Emotion Regulation Treatment to Enhance Active Aging in Older Adults with Affective Distress: A Pilot Study

Abstract

This pilot study evaluated the feasibility and acceptability of a five-session version of the transdiagnostic Unified Protocol adapted for older adults with emotional distress and impaired functional activity. In Phase 1, the therapist-delivered treatment was adapted for this population. In Phase 2, 16 older adults with emotional distress and impairments in functioning were randomly assigned to either a Self-Guided or Therapist-Delivered version of the 5-session protocol. Assessments were conducted after one week and one month. The intervention was feasible, with participants in the therapist-delivered group expressing significantly higher treatment satisfaction (Cohen’s d_{1_week} = 2.08; d_{1_month} =2.00). Both groups showed improvement in functioning (d = 3.11), with no significant differences between conditions. Emotional distress decreased significantly (d_anxiety =1.14; d_depression =0.81) with no condition differences. Physical activity showed modest gains (ds = 0.17–0.18). These findings support the feasibility and preliminary efficacy of the adapted intervention. The UP-ST-5 may be a promising intervention for older adults, with the self-guided version offering a scalable option.

Introduction

Up to 20% of older adults (age 65+) report emotional disorders (e.g., anxiety, depression), which negatively impact their overall physical and mental health (Jalali et al. 2024). Reduced engagement in daily activities and social interactions exacerbates affective distress (Gyasi et al. 2023), worsens mood (Miller et al. 2019), accelerates aging (Wolkowitz et al. 2010), and leads to cognitive decline (Wollesen et al. 2023). Conversely, increased mobility improves mood, selfefficacy (Rebar et al. 2015), emotional well-being (Tseng et al. 2019), and a predisposition towards participating in activities, such as domestic chores or travel, which have been associated with cognitive enhancement as people age (Parisi et al. 2009).

Meta-analyses indicate that programs designed to increase physical activity among older adults lead to reductions in depression and anxiety and improvements in quality of life (Park et al. 2014). However, encouraging physical activity presents challenges, and many older adults struggle to adopt these behaviors (Kilgour et al. 2024). Psychological barriers such as distress, low motivation, low self-efficacy, and negative self-perceptions often prevent engagement in regular activity, even with subclinical distress (Rhodes et al. 1999). Cognitive-behavioral therapies (CBTs) are well-established for addressing these barriers (Romera-Gasparico et al. 2026) but have not been designed to directly address mobility or activity impairments in older adults. The demand for mental health services among older adults is rising (Suran 2023) and novel adaptations of CBT that focus on distress and mobility could promote mental and physical well-being for a growing segment of the population. CBTs could be better adapted for older adults by decreasing the typical number of sessions to 5 (Wolitzky- Taylor et al. 2015), using a transdiagnostic approach, given the high likelihood of comorbidities clustering (Tobin et al. 2025), or employing telehealth or self-guided pacing to address physical and contextual limitations (Maresova et al. 2023). Therefore, the next generation of evidence-based treatments for anxiety and depression in older adults should expand to include brief, transdiagnostic, and virtual or selfpaced options that address activity levels and distress at the same time.

The Unified Protocol is a promising transdiagnostic treatment for emotional distress, with emerging evidence in older adults (Cassiello-Robbins et al. 2020) and an established five-session format (UP-5) (Bentley et al. 2017). The 5-session adaptation includes skills for enhancing motivation; encouraging present-moment awareness; promoting cognitive flexibility; reducing avoidance behaviors and emotion-driven actions; and planning for continued use of learned skills. Nevertheless, the UP-5 has not been adapted or tested with older adults or administered via telehealth.

Telehealth has proven to be an effective treatment modality, particularly for older adults who may face mobility or transportation issues (Lavingia et al. 2020). A recent review showed that interventions delivered over the internet may effectively reduce depression in older adults, although therapist-directed formats had better retention (Peng et al. 2024). Nevertheless, evidence for short-term, transdiagnostic telehealth approaches for mobility and emotional distress in older adults is limited. Key takeaways from existing telehealth trials emphasize considering caregiver involvement, supporting technology literacy, and using language and examples that reflect older adults’ challenges, with pacing that aligns with their attention and cognitive needs (Aliberti et al. 2022).

