Buck, Harleah G.

ABSTRACTBackgroundAn estimated one‐third of cancer survivors suffer from post‐traumatic stress (PTS) symptoms. PTS is associated with high levels of cancer distress, anxiety, and depression. Few evidence‐based treatments are available for PTS. Accelerated Resolution Therapy (ART) is a form of trauma‐focused psychological therapy that has been found to be both safe and effective at alleviating post‐traumatic stress symptoms, psychological distress, anxiety and depressive symptoms in non‐cancer populations.MethodsThe purpose of this single arm, pilot study was to examine the preliminary efficacy of ART for alleviating post‐traumatic stress symptoms, cancer distress, depressive symptoms and anxiety among cancer survivors, as well as to evaluate baseline characteristics of persons most likely to respond to ART. Participants were provided with five ART sessions and outcome variables were assessed at enrollment, immediately following ART, and 30 days post ART. Paired t‐tests were used to examine differences between scores at each time point. Associations between the PCL‐5 score from baseline to post 30‐day visit were assessed and other variables were examined using univariate linear regression.ResultsIn a sample of 20 cancer survivors, statistically significant decreases in PTS symptoms (p < 0.0001), cancer distress (p < 0.0001), anxiety (p = 0.0002), and depression (p < 0.0001) from pre to post intervention were present. These improvements remained 30 days post‐intervention. Higher baseline PCL‐5 scores, as well as higher scores on two subscales of the cancer distress measure were associated with response to treatment.ConclusionsFindings suggest that ART is an effective therapeutic intervention for reducing PTS symptoms and cancer distress among cancer survivors.

The objective of this manuscript is to present the protocol of a study aiming to test the effects of Accelerated Resolution Therapy® (ART) on pre-loss grief and prolonged grief among older adult family caregivers. This study also aims to better understand predictors of response to ART®, and cognitive processes that occur among grieving individuals following ART®. Design: The study is a double-blinded, randomized clinical trial. Setting: This study takes place at both inpatient and outpatient palliative care and hospice programs at two Mayo Clinic sites. Participants: Participants include older adult ( ≥ 60 years) immediate family members who are primary caregivers of someone with an advanced illness and life expectancy of less than 12 months. Intervention: Participants are randomized to either the ART® intervention group or the attention control group. In the ART® intervention, caregivers engage in imaginal exposure, lateral eye movements, and imagery rescripting via 4 sessions lasting 1-1.5 hours each. The attention control group receives a standard social work intervention, including education, resources, and active listening, which is matched for time and attention. Both interventions will longitudinally follow caregivers from active caregiving into bereavement. Outcomes Measured: The primary outcomes of pre-loss grief and prolonged grief will be measured with the Pre-Loss Grief 12 item (PG-12-R) before the care recipient’s death, and with the Prolonged Grief-13 (PG-13-R) afterwards.

Little is known about the experience of family caregivers when their care partner dies and their dyadic relationship comes to an end. This study qualitatively examined and characterized the loss of the dyadic experience for the caregiver after the death of their care partner. Data was accrued as part of a randomized clinical trial in 29 older hospice caregivers. Iterative thematic analysis focused on dyadic processes before, during and post death. Using two relational parameters from Relational Turbulence Theory resulted in a preliminary characterization of a new concept—dyadic dissolution as a cognitive and affective process whereby a remaining member of a dyad experiences relational uncertainty and partner interference while adapting (or not) to the death of their care partner. Findings suggest that asking several open-ended questions about the dyadic relationship will enable assessment for any continuing impact of relational uncertainty and partner interference on bereaved caregivers.

Abstract Complicated grief (CG), severe, prolonged (&gt;12 months) grieving, disproportionately affects older adults. A prospective two-group, waitlisted RCT examined whether four sessions of Accelerated Resolution Therapy (ART) was effective in informal caregivers by comparing pre-to-post ART changes and investigating variation in treatment response by baseline CG levels. Inclusion: ≥60 years, Inventory of Complicated Grief &gt;25. Paired t-tests of mean (SD) differences compared pre- to post-ART; pre-ART to 8-week follow-up, and post-ART to 8-week follow-up; then stratified by median baseline level of CG. Mean (SD) age of 54 participants was 68.7 (7.2) years, 85% female, and 93% white. Significantly greater CG reduction (-22.8 (10.3)) vs. waitlist (-4.3 (6.0)) was found. Within-participant effect sizes from baseline to 8-weeks post treatment were 1.96 (95% CI: 1.45, 2.47; p&lt;0.0001). Treatment effects did not substantially differ by baseline levels. Lesson learned was that it was possible to successfully recruit and treat CG in the community.

Biomarkers may serve as objective measures in complicated grief (CG) potentially capturing responses to stress reduction treatment. This paper reports challenges in obtaining and assessing salivary cortisol and α-amylase (sAA) for a recent randomized clinical trial. Within-session changes in salivary cortisol and sAA for 54 older adults with CG who received Accelerated Resolution Therapy were compared with perceived stress measured by Subjective Units of Distress Scale. Bivariate correlations and multiple regressions examined changes in biomarkers. Protocols, study logs, and audit reports identified challenges. Challenges included obtaining unstimulated passive drool salivary samples and their analyses. Our sample of older females on multiple medications may have resulted in a perfect storm of moderating and intervening variables which affected the stress response. This paper contributes to the discussion on designing clinical trials for older adults which must account for physiologic changes, multimorbidity, and polypharmacy common in this population and makes recommendations moving forward.

Complicated grief is a significant health concern for older adults, resulting in significant psychological and physical morbidity. Elements of post traumatic stress disorder (PTSD) are often present in individuals with complicated grief. Accelerated Resolution Therapy (ART) is a brief form of psychotherapy that utilizes the techniques of imaginal exposure, rescripting of events, and lateral eye movements that may be useful in complicated grief with PTSD symptoms. Two cases where ART was used for complicated grief with PTSD are presented. Both individuals had attempted to come to terms with their loss through traditional grief therapy with an inadequate response and substantial residual grief symptoms. These cases illustrate how ART can be used to address CG and PTSD and describe situations where it may be appropriate. Clinical and research implications are also discussed.