Development of a video-delivered relaxation treatment of late-life anxiety for veterans
Open accessAbstract
BACKGROUND: Behavioral treatments reduce anxiety, yet many older adults may not have access to these efficacious treatments. To address this need, we developed and evaluated the feasibility and acceptability of a video-delivered anxiety treatment for older Veterans. This treatment program, BREATHE (Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment), combines psychoeducation, diaphragmatic breathing, and progressive muscle relaxation training with engagement in activities. METHODS: A mixed methods concurrent study design was used to examine the clarity of the treatment videos. We conducted semi-structured interviews with 20 Veterans (M age = 69.5, SD = 7.3 years; 55% White, Non-Hispanic) and collected ratings of video clarity. RESULTS: Quantitative ratings revealed that 100% of participants generally or definitely could follow breathing and relaxation video instructions. Qualitative findings, however, demonstrated more variability in the extent to which each video segment was clear. Participants identified both immediate benefits and motivation challenges associated with a video-delivered treatment. Participants suggested that some patients may need encouragement, whereas others need face-to-face therapy. CONCLUSIONS: Quantitative ratings of video clarity and qualitative findings highlight the feasibility of a video-delivered treatment for older Veterans with anxiety. Our findings demonstrate the importance of ensuring patients can follow instructions provided in self-directed treatments and the role that an iterative testing process has in addressing these issues. Next steps include testing the treatment videos with older Veterans with anxiety disorders.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Depending on the type and severity of a person's mental health symptoms, studies that involved health care providers supporting digital intervention use reported that there was sometimes a need for face-to-face contact.
“Depending on the type and severity of a person’s mental health symptoms, studies that involved health care providers supporting digital intervention use reported that there was sometimes a need for face-to-face contact, as issues could be difficult to address remotely via a digital platform [102-104].”
From Barriers to and facilitators of user engagement with digital mental health interventions: Systematic review (2021) · cites this paper as [102]
Cites
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987) · Journal of Chronic Diseases · doi:10.1016/0021-9681(87)90171-8 · Cited by 49,742 · see citing works
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
Kytle, J., & Bandura, A. (1978) · Contemporary Sociology · doi:10.2307/2065952 · Cited by 25,422 · see citing works
Designing and Conducting Mixed Methods Research
Robinson, P. M. (2007) · Australian and New Zealand Journal of Public Health · doi:10.1111/j.1753-6405.2007.00096.x · Cited by 23,297 · see citing works
How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability
Guest, G., Bunce, A., & Johnson, L. (2006) · Field Methods · doi:10.1177/1525822x05279903 · Cited by 20,808 · see citing works
Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., Stewart, L. A., & the PRISMA-P Group (2015) · BMJ · doi:10.1136/bmj.g7647 · Cited by 13,120 · see citing works
Designing and Conducting Mixed Methods Research
นิลพันธุ์, ม. (2010) · Silpakorn Educational Research Journal · Cited by 9,350 · see citing works
Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study
Vaismoradi, M., Turunen, H., & Bondas, T. (2013) · Nursing & Health Sciences · doi:10.1111/nhs.12048 · Cited by 8,327 · see citing works
Qualitative research: standards, challenges, and guidelines
Malterud, K. (2001) · The Lancet · doi:10.1016/s0140-6736(01)05627-6 · Cited by 5,014 · see citing works
Enhancing the quality and credibility of qualitative analysis.
(1999) · PubMed Central · Cited by 4,133 · see citing works
Validation of a short Orientation-Memory-Concentration Test of cognitive impairment
Katzman, R., Brown, T., Fuld, P. A., Peck, A., Schechter, R., & Schimmel, H. (1983) · American Journal of Psychiatry · doi:10.1176/ajp.140.6.734 · Cited by 2,119 · see citing works
Can Comorbidity Be Measured By Questionnaire Rather than Medical Record Review?
