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Objectives: The purpose of this project was to develop, implement, and evaluate a 12-session Acceptance and Commitment Therapy (ACT) for Older Veterans group protocol., Methods: The Plan-Do-Study-Act (PDSA) quality improvement model was the foundational process for this project. Veterans age 55 years and older participated in an ACT for Older Veterans group in an outpatient geropsychology clinic at a Veterans Affairs Medical Center. Study methods included analysis of participant feedback gathered in a focus group, process measures (i.e., number of sessions attended and number of early terminations), and outcome measures (i.e., depressive symptoms, anxiety symptoms, and psychological flexibility)., Results: Seventeen participants completed an average of ten sessions. Less than 25% of participants terminated early. Depressive symptoms improved, though there were no statistically significant changes in anxiety symptoms and psychological flexibility. The focus group yielded several recommendations that were implemented in subsequent groups., Conclusions: The PDSA model helped in the development of a group therapy intervention that is both relevant and beneficial to older Veterans presenting with a variety of biopsychosocial issues. Results provide support for further research investigation of ACT for Older Veterans Group., Clinical Implications: ACT used in a group format is a feasible and acceptable psychotherapy for older Veterans.

Introduction: Depression and anxiety disorders are highly prevalent among primary care patients. Group visits provide a way of delivering interventions to multiple patients at the same time. Group visits for depression and anxiety present an opportunity to expand the reach of behavioral health services for primary care patients. The goal of the current study was to evaluate the implementation of an acceptance and mindfulness-based group for primary care patients with depression and anxiety., Methods: Adult family medicine patients with Patient Health Questionnaire-9 (PHQ-9) and/or Generalized Anxiety Disorder Scale-7 (GAD-7) scores > 5 were eligible for the group. The group was held biweekly in the family medicine practice with rolling enrollment. The PHQ-9 and GAD-7 were administered at every visit, and changes in depression and anxiety symptoms were analyzed using multilevel modeling. We evaluated feasibility, acceptability/satisfaction, penetration, and sustainability., Results: Over the course of 19 months, 50 patients were referred to the group, and 29 enrolled. The median number of visits attended was four among those who attended more than one group visit. Results revealed that depression and anxiety symptoms decreased significantly over the first four visits attended (d = -.26 and -.19, respectively). Patients who attended more than one group reported high satisfaction. The group was sustainable after the research funding ended; however, penetration was low., Discussion: A rolling enrollment group for patients with depression and anxiety that utilized mindfulness- and acceptance-based treatment principles is feasible to implement in a primary care setting but is not without challenges. Recommendations for ways to enhance implementation and future research are provided. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Objective: To test the effectiveness at 6 and 12 months' follow-up of group cognitive behavioural therapy (CBT) compared with blood glucose awareness training (BGAT) in poorly controlled Type 1 diabetic patients and to explore the moderating effect of baseline depression., Research Design and Methods: Adults with Type 1 diabetes (n = 86) with glycated haemoglobin (HbA(1c)) >or= 8% were randomized to CBT or BGAT. Primary outcome was HbA(1c) control. Secondary outcomes were: self-care, diabetes-related distress (Problem Areas in Diabetes scale; PAID), diabetes self-efficacy (Confidence in Diabetes Self-care scale; CIDS) and depressive symptoms (Centre for Epidemiological Studies--Depression scale; CES-D). Measurements were scheduled before CBT and BGAT, and at 3, 6 and 12 months after. Differential effects were analysed for the subgroup of patients reporting low vs. high baseline levels of depression., Results: Neither CBT nor BGAT had a significant impact on HbA(1c) at 6 and 12 months' follow-up. Both interventions resulted in lower depressive symptoms (CES-D 15.7-13.3, P = 0.01) up to 12 months, but only CBT was effective in lowering HbA(1c) in patients with high baseline depression scores (HbA(1c) 9.5-8.8%) up to 1 year of follow-up (P = 0.03)., Conclusions: Our findings suggest that group CBT can effectively help Type 1 diabetic patients with co-morbid depression achieve and maintain better glycaemic outcomes.

Introduction: Psychotherapy of depressive conditions is more and more in demand by patients. The effect of individual cognitive behavioral therapy (CBT) on depression is well-documented, and foreign studies indicate that group CBT also works well. There was no Danish manual on group CBT for the purpose of clinical implementation. The aim of the present project was to develop such a manual and complete a preliminary evaluation of the outcome., Materials and Methods: A therapy manual consisting of 12 group sessions of 2 hours duration was developed. A constituent part of the evaluation of the clinical effect was 10 group courses with a total of 51 consecutively referred patients with a non-psychotic depression requiring treatment., Results: On the basis of clinical experience, the manual has been revised and is now ready for publication. 80% of the patients completed the therapy course with a large Effect Size (ES) on psychiatric/depression symptoms (SCL-90R) and function level (GAF), as well as moderate ES on the degree of hopelessness (BHS)., Conclusion: The development and clinical implementation of a manual in cognitive behavioral group therapy has resulted in this treatment now being offered as permanent treatment for depressive patients throughout the cooperating centers. The existing manual can relatively easily be implemented in other treatment centers and clinics. The preliminary results are positive, but the design does not permit further conclusions.

Geriatric depression is a disabling illness that is associated with increased morbidity and mortality and deserves aggressive and early intervention. Cognitive-behavioral group therapy is an effective intervention for the treatment of geriatric depression and can be used with residents in an assisted living facility to manage and prevent depression. Cognitive-behavioral group therapy protocol modifications for residents in assisted-living facilities aids their participation and learning.