1 - (OP24) Improving Psychological Treatment Outcomes in Anxious and Depressed Older Adults Through Social Participation: The SPAA Clinical Trial

Saturday, June 27, 2026

11:06 AM - 11:27 AM PDT

Location: Yerba Buena Salon 6, B3 Level

Keywords: Aging, CBT, Clinical Trial
Recommended Readings: Wuthrich, V.M., Huang-Smith, T., Rapee, R.M., Kangas, M., & Jones, M.P. (in press, accepted 10th December, 2025). Predictors and moderators of cognitive behavioural therapy outcomes in older adults with anxiety and mood disorders, Cognitive Therapy and Research., , , ,

Author(s)

Viviana Wuthrich, Ph.D., Other (she/her/hers)

Professor
Macquarie University
Macquarie University, New South Wales, Australia

Co-Author(s)

JC

Jessamine Chen, Ph.D., Other

Professor
Macquarie University
Macquarie University, New South Wales, Australia
Carly Johnco, Ph.D. (she/her/hers)

Associate Professor
Macquarie University
Sydney, New South Wales, Australia
BD

Brian Draper, M.D., Ph.D.

Professor
University of New South Wales
Sydney, New South Wales, Australia
HB

Henry Brodaty, M.D., Ph.D.

Professor
University of New South Wales
Sydney, New South Wales, Australia
HC

Henry Cutler, Ph.D.

Professor
Macquarie University
Macquarie University, New South Wales, Australia
LL

Lee-Fay Low, Ph.D.

Professor
University of Sydney
Sydney, New South Wales, Australia
AG

Andrew Georgiou, Ph.D.

Professor
Macquarie University
Macquarie University, New South Wales, Australia
TH

Tina Huang-Smith, Other

Student
Macquarie University
Macquarie University, New South Wales, Australia
MJ

Michael Jones, Ph.D.

Professor
Macquarie University
Macquarie University, New South Wales, Australia
RR

Ronald Rapee, Ph.D.

Distinguished Professor
Macquarie University
Sydney, New South Wales, Australia

Background: In older adults, social isolation and poor social support is associated with worse depression and anxiety, suicide risk, loneliness and poorer quality of life. Whilst higher levels of social participation are associated with better mental health and quality of life. Recently, social participation has been found to moderate treatment effects in CBT. Increasing social participation may therefore enhance treatment effects and reduce relapse of anxiety and depression, particularly in older adults. In a novel pre-registered two-armed parallel-group, pragmatic, superiority clinical trial we compared standard CBT to an enhanced CBT intervention on clinical and economic outcomes. It was hypothesised that enhanced CBT would result in significantly reduced clinician-rated mean severity of mood and anxiety disorders compared to standard CBT at post-treatment, with effects maintained at 12-month follow-up.

Methods: 172 participants aged 65 to 93 years (M=73.44, SD=6.41; 42% male) with an anxiety and/or mood disorder were randomised to either standard CBT (Ageing Wisely program) or an enhanced version with added skills to increase social participation. Participants completed demographic, self-report symptom measures, semi-structured clinical interviews, quality of life and economic measures, pre, post and at 12-month follow-up.

Results: Using linear mixed models intent-to-treat, few significant differences between conditions emerged with both conditions resulting in significant benefits with large effect sizes across all variables. A significant group by time interaction at post-treatment was found for self-reported depression, with superior effects in the enhanced CBT condition. Post-hoc tests suggest enhanced CBT was particularly beneficial for individuals with loneliness and/or social isolation.

Conclusions: A CBT intervention that aimed to increase social participation and social connection was not statistically significantly more effective than standard CBT across groups. However, the socially enhanced CBT intervention was associated with significant clinical benefits for older adults with heightened social isolation and/or loneliness. Enhancing social participation may be an important avenue in the treatment of depression and anxiety in older adults. Discussion of how social connectedness can be readily increased within CBT frameworks will be discussed.

Learning Objectives:

Upon completion , participant will be able to understand the benefits of increasing social participation on CBT outcomes for the treatment of depression and anxiety in older adults.