among older adults with executive dysfunction (43%),24, 27, 28 and inclusion via facilitated provider referral (16%) was comparable to our own prior work using a similar recruitment strategy (14%).32 In addition, attrition from Peaceful Mind was within the range of rates reported in clinical trials of

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