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Cognitive Behavioral Therapy and Ageism

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT04319393
Recruitment Status : Completed
First Posted : March 24, 2020
Last Update Posted : March 24, 2020
Information provided by (Responsible Party):
Jordan University of Science and Technology

Brief Summary:

Background: Healthcare settings must be a patient-friendly environment for the investigator's older adults who are in an imperative need for compassionate healthcare when approaching their later life. However, older adults until this moment are experiencing age discriminative acts by nurses who are supposed to act in favor of their patients. Ageism is not always a result of either negative attitudes or misconceptions toward older adults, but to the innate fear of death where nurses perceive older adults as a powerful reminder of death. Although cognitive-behavioral therapy (CBT) is well known for targeting psychological distresses, to date, no research has investigated its effectiveness in relieving nurses' death anxiety and ageism. This study examined the effectiveness of CBT to relieve nurses' death anxiety and ageism toward older adults.

Methods: A randomized controlled trial was conducted during August 2019 in the university hospital. A total of 110 nurses selected through proportional stratified sampling and randomly assigned to the experimental and control groups. The intervention consisted of six two-hour training sessions delivered in five modules with the integration of different CBT exercises. The effect of CBT was assessed on measures of a series of validated questionnaires of study variables before and after the training sessions.

Condition or disease Intervention/treatment Phase
Ageism Behavioral: Cognitive Behavioral Therapy Not Applicable

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 110 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Care Provider)
Primary Purpose: Treatment
Official Title: Testing the Effectiveness of Cognitive Behavioral Therapy in Relieving Nurses' Ageism Toward Older Adults
Actual Study Start Date : January 1, 2019
Actual Primary Completion Date : September 1, 2019
Actual Study Completion Date : November 1, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Anxiety

Arm Intervention/treatment
Experimental: CBT Nurses
Interventional group
Behavioral: Cognitive Behavioral Therapy

The CBT intervention was carried out through six two-hour sessions over a month. The intervention group was divided into three subgroups of 18 to 19 nurses each. It was required for each subgroup to attend two CBT sessions to complete the intervention.

The CB therapist followed the same structure in the delivery of each CBT session. The CBT session was delivered in five modules: generating objectives and outcomes, enhancing self-esteem and interpersonal relationships, changing beliefs regarding symbolic mortality, and changing attitudes regarding death anxiety. The first session began with highlighting the objectives of the CBT. Then, a detailed presentation of the intervention modules was provided to the nurses with integration of CBT exercises, including cognitive restructuring, graded exposure, mindfulness meditation, interpersonal skills training, and activity scheduling

No Intervention: Consultation Nurses
Control Group

Primary Outcome Measures :
  1. Ageism [ Time Frame: Two months ]
    The Fraboni Scale of Ageism (FSA) (Fraboni et al., 1990) was used to measure nurses' ageist attitudes toward older adults. The FSA is a 29-item scale measuring the attitudinal and affective aspects of ageism. The FSA has three positive items (e.g., "Old people can be very creative"), which were reverse coded before calculating the total score. Each item of the FSA has four possible responses, including: "1= strongly disagree,"; "2= disagree,"; " 3=agree,"; and " 4= strongly agree". The possible range of the total score of the FSA is from 29 to 116. Higher scores indicate greater levels of ageist attitudes. The internal consistency reliability of the FSA in this study was high (Cronbach's alpha = 0.89), which is very close to the original research (0.86) (Fraboni et al., 1990)

  2. Death anxiety [ Time Frame: two Months ]
    Death anxiety was measured using The revised Collett-Lester Fear of Death Scale (CL-FODS) (Lester & Abdel-Khalek, 2003). The CL-FODS is a 28-item scale measure death anxiety about four main aspects of death and dying, including: " your own death,"; "your own dying"; " the death of others,"; and " the dying of other". Each subscale has seven items answered on a 3-point intensity scale (ranged from 1= "no" to 5= "very"). The CL-FODS had very satisfactory reliability scores ranged from .88 to .93, and good internal consistency scores ranged from .74 to .90 in the original study. In the current study, the internal consistency reliability was satisfactory (Cronbach's alpha= 0.79)

Secondary Outcome Measures :
  1. symbolic immortality [ Time Frame: Two Months ]
    Symbolic immortality was measured using the Sense of Symbolic Immortality Scale (SSIS) (Drolet, 2007). The SSIS contains 11 negatives (e.g., nothing interesting happens in my life) and positive (e.g., I feel that I am doing what I want in life) items about areas of life showing the desire for symbolic immortality. The nurses responded to these items using a Likert scale of five choices ranging from 1 = "strongly disagree," to 5 = "strongly agree." The total score of the SSIS was calculated after reverse coding the negative items, yielding a range from 26 to130. Higher scores indicate a greater sense of symbolic immortality. The SSIS had good internal consistency in this study (Cronbach alpha = 0.86).

  2. self-esteem [ Time Frame: two Months ]
    Nurses' self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES) (Rosenberg, 2015). The RSES has five positive (e.g., "I take a positive attitude toward myself") and five negatives (e.g., "I feel I do not have much to be proud of") items. The nurses responded to these items using a 4-point Likert scale ranging from 1= "strongly disagree" to 4= "strongly agree." The total score of the RSES was calculated after reverse coding of the negative items yielding a range from 10 to 40, with higher scores indicating greater levels of self-esteem. The Cronbach's alpha reliability of the RSES in this study was high (0.91)

  3. interpersonal relationship [ Time Frame: two Months ]
    Nurses' interpersonal relationships were measured using the Interpersonal Reactivity Index (IRI) (Davis, 1980). The IRS has four subscales consisting of five positive and two negative items each. The subscales include perspective-taking, fantasy, empathic concern, and personal distress. The nurses responded to the 28 items of IRS with five responses ranging from 0=" Does not describe me well" to 4= "describes me very well." The total score of the IRS was calculated after reverse coding the negative items, yielding a range from 0 to 112. The Cronbach's alpha reliability of the IRI in this study was very good (0.81)

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Ages Eligible for Study:   22 Years to 45 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • The eligible participants in this study were nurses caring for older adults and working in the hospital for at least one year of clinical experience.

Exclusion Criteria:

  • Nurses working in Pediatric, maternity, and psychiatric departments
  • Nurses with clinical experience less than one year

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT04319393

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King Abdullah University Hospital
Irbid, Jordan, 22110
Sponsors and Collaborators
Jordan University of Science and Technology
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Principal Investigator: Mohammad Rababa, PhD Jordan University of Science and Technology
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Responsible Party: Jordan University of Science and Technology Identifier: NCT04319393    
Other Study ID Numbers: 20180217
First Posted: March 24, 2020    Key Record Dates
Last Update Posted: March 24, 2020
Last Verified: March 2020

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Jordan University of Science and Technology:
Cognitive Behavioral Therapy
Older Adults
Death anxiety
Randomized Clinical Trials