Kicks, Ella
(2025)
EnACTing change: an exploration of older adults experiences of change with Acceptance and Commitment Therapy.
DClinPsy thesis, University of Nottingham.
Abstract
Background
Older adults (OAs) are an increasing demographic, with a range of physical health and mental health challenges that are unprioritized. Psychotherapy has utility with OAs, despite assumptions about their difficulties engaging due to the comorbidities of their physical and mental health and social stressors. The promising evidence base and the transdiagnostic and practical nature of Acceptance and Commitment Therapy (ACT) makes it appear uniquely suited for this client group (Petkus & Wetherell., 2013; Robert et al., 2016). However, there is a lack of exploration of the processes of change for ACT, for OAs, and generally – despite that understanding processes of change is thought allow for the optimisation of psychotherapy (Kazdin, 2007).
Methods
This thesis project completed secondary qualitative analysis using Change Interview data from three Hermeneutic Single Case Efficacy Design series studies that used ACT interventions with OAs with dementia, or depression and anxiety, or who were hearing voices. An inductive-deductive reflexive thematic analysis was used, and the inductive analysis allowed for exploration of OAs experiences of change. The deductive analysis allowed for exploration of the theoretically proposed ACT-specific and common factors processes that might have underpinned experiences of change. Analysis was completed on the semantic and latent levels of meaning, and saliency analysis and consultation with an expert by experience were used to enhance analysis.
Results
Three themes were generated from the data and highlighted that participants experiences of change were moderated by whether it was the right time for them to engage considering their circumstances and access to internal and external resources, that therapy led to behavioural changes and realisations, and that they experienced they experienced positive therapeutic relationships and their therapists as skilled, but that therapy was exposing. ACT-specific processes of psychological flexibility were evidenced throughout, but so were the processes of psychological inflexibility. This might explain some of the variance in change captured in the original studies.
Discussion
This thesis has provided a unique contribution to the literature by highlighting how OAs experienced change, the contexts that impact their experiences of change, and the therapy-specific and common factors processes that mapped onto their experiences of change. The findings have provided evidence towards the transdiagnostic nature of ACT. The findings are theoretically aligned the findings with the understanding of change-processes, the behavioural origins of ACT. However, the results give greater detail about the contexts and types of factors that impact OAs experiences of change, and provide experiential evidence to supplement the current evidence base for ACT. Future research would do well to address the limitations of this study in terms of the limited diversity of OAs, and to consider using current ideas like social capital or stabilisation to help OAs to engage at the right time and with the right resources to benefit from therapy.
This study has also provided evidence towards the utility of secondary qualitative analysis for the field of contextual behavioural science, and how Change Interview data can be used to provide new insights with populations where research can be burdensome.
Actions (Archive Staff Only)
 |
Edit View |
Tools
Tools