Katz, J. N., Chang, L. C., SANGHA, O., Fossel, A. H., & Bates, D. W. (1996) · Medical Care · doi:10.1097/00005650-199601000-00006 · Cited by 1,035 · see citing works
Motivational interviewing in health care: helping patients change behavior
(2008) · Choice Reviews Online · doi:10.5860/choice.45-6211 · Cited by 907 · see citing works
Cuijpers, P., Donker, T., van Straten, A., Li, J., & Andersson, G. (2010) · Psychological Medicine · doi:10.1017/s0033291710000772 · Cited by 832 · see citing works
Benzodiazepine use and risk of Alzheimer's disease: case-control study
de Gage, S. B., Moride, Y., Ducruet, T., Kurth, T., Verdoux, H., Tournier, M., Pariente, A., & Bégaud, B. (2014) · BMJ · doi:10.1136/bmj.g5205 · Cited by 560 · see citing works
More Than Miracles: The State of the Art of Solution-Focused Brief Therapy
de Shazer, S., Dolan, Y. M., Korman, H., Trepper, T. S., McCollum, E. E., & Berg, I. K. (2007) · Cited by 433 · see citing works
Stepped-Care Prevention of Anxiety and Depression in Late Life
Veer-Tazelaar, P. J. V., van Marwijk, H., van Oppen, P., van Hout, H. P. J., van der Horst, H. E., Cuijpers, P. J., Smit, F., & Beekman, A. T. F. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2008.555 · Cited by 320 · see citing works
Gould, R. L., Coulson, M. C., & Howard, R. J. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2011.03824.x · Cited by 267 · see citing works
Introduction to the special section on stepped care models in psychotherapy.
Haaga, D. A. F. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.4.547 · Cited by 259 · see citing works
Porensky, E. K., Dew, M. A., Karp, J. F., Skidmore, E., Rollman, B. L., Shear, M. K., & Lenze, E. J. (2009) · The American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e31819b87b2 · Cited by 255 · see citing works
Segal, D. L., June, A., Payne, M., Coolidge, F. L., & Yochim, B. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.05.002 · Cited by 219 · see citing works
(2000) · Cited by 185 · see citing works
Quality of life in geriatric generalized anxiety disorder: a preliminary investigation
Loebach Wetherell, J., Thorp, S. R., Patterson, T. L., Golshan, S., Jeste, D. V., & Gatz, M. (2004) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2003.09.003 · Cited by 170 · see citing works
Self-citationHall, J., Kellett, S., Berrios, R., Bains, M. K., & Scott, S. (2016) · The American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2016.06.006 · Cited by 157 · see citing works
Designing Training and Instructional Programs for Older Adults
Czaja, S. J., & Sharit, J. (2012) · CRC Press eBooks · doi:10.1201/b13018 · Cited by 138 · see citing works
Meta-analysis comparing different behavioral treatments for late-life anxiety
Thorp, S. R., Ayers, C. R., Nuevo, R., Stoddard, J. A., Sorrell, J. T., & Wetherell, J. L. (2009) · The American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e31818b3f7e · Cited by 134 · see citing works
Self-citationEfficacy of Pursed-Lips Breathing
Nield, M., Hoo, G. W. S., Roper, J. M., & Santiago, S. (2007) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/01.hcr.0000281770.82652.cb · Cited by 128 · see citing works
Anxiety is associated with increased risk of dementia in older Swedish twins
Petkus, A. J., Reynolds, C. A., Wetherell, J. L., Kremen, W. S., Pedersen, N. L., & Gatz, M. (2015) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2015.09.008 · Cited by 92 · see citing works
Self-citationGould, C. E., Segal, D. L., Yochim, B. P., Pachana, N. A., Byrne, G. J., & Beaudreau, S. A. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.08.001 · Cited by 84 · cited 1× · see citing works
“%) obtaining scores above the GAS cut-off (> 16) in community dwelling older adults (Gould et al., 2014).”
BackgroundSelf-citationDepression and anxiety symptoms in male veterans and non‐veterans: the Health and Retirement Study
Gould, C. E., Rideaux, T., Spira, A. P., & Beaudreau, S. A. (2014) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4193 · Cited by 81 · see citing works
Self-citationZou, J. B., Dear, B. F., Titov, N., Lorian, C. N., Johnston, L., Spence, J., Knight, R. G., Anderson, T. M., & Sachdev, P. S. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.04.002 · Cited by 71 · see citing works
A community based survey of older adults' preferences for treatment of anxiety.
