An emerging psychological approach is changing how older adults relate to their fears.
Imagine constantly feeling on edge, your mind racing with worries about health, finances, or family, yet dismissing these feelings as just "part of getting older." For millions of older adults, this is daily reality. While often overlooked, anxiety disorders are among the most persistent and prevalent mental health challenges in later life, affecting between 15% to 52% of older adults with clinically significant symptoms 1 . The mental health needs of our senior population have long been overshadowed by other age groups, leaving a gap in effective, age-appropriate treatments.
Now, an innovative approach called Acceptance and Commitment Therapy (ACT) is showing remarkable promise where traditional methods sometimes fall short. Rather than fighting against anxious thoughts and feelings, ACT teaches a different path: making peace with inner experiences while building a meaningful life aligned with personal values. This article explores the growing evidence behind this revolutionary approach to anxiety in adults aged 65 and over.
Anxiety in older adults often centers around declining health, cognitive changes, and managing chronic conditions.
Worries about retirement savings, healthcare costs, and financial stability in later years are common anxiety triggers.
Anxiety in older adults often differs from anxiety experienced earlier in life. Concerns typically shift from career advancement and raising families to more fundamental issues: declining health, cognitive changes, financial security in retirement, and the loss of loved ones. Unlike the episodic anxiety that might come and go in younger years, anxiety disorders in older adults tend to be remarkably persistent, with research showing an average duration of 20 years or more 1 .
"The bidirectional relationship between anxiety and physical health conditions creates a challenging cycle where anxiety exacerbates health problems, which in turn fuels more anxiety."
What makes anxiety particularly detrimental for seniors is its strong connection to negative health outcomes. Studies have linked anxiety in older adults to increased disability, poorer quality of life, higher healthcare utilization, and even elevated risk of cognitive decline 1 5 .
Despite its significant impact, anxiety in older adults remains underdiagnosed and undertreated. Many older adults dismiss symptoms as normal aging, while healthcare providers may overlook anxiety in favor of treating physical comorbidities. Even when recognized, many standard treatments like traditional Cognitive Behavioral Therapy (CBT) show limited effectiveness for some older adults with anxiety, particularly those with chronic conditions 7 . This treatment gap has prompted researchers to explore alternative approaches like ACT.
Acceptance and Commitment Therapy represents a groundbreaking shift in psychological treatment. Developed in the late 1980s, ACT (pronounced as the word "act," not initials) belongs to the "third wave" of cognitive-behavioral therapies. While traditional CBT focuses on challenging and changing thought patterns, ACT takes a different approach: it teaches people to accept their inner experiences while simultaneously committing to actions that enrich their lives.
Cognitive-Behavioral Therapy
The core goal of ACT is to develop psychological flexibility - the ability to be fully present with what's happening in the moment, including uncomfortable thoughts and feelings, while still moving toward what matters most. ACT proposes that much of human suffering comes not from painful experiences themselves, but from our attempts to avoid or control them - a process known as "experiential avoidance."
Making room for difficult feelings and sensations instead of fighting them
Learning to step back from thoughts rather than being caught up in them
Connecting fully with the here and now
The flexible perspective-taking aspect of consciousness
Discovering what matters most in life
Taking effective steps guided by values
"The transdiagnostic nature of ACT may make the assessment and treatment of anxiety and depression more efficient with older adults." 7
For older adults facing anxiety, this approach is particularly relevant. Since anxiety and depression commonly co-occur in later life, a approach that addresses both simultaneously offers significant advantages.
Recent systematic reviews and meta-analyses have synthesized the available evidence on ACT for older adults with anxiety symptoms. The findings, while nuanced, point toward promising benefits:
Frontiers in Psychiatry
7 studies involving 633 older adults
Average age: 68.89 years
Provided evidence for the efficacy of ACT in reducing anxious and depressive symptoms in this population.
Journal of Psychiatric and Mental Health Nursing
6 randomized controlled trials with 576 older adults
Small but significant effect on depressive symptoms
Found small but non-significant effect on anxiety symptoms with very low-quality evidence.
| Review Type/Publication Year | Number of Studies | Sample Size | Main Findings on Anxiety |
|---|---|---|---|
| Systematic Review (2022) 1 | 7 | 633 | Evidence supporting efficacy in reducing anxiety symptoms |
| Meta-Analysis (2025) 1 | 6 | 576 | Small, non-significant effect (very low-quality evidence) |
The mixed findings highlight that ACT is not a panacea, but rather a promising approach that requires further investigation. The moderate methodological quality of many existing studies and the relatively small sample sizes limit the strength of conclusions that can be drawn 1 . However, the consistency across studies in showing at least some benefit suggests that ACT deserves its place in the therapeutic toolbox for older adults with anxiety.
One of the most compelling studies on ACT for late-life anxiety comes from a 2021 feasibility study focusing specifically on treatment-resistant generalized anxiety disorder (TR-GAD) 5 . This research is particularly significant because it addresses a population that has not benefited from first-line treatments - precisely those most in need of effective alternatives.
