Discussion
Anxiety, memory loss, ADRD, ’, teasing, cognitive and social engagement, avoidance behaviors, depression
SECONDARY
To our knowledge, this is the first study to investigate the efficacy of a brief psychological intervention to promote adaptive coping in older adults experiencing heightened fear and avoidance specific to memory loss. Our intervention included three core components: psycho-education around ADRD, training in mindful awareness of fears, and behavioral activation [As hypothesized, both REFRAME and active control intervention arms were associated with a reduction in fears and avoidance behaviors around the ADRD symptom of memory loss. Specifically, we observed a significant reduction in fear-avoidance scores, which was maintained at 4-week follow-up. In addition to our primary outcome, we observed a significant decrease in fear of AD, which was also maintained at follow-up. These positive findings for both primary and secondary fear-based outcomes indicate that providing psycho-education about ADRD and tailored mindfulness exercises is beneficial for individuals experiencing heightened fear.Contrary to our original hypothesis, effects on fear reduction were not stronger in the REFRAME compared to the control group. Both REFRAME and control groups included guided mindfulness exercises intended to impact the way participants interpreted everyday memory lapses. Specifically, participants were trained to be aware of distressing thoughts and feelings (e.g., Anxiety and depression symptoms decreased over time, while ability to participate in social activities and well-being increased. As hypothesized, the REFRAME condition was associated with a greater reduction in depression scores relative to the control condition, implying that the inclusion of therapeutic components to boost cognitive and social engagement (i.e., behavioral activation) had a unique positive impact. This finding is consistent with our etiological model, which suggests that poorer health and well-being outcomes in older adults’ results, at least partially, from avoidant coping strategies intended to mitigate distress around perceived changes in memory ability [Overall, our findings demonstrate that a low-intensity psychological intervention has salutary effects in older adults who are fearful and avoidant of ADRD, and that these benefits extend to broader health-related outcomes. That fears and avoidance behaviors can be mitigated is important because ADRD are among the most feared conditions associated with aging [Identifying strategies to manage fear and avoidance coping associated with ADRD will become more of a priority with the advent of second-generation memory clinics [Like other health domains, the relationship between fear, behavioral avoidance and lifestyle risk factors is likely to be reciprocal and recursive [Our study had multiple strengths. To our knowledge, this study is the first to evaluate the efficacy of a psychological intervention to promote adaptive coping in healthy older adults experiencing heightened fears and avoidance behaviors specific to the ADRD symptom of memory loss. The use of an RCT design with an active control condition allowed us to compare fear and avoidance components separately. Our sample size was sufficiently powered to detect medium-sized within- and between-groups differences. Our intervention proved feasible to deliver (> 75% module completion). Finally, inclusion of multiple measures and time points allowed for comprehensive outcome assessment.One limitation was the short length of follow-up. Four weeks may have been too short to gauge efficacy around broader lifestyle-related outcomes. However, as this study involved a novel intervention, our primary aim was to demonstrate initial evidence of efficacy and proof-of-concept. Another limitation was that remote delivery required participants to have a good level of digital literacy, which may have biased the sample. The sample was predominately White, female, and well-educated, which limits generalizability. These limitations will be addressed in a larger-scale RCT with a more diverse sample, currently under development. Replication in a larger trial will also allow for more in-depth analysis of attrition and retention, and potential factors driving these. Finally, our intervention did not assess reasons underlying individuals’ fear of memory loss. Future work is needed to better understand these root causes in order to address the pervasive societal stigma surrounding ADRD.Extensions of this work should include a larger RCT with a more diverse sample and longer follow up, or ‘booster’ sessions, to further evaluate the efficacy of the intervention. An important avenue for future research will be to focus on higher risk groups, such as people with family history of ADRD, APOE4 carriers, family carers, or clinical populations (e.g., individuals attending memory clinics). Contrary to our original hypothesis that outcome effects would be stronger in the REFRAME group, we observed only one significant difference for depression as a secondary outcome. This was likely due to the use of an active comparison. Future studies should therefore consider if increasing content or duration would lead to stronger group differences. This will be particularly important for teasing apart effects of psychological fear and behavioral avoidance components. Finally, future studies could consider a more individualized intervention approach, consistent with precision medicine frameworks [