Compassion Meditation for Older Adults

Many older Veterans in VA primary care clinics experience anxiety and depressive symptoms, but only a minority of these Veterans seek care through VA mental health services. Research suggests that some older Veterans with psychological distress under-utilize mental health services due to perceived stigma of treatments focused on mental health symptoms. However, prior research with civilians, including one study of Veterans with PTSD, suggests a strengths-focused intervention that provides group training in compassion meditation may be effective in reducing negative emotions and increasing positive emotions and well-being. The proposed project is designed to examine the feasibility of this approach with Veterans ages > 55 years with anxiety or depression. The information from the study will guide and support development of a larger-size, more definitive study, planned as the follow-up after this project. If successful, this line of research could open the door to a novel and effective treatment that widens acceptance by older Veterans with psychological distress.

Older Veterans show a high prevalence of clinically significant psychological distress such as anxiety and depressive symptoms. This high prevalence includes patients seen in Primary Care clinics. These symptoms are not only aversive in themselves, they are also associated with risk of psychosocial disability, increased medical comorbidity, early mortality, and increased health care costs. Although these concerns similarly exist among younger Veterans, the situation is particularly problematic among older Veterans as older age is associated with low utilization of mental health services. Prior research focused on identifying barriers to mental health care utilization among older Veterans have repeatedly pointed to the perceived stigma of symptom-focused treatments, which can be perceived by some Veterans as being "deficit-focused". Therefore, it may be useful to develop effective strengths-based interventions. Compassion meditation (CM) training is a promising strengths-focused candidate in this regard, in that prior research, albeit with civilian samples, has suggested CM training promotes positive emotions and well-being, while reducing anxiety, depression, and other negative emotions. There has been less research with Veteran samples, but one study by Lang and colleagues also suggested effectiveness for Veterans with PTSD. CM has not been adapted or tested in the context of treating older Veterans with anxiety or depression. The proposed project will collect pilot data to establish feasibility for a future randomized controlled trial (RCT) of manualized CM group intervention to restore functioning in older Veterans identified through VA Primary Care clinics as having clinically significant psychological distress. This non-randomized feasibility study represents a critical initial step in adapting CM and evaluating its potential as an effective strengths-focused treatment for use with this population. Participants will include up to 40 Veterans age > 55 years identified through the Primary Care Mental Health Integrated program at the VA San Diego Healthcare System with mild-to-moderate anxiety or depressive symptoms. Twenty to 30 of these participants will be enrolled in a 10-week CM training group (with 8-10 participants in each group). The groups will be conducted with a manualized CM intervention, although part of the goal of the feasibility study is to identify and adapt the intervention to the needs of this specific population. Key questions for the feasibility study include determining participants' willingness to enroll, adherence and completion of the intervention, as well as to determine appropriate modifications in the intervention to make it maximally acceptable and appropriate to older Veterans. The investigators will also be collecting pilot data regarding the potential of the intervention to improve well-being, symptom severity, and/or positive psychological factors. There is a growing interest in the field in expanding outcome measures beyond subjective behavioral reports, thus, the investigators will also explore the feasibility of using inflammatory biomarkers as a non-behavioral indicator of CM intervention response. As part of establishing feasibility for a subsequent large-scale RCT, 10 additional participants will be enrolled in a 10-session manualized psychoeducational group focused on topics in healthy aging. The latter group will be conducted to examine the feasibility and appropriateness of employing this as a control condition in a follow-up RCT. Participants will also be interviewed after completion of the CM or psychoeducational groups in order to obtain their subjective impressions and recommendations for the content and structure of the groups. Given the preliminary nature of this line of research for this population, analyses will be primarily descriptive rather than focused on hypothesis testing.