“Balanced Brain”: development, implementation, and acceptability of an acceptance and commitment therapy-based pilot intervention to promote brain health in older veterans

Brain health encompasses a multitude of health and lifestyle factors that can reduce the occurrence and severity of dementia. Older Veterans face unique risk factors for dementia, which makes promoting brain health a priority for the Veteran Health Administration (VHA). However, Veterans encounter barriers to implementing these recommendations, such as uncertainty about where to start, minimal personal investment, lack of social support, or negative emotional reactions to cognitive changes. We explain how principles from acceptance and commitment therapy (ACT) can address these barriers and facilitate personal engagement with brain health, and describe a group ACT intervention called Balanced Brain. We used a mixed-method, multiphase approach using clinician interviews to develop and refine the intervention, followed by pilot testing to determine feasibility and acceptability with older Veterans. Six VHA clinicians described barriers and facilitators to brain health promotion and suggested content to include in an intervention. We then recruited 21 Veterans into two group cohorts, collected data on feasibility and attrition, and assessed program satisfaction using the Client Satisfaction Questionnaire-8. Over three-quarters of Veterans attended 75% or more of group sessions, although telehealth connectivity issues were common. Veterans indicated high overall satisfaction with Balanced Brain, suggesting it as a feasible and acceptable intervention for teaching brain health principles alongside ACT coping skills to address psychosocial barriers to health behavior change.