Acceptance and commitment therapy (ACT) for people with dementia experiencing psychological distress: A hermeneutic single-case efficacy design (HSCED) series

IntroductionPeople with dementia have a high prevalence of psychological distress but are underserved with evidence-based psychological interventions. To promote choice and improve clinical outcomes, there is a necessity to test different psychological intervention options for this population. PurposeThis study aimed to investigate the effectiveness and acceptability of acceptance and commitment therapy (ACT) for people with dementia, considering carer-supported, remote delivery and necessary therapy adaptations. MethodsA hermeneutic single-case efficacy design series was used to analyse the therapy process and change for three clients with dementia and psychological distress. A matrix of quantitative and qualitative data was collated (rich case records) and subject to critical analyses by three independent psychotherapy experts (judges) who identified change processes and determined the outcome for each client. ResultsAdjudication concluded that one client made positive changes, specifically reliable reductions in psychological distress, which were largely attributable to ACT. Two clients remained unchanged. Discussion/ConclusionWhere change was achieved, the ACT-specific processes of values, committed action and acceptance, in combination with non-specific therapy factors, including a strong client-carer relationship, existing client interests and individualised therapy adaptations, were facilitative. Hence, ACT may be a feasible and effective vehicle for therapeutic change by helping carers to better meet the needs of their loved ones. Future research to optimise ACT delivery in this population may be beneficial. Furthermore, the assessment of carer factors (e.g., their psychological flexibility and the client-carer relationship) may strengthen the evidence base for systemic ACT use.

Automated summary

This study investigated the effectiveness and acceptability of acceptance and commitment therapy (ACT) for people with dementia, considering carer-supported, remote delivery and necessary therapy adaptations. The results showed that ACT had positive effects in reducing psychological distress and helping carers meet the needs of their loved ones. Future research should focus on optimizing ACT delivery in this population.