Mohlman, J. (2011) · Psychology and Aging · doi:10.1037/a0023126 · Cited by 71 · see citing works
Motivational Interviewing in Health Care: Helping Patients Change Behavior
Kleban, M. (2009) · Psychiatric Services · doi:10.1176/appi.ps.60.9.1275-a · Cited by 66 · see citing works
Gum, A. M., Iser, L., & Petkus, A. (2010) · The American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181c29495 · Cited by 64 · see citing works
Age at Onset of Generalized Anxiety Disorder in Older Adults
Chou, K.-L. (2009) · The American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e31818f3a93 · Cited by 61 · see citing works
Progressive and imaginal relaxation training for elderly persons with subjective anxiety.
Scogin, F. R., Rickard, H. C., Keith, S., Wilson, J., & al, E. (1992) · Psychology and Aging · doi:10.1037/0882-7974.7.3.419 · Cited by 59 · see citing works
Newman, M. G., & Fisher, A. J. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0031690 · Cited by 45 · cited 6× · see citing works
“The leading non-pharmacological treatment, Cognitive Behavioral Therapy (CBT), has been tested in many studies of late-life anxiety, predominantly focused on generalized anxiety disorder (GAD).”
ResultInfluentialOtt, D. L. (2024) · Edward Elgar Publishing eBooks · doi:10.4337/9781803928180.ch33 · Cited by 27 · see citing works
Karlin, B. E., & Cross, G. M. (2014) · American Psychologist · doi:10.1037/a0037384 · Cited by 16 · see citing works
Guided self-help for generalized anxiety disorder in older adults.
Landreville, P., Gosselin, P., Grenier, S., Hudon, C., & Lorrain, D. (2016) · Aging & Mental Health · doi:10.1080/13607863.2015.1060945 · Cited by 14 · cited 1× · see citing works
“Two studies demonstrate the feasibility and potential benefit of GSH treatments for late-life anxiety, with one testing internet-based CBT for anxiety (Zou et al., 2012) and the other testing written CBT modules (i.e. bibliotherapy; Landreville et al., 2016).”
Background
Flagged first, then by citations
Cited by
Sorted by citations
Borghouts, J., Eikey, E., Mark, G., De Leon, C., Schueller, S. M., Schneider, M., Stadnick, N., Zheng, K., Mukamel, D., & Sorkin, D. H. (2021) · Journal of Medical Internet Research · doi:10.2196/24387 · Cited by 1,069 · see citing works
“As seen in Multimedia Appendix 2, the 208 articles included in this review [27-237] reported on 2 types of user studies: (1) 69 studies were needs assessments that aimed to understand user needs and attitudes toward DMHIs without or before engaging with a specific intervention as part of a study and (2) 135 studies we…”
BackgroundSu, J. J., Yu, D. S. F., & Paguio, J. T. (2019) · Journal of Advanced Nursing · doi:10.1111/jan.14272 · Cited by 101 · see citing works
Yin, R., Martinengo, L., Smith, H. E., Subramaniam, M., Griva, K., & Car, L. T. (2024) · The Lancet Healthy Longevity · doi:10.1016/j.lanhl.2024.08.007 · Cited by 44 · see citing works
Mental Health Needs of Aging Veterans: Recent Evidence and Clinical Recommendations
Karel, M. J., Wray, L. O., Adler, G., Hannum, A. O. R., Luci, K., Brady, L., & McGuire, M. H. (2020) · Clinical Gerontologist · doi:10.1080/07317115.2020.1716910 · Cited by 34 · see citing works
Guthrie-Gower, S., & Wilson, G. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269678 · Cited by 30 · see citing works
Peng, R., Li, X., Guo, Y., Ning, H., Huang, J., Jiang, D., Feng, H., & Liu, Q. (2024) · Digital Health · doi:10.1177/20552076241234628 · Cited by 26 · see citing works
Gould, C., Kok, B. C., Ma, V. K., Wetherell, J., Sudheimer, K., & Beaudreau, S. (2018) · The American journal of geriatric psychiatry · doi:10.1016/j.jagp.2018.12.018 · Cited by 20 · see citing works
Self-citationPoetar, C.-R., & Dobrean, A. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1684-0 · Cited by 10 · see citing works
Distinctions between depression and anxiety with fear of being a burden in late life
