Above: Dr. Christine Gould, a psychologist and VA researcher, is investigating the effectiveness of a new intervention to help older Veterans who experience anxiety. (Photo by Adan Pulido)

This article originally appeared in VA Research Quarterly Update.

Dr. Christine Gould is a clinical geropsychologist—a psychologist who works with older adults—and a researcher with the Geriatric Research, Education, and Clinical Center at the VA Palo Alto Health Care System. She is also an affiliated instructor with Stanford University in the department of psychiatry and behavioral sciences.

Her research is focused on understanding and developing new treatments for anxiety disorders that occur in older adults. She is currently investigating the effectiveness of a new delivery method for an intervention to help older Veterans who are experiencing anxiety in later life.

VA Research Quarterly Update spoke with Gould about her Career Development Award to help develop a video-based relaxation therapy for older Veterans.

How common is anxiety in later life for Veterans and older people in general?

Anxiety is actually almost twice as common as depression in older adults. We don’t have great data on the number of older Veterans with anxiety, but we did find that 1 in 10 older Veterans has elevated anxiety symptoms using the Health and Retirement Study data.

I believe that one specific anxiety disorder—one of the more problematic ones called generalized anxiety disorder—affects about 12 percent of Veterans. When older Veterans have other conditions like medical problems and PTSD in particular, anxiety disorders other than PTSD often co-occur with both medical conditions and PTSD.

What do you aim to accomplish through your VA Career Development Award?

My award is focused on improving functioning in older Veterans with anxiety disorders. There are two parts to it. One part is to develop and test the relaxation intervention. The other part is to look at ways that older Veterans are interested in receiving psychological treatment over a distance.

We know many older Veterans live in more rural areas or might live at further distances from VA clinics, in addition to having mobility difficulties or transportation difficulties which make it hard to get into clinics. So what I wanted to do was to find and identify some ways of receiving treatment that older Veterans are interested in, for further dissemination.

How are you providing the relaxation therapy?

The relaxation videos—we are calling it the BREATHE program—are delivered through DVD videos. Eventually we might consider using internet delivery or mobile app delivery as well. But right now, people get a set of DVDs—it’s a four-week program—and each week they are asked to watch a video lesson, which explains what anxiety is, teaches diaphragmatic or deep breathing, and teaches a specific type of relaxation called progressive muscle relaxation.

People will watch the lesson once and then they have a practice video which they can use to guide their relaxation practice every day. It’s a four-week treatment, and each week they have a different lesson that builds on the previous week.

There is a coach as well, so the patients will receive a telephone call from a provider who will coach them through the treatment, help them adhere to it, and troubleshoot any issues that come up.

Could you explain more in-depth what the BREATHE technique involves?

The BREATHE program is pulling together some different techniques that research has shown work well for anxiety. Diaphragmatic breathing or deep breathing is a skill that is often taught to individuals with anxiety. So we teach that along with the modifications for older Veterans who might have different medical conditions such as lung programs, like COPD.

Then the relaxation technique is progressive muscle relaxation. It’s been around for many, many years. It has been well-studied since the 70s. What this technique does is you go through your body and you are guided in tensing and then releasing each muscle group. The thought is first that is helps people really understand and identify where they are holding tension in their body, which often comes up when people are worried or feeling anxious. And also it helps promote relaxation by tensing and releasing different muscle groups—we say it gives patients a running start to relaxation, rather than trying to relax that muscle group from the beginning.

It also gives people who worry a lot a strategy to release that tension and focus on something else, and really focus on taking care of themselves.

To read the full interview, click here to visit VA Research Quarterly Update.

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Published on Aug. 29, 2018

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