Self-guided interventions do not require input from a therapist or coach, and meta-analyses found CBT-based self-guided interventions to have a small-to-moderate effect in reducing depression severity (Edge et al. 2023) when compared to control treatments. Specifically for older adults, one large study found no difference between a therapist-assisted and a self-guided intervention for anxiety and depression, but a significant change in distress from before to after treatment (Cohen’s d > 1.00) (Titov et al. 2016). Developing interventions that minimize reliance on therapists could enhance accessibility to mental health support. However, their effectiveness in improving activity levels and functioning is unclear and may require further refinement, especially for older adults, where mobility challenges are complex.

The Current Study

We conducted a pilot study with adults aged 65 and older in two phases. Phase 1 aimed to adapt a five-session therapist- delivered version of the UP into a virtual and self-guided treatment for older adults experiencing emotional distress and impaired functional activity. We used a successive- cohort design, administering the adapted UP-5 to two cohorts of two patients each. In Phase 2, we conducted a parallelarm pilot randomized controlled trial examining two modes of administering the intervention: Therapist-Delivered (TD) and Self-Guided (SG). The primary aim was to evaluate the feasibility and acceptability of two approaches. The secondary aim was to explore preliminary signals of efficacy by assessing pre- to post- effect sizes to inform future trials.

We hypothesized that the interventions would be acceptable, feasible, and credible. Additionally, we hypothesized that participants in both conditions would report progress on their goals as measured by the Patient-Specific Functional Scale [PSFS] (Mathis et al. 2019); primary outcome), experience reduced emotional distress (secondary outcomes), and have high confidence in the skills learned, with no differences between modality of administration. We explored changes in mobility indices.

Methods

Participants

Participants were recruited via electronic medical record from primary care clinics and via provider referrals. Interested participants completed an online screening, followed by a phone screen with the first author to assess eligibility. Four participants were enrolled in Phase 1, and 16 in Phase 2. Because we were interested in pre-post effects for both intervention administration modalities, we powered the Phase 2 study to detect changes corresponding to a large effect size (Cohen’s d = 1.00; alpha = 0.05) from pre- to post-treatment, as previously observed with 5-session self-guided or therapist-delivered interventions (Titov et al. 2016). A dependent-samples t-test power analysis conducted in G*Power 3.1.9 yielded a sample size of 8 participants/group. Inclusion criteria were (Jalali et al. 2024) age 65 and older (Gyasi et al. 2023), clinical emotional distress (T-scores ≥ 60¹) on the Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety/depression forms (Miller et al. 2019), reduced engagement in daily activities (PSFS average score < 8), and (Wolkowitz et al. 2010) willingness to participate in Telehealth. Exclusion criteria were (Jalali et al. 2024) need for immediate hospitalization (e.g., high suicidality) (Gyasi et al. 2023), active ongoing psychotherapy (Miller et al. 2019), diagnosis of dementia (self-reported), or (Wolkowitz et al. 2010) changes in psychotropic medications within the past six weeks (Table 1).

Table 1.

Descriptive statistics of sample sociodemographic and pretreatment clinical characteristics

	Selfguided (n = 8)	Therapist-delivered (n = 8)	Total sample
	Mean [SD]		Reliability‡ [95% CI]
Age	69.5 [2.3]	70.6 [6.0]	–
Patient-specific functional scale	3.5 [1.1]	4.2 [1.0]	–
Brief experiential avoidance questionnaire	52.3 [11.4]	48.5 [8.9]	0.74 [0.50, 0.85]
Cognitive flexibility scale	53.5 [8.4]	56.6 [7.1]	0.75 [0.56, 0.86]
PROMIS anxiety	23.5 [3.7]	21.6 [4]	0.80 [0.55, 0.91]
PROMIS depression	24.3 [5.3]	21.5 [5.2]	0.86 [0.73, 0.93]
PROMIS physical functioning	32.5 [6.4]	33.1 [6.2]	0.86 [0.69, 0.93]
Southampton mindfulness questionnaire	36.4 [12.0]	36.9 [14.1]	0.79 [0.54, 0.91]
Short physical performance battery gait speed	3.58 [0.95]	4.05 [1.43]	0.95 [0.90, 0.97]
Weekly average daily steps	4,124 [2,660]	3,914 [1,498]	0.89 [0.64, 0.97]
	Count [%]
Sex
Female	6 [75%]	5 [62%]
Race
White	8 [100%]	6 [75%]
Native American	0 [0%]	2 [25%]
Ethnicity
Not Hispanic/Latino	8 [100%]	8 [100%]
Marital status
Never Married	0 [0%]	1 [12%]
Married	6 [75%]	6 [75%]
Divorced or Widowed	2 [25%]	1 [12%]
Education
Some college or less	2 [25%]	2 [25%]
Some graduate school or less	4 [50%]	3 [38%]
Masters or Doctoral degree	2 [25%]	3 [38%]
Salary
< $65,000	4 [50%]	5 [62%]
>$65,001	4 [50%]	3 [38%]