Alfaro, A., Carlson, C., Segal, D., & Gould, C. (2021) · Aging & Mental Health · doi:10.1080/13607863.2021.1993131 · Cited by 10 · see citing works
Self-citationGuided Self-Management Targeting Anxiety and Activity Participation in Older Veterans
Gould, C., Carlson, C., Wetherell, J., O'Hara, R., Goldstein, M., Loup, J., Ma, F., & Beaudreau, S. (2020) · Aging & Mental Health · doi:10.1080/13607863.2020.1758905 · Cited by 6 · see citing works
Self-citationThompson, A., Naidoo, D., Becker, E., Trentino, K. M., Rooprai, D., & Lee, K. (2024) · Healthcare · doi:10.3390/healthcare12202084 · Cited by 6 · see citing works
Stanford, J. A., & Just, S. A. (2025) · JMIR Mental Health · doi:10.2196/70321 · Cited by 4 · see citing works
Depression Self-Care Apps’ Characteristics and Applicability to Older Adults: Systematic Assessment
Yin, R., Rajappan, D., Martinengo, L., Chan, F. H. F., Smith, H. E., Griva, K., Subramaniam, M., & Car, L. T. (2025) · Journal of Medical Internet Research · doi:10.2196/56418 · Cited by 6 · see citing works
Gould, C. E., Carlson, C., Wetherell, J., Goldstein, M. K., Anker, L., & Beaudreau, S. (2024) · JMIR Aging · doi:10.2196/56959 · Cited by 3 · see citing works
Self-citationGanapathy, A., Casey, L. M., Rowland, D. P., Grady, A. B., Sotheren, K. V., & Clough, B. A. (2023) · Advances in Mental Health · doi:10.1080/18387357.2023.2254864 · Cited by 4 · see citing works
Barriers to Implementing Evidence-Based Treatments for Anxiety Disorders in Community Settings
Youn, S. J., Silvan, Y. A., Bartuska, A. D., & Marques, L. M. (2019) · Current clinical psychiatry · doi:10.1007/978-3-030-30687-8_18 · Cited by 3 · see citing works
Anxiety and its disorders in old age
Beaudreau, S., Gould, C., Kolderup, S. S., & Mashal, N. M. (2020) · Handbook of Mental Health and Aging · doi:10.1016/b978-0-12-800136-3.00011-9 · Cited by 1 · see citing works
Self-citationMental Health and Treatment Considerations for Older Adults
Edelstein, B. A., Spalding, R., & Katz, E. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00137-0 · Cited by 3 · see citing works
Gould, C. E., Zapata, A. M. L., Shinsky, D. N., & Goldstein, M. K. (2017) · Educational Gerontology · doi:10.1080/03601277.2017.1395986 · Cited by 2 · see citing works
Self-citationReis, J., Hills, S., Robinson, T., & Hills, D. (2024) · Contemporary Nurse · doi:10.1080/10376178.2024.2310254
Liu, K., & Zhou, S. (2021) · OSF Preprints (OSF Preprints)
- Authors
- Gould, C. E., Zapata, A. M. L., Bruce, J., Bereknyei Merrell, S., Wetherell, J. L., O'Hara, R., Kuhn, E., Goldstein, M. K., & Beaudreau, S. A.
- Affiliations
- VA Palo Alto Health Care System (US)
- Palo Alto University (US)
- Stanford Medicine (US)
- University of California San Diego (US)
- Corresponding author
- Gould, Christine E.
- ORCID
- Venue
- International Psychogeriatrics
- Publisher
- Elsevier BV
- Published
- 2017-10
- Volume
- 29
- Issue
- 10
- Pages
- 1633-1645
- ISSN
- 1041-6102 (ISSN-L)
- OpenAlex
- W2622300191
- Cited by
- 23
- References
- 40
- Citations by year
- 2025: 2 · 2024: 5 · 2023: 1 · 2022: 1 · 2021: 6 · 2020: 3 · 2019: 2 · 2018: 2 · 2017: 1
- FWCI
- 2.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Psychogeriatrics (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Funders
- National Alliance for Research on Schizophrenia and Depression
- Rehabilitation Research and Development Service (RRandD IK2 RX001478, RR&D IK2 RX001478)
- Brain and Behavior Research Foundation
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- late-life anxiety, older veterans, diaphragmatic breathing, progressive muscle relaxation, psychoeducation, treatment feasibility, acceptability
- MeSH terms
- Aged, Aged, 80 and over, Anxiety, Anxiety Disorders, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Self Care, Veterans, Videodisc Recording, Cognitive Behavioral Therapy, Treatment Outcome, Telemedicine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
