Terapia de Aceitação e Compromisso com Pessoas Idosas: um modelo de intervenção breve

Abstract

Brazilian population aging poses significant challenges to public policies aimed at older adults, particularly regarding the provision of feasible psychological interventions sensitive to the specificities of later life. Increased life expectancy, associated with contexts of social vulnerability, demands care strategies that go beyond exclusively biomedical models and consider subjective resources related to adaptation throughout human development. In this context, Acceptance and Commitment Therapy (ACT), a process-based contextual behavioral approach, emerges as an alternative by emphasizing psychological flexibility, understood as the ability to act consistently with personal values even in the presence of difficult internal experiences. This dissertation aimed to investigate the feasibility and possible effects of a brief group-based ACT intervention for older adults in a public care context, articulating developmental perspectives on aging, especially the life-span paradigm and the Selection, Optimization, and Compensation (SOC) model, with the ACT framework. The dissertation was organized into four complementary studies. Study I consisted of a literature review on the application of ACT among older adults. Findings indicated favorable evidence for the use of ACT and brief versions such as FACT, particularly in reducing psychological distress, depressive symptoms, and chronic pain, as well as increasing engagement with personal values. However, methodological heterogeneity, sample limitations, and a scarcity of Brazilian studies were identified. Study II, qualitative in nature, analyzed meanings attributed to aging by 116 older adults receiving public care services through lexical analysis of open-ended questions. Three discursive classes were identified: social withdrawal, reflective adaptation, and aging as maturity. Findings indicated a predominance of meanings associated with adaptive reorganization in response to aging-related changes. Study III, with a cross-sectional design, investigated associations between psychological flexibility, self-efficacy, and resilience in the same sample. The AAQ-II, GSES, and CD-RISC-10 instruments were used, in addition to sociodemographic and behavioral data. Results showed correlations between greater psychological flexibility and higher levels of self-efficacy and resilience. Associations were also observed between these resources and contextual factors such as participation in physical activities, leisure, and social networks. Study IV consisted of the implementation and evaluation of a pilot group-based ACT protocol composed of six weekly sessions, conducted with five participants who completed all stages of the intervention. A reduction trend in psychological inflexibility scores and high intervention acceptability were observed. Qualitative reports highlighted the relevance of the group setting, reflection on personal values, and the practical applicability of the exercises in daily life. Structural barriers, such as mobility difficulties and schedule availability, were identified as relevant challenges for future implementations. Overall, findings suggest that brief ACT-based interventions are feasible in public care settings for older adults and may foster processes related to psychological adaptation in later life. The articulation between developmental models and contextual behavioral approaches represents a theoretical contribution by indicating convergences between the adaptive reorganization described in the SOC model and the psychological flexibility proposed by ACT.