Effect of distinct psychological interventions on changes in self-reported distress, depression and loneliness among older adults during COVID-19

Abstract

Background: Older adults have been considered a primary at-risk population during the coronavirus disease 2019 (COVID-19) pandemic, and many efforts have been and still are directed toward supporting them and enhancing their capacity to cope with the pandemic. Evidence shows that by enhancing proactive coping abilities through psychological interventions, in which cognitive-behavioral and mindfulness techniques are taught and practiced effectively, these interventions have supported older adults throughout the pandemic. However, the underlying mechanisms by which specific intervention components affect various mental states such as distress, depression and loneliness among older adults remain unclear and warrant investigation.

Aim: To determine the effect of an intervention using cognitive-behavioral and mindfulness techniques on changes in distress, depression and loneliness.

Methods: We performed a secondary analysis on data from a previous study in which community-dwelling older adults attended a short-term, internet-based intervention during the first COVID-19 wave in Israel. 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. Participants also filled out questionnaires that evaluated levels of depression [Patient Health Ques-tionnaire (PHQ-9)] and loneliness (UCLA loneliness Scale) 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.

Results: The findings indicated in-session differences in terms of a decrease in psychological distress (SUDS). Sessions that included relaxation exercises and guided imagery, as well as sessions that included cognitive restructuring and mindfulness meditation, demonstrated the largest decreases in in-session psychological distress (≥ 35%). Two multivariate regression models, one for levels of post-intervention depression (PHQ-9 score) and the other for levels of post-intervention loneliness (UCLA loneliness score), were fitted. The results revealed two statistically significant explanatory variables for depression: The SUDS difference for sessions in which cognitive restructuring and mindfulness meditation were practiced, beta = -0.25, 95%CI: -1.23 to -0.1, and the pre-intervention level of depression, beta = 0.62, 95%CI: 0.37-0.75. The second model for loneliness revealed only one significant explanatory variable: The SUDS difference for sessions in which relaxation and guided imagery were practiced, beta = 0.41, 95%CI: 0.14-0.65.

Conclusion: Different psychological techniques seem to have different effects on distress, loneliness and depression. Understanding the pathways by which distinct techniques affect negative mental symptoms has implications for future intervention design.

Keywords: Aged; COVID-19; Cognitive behavioral therapy; Depression; Intervention studies; Loneliness; Subjective Units of Distress Scale.

Figure 1

Intervention protocol: Skills and techniques learned in each session.

Figure 2

Mean values for the Subjective Units of Distress Scale measure at the start and end of the intervention sessions for the entire study sample (n = 64). The dashed lines and accompanying values represent the mean percentage of change in Subjective Units of Distress Scale scores for each session. SUDS: Subjective Units of Distress Scale.