^‡Reliability coefficients reflect Cronbach’s α (i.e., internal consistency between scale items) for the BEAQ, CFS, PROMIS Scales, and SMQ, and ICC (2,k) (i.e., correlation and agreement between repeated measurements) for the SPPB Gait Speed and Average Daily Steps variables. ICC was computed based on a mean-rating, absolute-agreement, two-way mixed effects model(77). Estimates represent the mean and quantiles (95% confidence intervals) of the bootstrapped sample with 1000 iterations

Procedures

Phase 1

This study received approval from [BLINDED] Institutional Review Board. The interventionist, a masters-level psychotherapist with extensive experience treating older adults, received comprehensive training in the Unified Protocol-5 from the last author before Phase 1 recruitment. After the initial revision of the UP-5 manual to replace examples with those relevant to older adults, the interventionist delivered the protocol to a first cohort of two eligible participants. Each visit was reviewed and coded for adherence by the first author, and suggested revisions were discussed during supervision. At the end of the intervention, participants completed exit interviews, and their feedback, combined with adherence data, guided the first author in making further refinements, including expanded guidance on emotional awareness and a clearer distinction between opposite action and problem-solving, drawing from Dialectical Behavior Therapy (Neacsiu et al. 2013). This iterative process was repeated with a second two-participant cohort, resulting in the finalized manual Thriving through Transitions: A Unified Emotion-Centered Skills Training Protocol for Active Aging (UP-ST-5), which also incorporated vignettes and case examples. A Self-Guided version of the UP-ST-5 was also created by adapting the manual into a participant-facing guide, and the interventionist filmed ~ 7-minute videos to introduce the skills taught in each session.

Phase 2

Using the two manuals developed in Phase 1, we randomly assigned 16 participants to complete either a Self-Guided or Therapist-Delivered version of the UP-ST-5. The interventionist conducted 45 to 60-minute psychotherapy sessions, focusing on developing core skills to manage emotional distress and enhance activity engagement in older adults. The Self-Guided intervention provided participants with structured materials containing the same content, automated prompts for review, and short videos introducing each skill. Participants completed a screening visit, five treatment sessions, and two follow-up visits (1-week and 1-month posttreatment completion). To assess physical activity levels, gait speed was measured twice (pre- and post-treatment), and daily step counts were recorded over 7 weeks.

Measures

The PSFS (Stratford et al. 1995) is a semi-structured interview that guides participants in rating impairment in activities of daily living. All PSFS interviews were conducted by the first author via phone at intake, with participants rating items independently during follow-ups. Client satisfaction was measured using the CSQ-8 (Stratford et al. 1995), a Likert-scale instrument assessing different aspects of therapy, rated from 1 (low satisfaction) to 4 (high satisfaction). Treatment credibility and expectations were assessed using the CEQ(Devilly and Borkovec 2000), with internal consistency ranging from 0.62 to 0.85. Emotional and physical health were evaluated using PROMIS (Cella et al. 2007) scales for Anxiety, Depression, and Physical Function, all demonstrating strong test-retest reliability and validity (Schalet et al. 2016, Jensen et al. 2015). Exploratory outcomes were measured with the Brief Experiential Avoidance Questionnaire (BEAQ) (Gámez et al. 2014), the Cognitive Flexibility Scale (CFS) (Martin and Rubin 1995), and the Southampton Mindfulness Questionnaire (SMQ) (Feng et al. 2022). Cronbach’s αs at intake for all measures were acceptable (α_CSQ = 0.83; α_{PROMIS_Anxiety} = 0.89; αPROMIS_Depression = 0.91; αPROMIS_Physical function = 0.88; α_BEAQ = 0.76; α_CFS = 0.76; α_SMQ = 0.81). At the 1-week follow-up assessment, participants answered open-ended questions about the protocol, its helpful aspects, and suggested changes. We inquired whether the treatment met their needs, whether loved ones should be involved, and about its potential benefit for others. Additionally, we sought feedback on our self-help platform, preferences for therapist-guided versus self-help options, and adjustments to the intervention duration.