The study recruited 37 participants aged 65 and older with TR-GAD, defined as not responding to, being unable to tolerate, or refusing standard GAD treatments. These individuals had lived with debilitating anxiety for decades - some for 30 years or more - and represented some of the most challenging cases clinicians face.
Individual, face-to-face sessions delivered weekly
GP practices, outpatient clinics, or participants' homes
Covering ACT's six core processes with home practice
| Outcome Measure | Results | Significance |
|---|---|---|
| Recruitment | 37 participants (exceeded 32 target) | Demonstrated feasibility of recruiting this challenging population |
| Retention | 81% retained at follow-up | High engagement despite previous treatment failures |
| Session Attendance | 70% attended ≥10 sessions | Good acceptability of the intervention |
| Satisfaction | 60% scored ≥21/30 on satisfaction scale | Moderate patient satisfaction; room for refinement |
This study was particularly groundbreaking because it demonstrated that older adults with chronic, treatment-resistant anxiety - many of whom had suffered for decades - could engage with and benefit from a psychological approach that didn't focus on eliminating anxiety, but rather on changing their relationship with it.
The researchers concluded that while further refinement might enhance satisfaction, the results strongly supported proceeding to a larger-scale randomized controlled trial 5 . For clinicians working with older adults who haven't benefited from standard approaches, this study provides a roadmap for an alternative path forward.
What does ACT look like in practice with older adults experiencing anxiety? The approach incorporates several distinctive components tailored to the unique needs and experiences of this population:
| Component | Description | Application to Late-Life Anxiety |
|---|---|---|
| Creative Hopelessness | Helping clients recognize the futility of control strategies | Exploring how decades of trying to control anxiety hasn't worked long-term |
| Acceptance | Willingly embracing private experiences without defense | Making room for anxiety sensations rather than resisting them |
| Cognitive Defusion | Seeing thoughts as thoughts rather than literal truths | Noticing "worry thoughts" as mere mental events rather than truths to obey |
| Present Moment Awareness | Flexible contact with the here and now | Anchoring attention to the current moment when anxiety pulls into future "what-ifs" |
| Values Clarification | Discovering what gives life meaning | Reconnecting with what matters beyond anxiety, often family, contribution, or spirituality |
| Committed Action | Taking steps guided by values | Building patterns of behavior that create a rich, meaningful life despite anxiety |
Therapists often incorporate life review techniques to help older adults connect with deeply held values that may have guided them throughout their lives.
ACT relies heavily on metaphors, and therapists working with older adults draw on imagery relevant to their experiences.
Unlike approaches that focus primarily on symptom reduction, ACT explicitly addresses questions of meaning, purpose, and legacy.
"The goal isn't to eliminate anxiety about health decline or loss, but to help people live meaningfully alongside these very human concerns." - ACT therapist working with seniors
The growing evidence supporting ACT for older adults with anxiety points toward an expanding role for this approach in geriatric mental health. Several factors suggest ACT may become increasingly important in coming years:
With the aging of baby boomers and increased life expectancy, the number of older adults is growing rapidly. By 2030, adults aged 65 and older are projected to represent 20% of the U.S. population 7 .
While traditional CBT and medications help many older adults with anxiety, a significant subset either doesn't respond, experiences side effects, or finds these approaches ill-suited to their needs.
The high rates of comorbidity between anxiety and depression in later life make transdiagnostic approaches like ACT particularly efficient.
ACT's focus on values, meaning, and living fully in the present aligns well with what developmental theorists identify as central tasks of later life.
While more research is needed - particularly large-scale randomized controlled trials with longer follow-up periods - the current evidence suggests ACT has found an important place in the spectrum of care for older adults with anxiety 1 8 . As research continues to refine our understanding of which components work best for whom, ACT will likely become an increasingly sophisticated and effective option.
The emergence of ACT as a viable approach for older adults with anxiety represents more than just another therapeutic option - it signifies a fundamental shift in how we conceptualize mental health in later life. Rather than viewing anxiety as a problem to be eliminated, ACT frames it as an experience to be understood, accepted, and carried mindfully while building a life of meaning and purpose.
"I spent 50 years trying to get rid of my anxiety. Now I'm learning I can have it and still do what matters. I wish I'd learned this sooner." - 72-year-old participant in an ACT study
The research evidence, while still developing, provides encouraging support for this innovative approach. Studies have consistently demonstrated that ACT is feasible, acceptable, and potentially effective for older adults with anxiety - including those who haven't benefited from other treatments 1 5 . While more rigorous research is needed, the consistency of positive findings across studies suggests that ACT has much to offer this population.
As our population ages and the need for effective, age-appropriate mental health care grows, approaches like ACT that honor the wisdom, experiences, and values of older adults will become increasingly vital. For older adults living with anxiety, ACT offers a powerful message: it's never too late to transform your relationship with your inner world and build a life rich with meaning and purpose.