(PS2-30) Emotion Regulation Treatment to Enhance Active Aging in Older Adults with Affective Distress: A Pilot Study Comparing Therapist-Delivered and Self-Guided Unified Protocol (UP) Modalities

Anxiety, depression, and emotional distress more broadly and commonly interfere with daily activities in older adults and contribute to worse health outcomes. Transdiagnostic modalities capable of addressing multiple disorders, such as the Unified Protocol (UP), offer promising avenues to reduce emotional distress and enhance mobility in 65+ adults. This pilot study aimed to develop and evaluate a transdiagnostic intervention for older adults with affective disorders and reduced activity levels. Conducted in two phases, Phase 1 iteratively adapted the therapist-delivered UP treatment using stakeholder feedback and successive cohort testing, and also developed a virtual self-guided version. Phase 2 involved a parallel-arm randomized controlled trial comparing the Self-Guided (SG) and Therapist-Delivered (TD) versions in older adults experiencing clinically significant emotional distress.

Sixteen participants (age ≥ 65) with moderate emotional distress (PROMIS T-score ≥ 60) and reduced daily activity (PSFS < 5) were randomized to either SG or TD treatment. Both groups completed five treatment sessions, with follow-up assessments at one week and one-month post-treatment. We examined treatment feasibility and acceptability (session attendance, attrition rates, client satisfaction [CSQ-8]), primary clinical outcomes (Patient Specific Functional Scale [PSFS]), and secondary outcomes assessing emotional distress (PROMIS depression/anxiety), cognitive flexibility (CFS), experiential avoidance (BEAQ), mindfulness (SMQ), and physical activity (gait speed, daily step count).

Results indicated high feasibility, with 100% treatment completion and good adherence (84%). The TD group reported significantly higher treatment satisfaction [CSQ scores; t(19.96)=2.33, p=0.030; Cohen’s d = .92] and confidence in recommending the intervention at one-week follow-up, though differences diminished by one month (d_CSQ = .40, p</em> > .05). Both groups showed improvements in personal functioning (PSFS scores), with Bayesian analysis supporting clinically meaningful changes corresponding to a large pre-post effect size (d = 3.11) with no differences between conditions. Secondary outcomes mirrored these patterns, showing a significant reduction in emotional distress (d_anxiety = 1.14; d_depression = 0.81), and improvements in cognitive flexibility (d = 0.58), experiential avoidance (d = 0.81), and mindfulness (d = 0.87 ), with no differences between conditions. Physical activity measures showed modest gains (ds = 0.17-0.18).

These findings support the feasibility and preliminary efficacy of both intervention formats. While the TD approach may offer greater initial engagement, the SG format presents a scalable alternative for increasing access to evidence-based interventions for older adults. Limitations and future directions will be discussed.