Published online Jul 19, 2022. doi: 10.5498/wjp.v12.i7.970
Peer-review started: January 30, 2022
First decision: April 18, 2022
Revised: April 24, 2022
Accepted: June 16, 2022
Article in press: June 16, 2022
Published online: July 19, 2022
Older adults have been considered a primary at-risk population during the coronavirus disease 2019 (COVID-19) pandemic. Recent evidence has shown that enhancing proactive coping abilities through psychological interventions can support older adults throughout the pandemic. However, the underlying mechanisms by which specific intervention components affect various mental states among older adults remain unclear and warrant investigation.
We previously reported the results of a short-term, internet-based intervention which was found to alleviate symptoms of loneliness and depression among older adults during the initial COVID-19 outbreak and the first general lockdown in Israel. We focused then on the effectiveness and acceptability of the intervention as a whole, but did not explore whether the mechanisms of change in mental states were related to the use of those specific techniques that constituted the full protocol. We believe that a better understanding of the role of each interventional strategy can support the design of more concise and efficient interventions tailored to the needs of different populations and mental states.
To determine the effect of an intervention using cognitive-behavioral and mindfulness techniques on changes in distress, depression and loneliness. Furthermore, we explored the links between the different techniques that were learned in terms of changes in psychological distress during sessions, as well as the effect of these changes (in distress) on post-intervention depressive symptoms and loneliness.
We performed a secondary analysis on data from the original intervention described above. The intervention included seven sessions during which various cognitive-behavioral and mindfulness techniques were learned and practiced. In-session changes in psychological distress were measured using the Subjective Units of Distress Scale (SUDS) which participants rated at the beginning and end of each session. In addition, levels of depression (Patient Health Questionnaire) and loneliness (UCLA Loneliness Scale) were assessed prior to and after the entire intervention process. The effect of in-session changes in the SUDS on changes in post-intervention depression and loneliness levels were assessed as a proxy for distinct technique effectiveness.
The findings indicated in-session differences in terms of decreases in psychological distress. Sessions during which the techniques of relaxation exercises and guided imagery were learned, and sessions during which cognitive restructuring and mindfulness meditation were learned, led to the highest reduction in distress, and these reductions were related to significant changes in levels of post-intervention loneliness and depression, correspondingly.
Different psychological techniques seem to have different effects on the specific mental states that were assessed in the current study. The findings shed light on potential paths by which different therapeutic interventions might affect mental health outcomes among older adults specifically, and thus have implications for future intervention design. These insights may help in the enhancement of older individuals’ resilience during future outbreaks and other emergencies.
Larger studies are needed to allow for subgroup analyses that would enable the determination of effectiveness for different program elements in a more robust manner.