Weekly Average of Daily Steps

In Phase 2, daily step counts were recorded using an Acusplit Pedometer over week-long intervals before each visit, from the first treatment session through the 1-month follow-up. Counts below 100 steps per day were filtered out, resulting in 4% of measurements being missing or excluded. An average was calculated from the valid data for each week, yielding seven data points per participant, unless more than three days had missing values. Data from one participant was excluded because her counts were identified as outliers.

Adherence

The Unified Protocol adherence scale was adjusted to match the UP-ST-5. Each session was assessed using a yes/no criterion across 6–19 dimensions, with an adherence score based on the achieved elements. The therapist’s skill was assessed using four items, each rated from 0 (“Poor”) to 5 (“Excellent”), averaged to produce a quality score. A session is considered adherent if the overall adherence rate exceeds 80% and the therapist’s skill is rated at least “adequate” (3/5).

Analytic Plan

All analyses were conducted using R software. Mixed- effects models were used to evaluate pre- and post-treatment outcomes, including measures of daily activity (PSFS), mobility (steps), depression (PROMIS-depression), anxiety (PROMIS-anxiety), and mechanistic variables (BEAQ, SMQ, CFS). Linear models were used to examine treatment X time interactions after comparing unconditional linear models to piecewise models on ELPD and number of highly influential observations. Treatment satisfaction (CSQ) and expectancies for improvement (CEQ) were evaluated posttreatment. A scorer trained by the PI rated 14 sessions (35%) for therapist adherence.

Results

Phase 1

In Phase 1, we screened 21 participants and enrolled 5 white, non-Hispanic women (M_age = 71, SD = 4.3). Three participants were married. All participants had at least some college, four were retired. One participant did not complete any intervention sessions. Another participant dropped out after the second session due to time constraints. A paired samples t-test showed a significant improvement in functional activity (PSFS) from pre-treatment to post-treatment, corresponding to a large effect size (Δ = 3.97, SD = 1.28, t(2) = −5.39, p=.03, Cohen’s d = 1.28). The first participant to complete was rated minimally improved by the therapist. The other two completers were rated as much improved.

After the first iteration, participants 1 and 2 provided feedback during an exit interview. Key suggestions included wanting a clearer organization in the treatment manual, better examples and terminology, shorter paragraphs, and integrated worksheets. The sections on emotional behaviors and on addressing negative thoughts were helpful, but more visuals and examples of physical sensations were needed. Participants thought the intervention was short but effective in managing negative thoughts. After the second adaptation, feedback improved, with participants able to articulate the skills learned and their positive impact, although a more natural flow in the materials was recommended.

Phase 2

Feasibility & Acceptability

Feasibility Measures

Treatment completion and attendance rates were 100% across both conditions, rendering inferential statistics unnecessary. Participants in the Therapist- Delivered group completed a mean of 92.66% of their homework assignments (95% confidence interval: 87.88, 97.44).

Adherence

A trained rater found 13/14 (92.86%) therapy sessions adherent to the protocol (i.e., having at least 80% of the required elements, ≥ 30 min spent in the session, and at least adequate skill). On average, sessions coded included 87.54% (SD = 9.53) of the required elements (range 67–100%) and evidenced therapist proficiency (M_skills=4.54, SD = 0.53; range 3.25–5.25).

CSQ Scores

A mixed effects linear regression model showed that client satisfaction was significantly higher in the Therapist-Delivered group (estimated marginal mean: 30.50 [28.18, 32.82]) than in the Self-Guided group (23.38 [21.06, 25.69]) at 1-week follow-up (γ₀₁ = 7.13, t(18.82) = 4.55, p <.001). The standardized mean difference was approximately d = 2.08 using the contemporaneous distribution of scores. At the 1-month follow-up visit, the difference between the Self-Guided (25.20 [22.93, 27.57]) and Therapist-Delivered (30.88 [28.56, 33.19]) treatments remained significant (t(18.82)₌3.59, p=.002, d = 2.00).

Credibility and Expectancies Ratings

There was no difference between groups in the credibility of the treatment or in expectations for improvement at baseline [p =.11]. Participants had average expectations for improvement (M_improvment=54.4%, SD = 20.97). There was significantly higher credibility in the Therapist-Delivered (M_1-week=8.30; SD_1-week=0.88; M_1-month=7.83; SD_1-month=1.02) versus the Self-Guided group (M_1-week=6.55, SD_1-week=1.46; M_1-month=6.78; SD_1-month=1.32) at the end of the treatment [t (Wolitzky-Taylor et al. 2015) = 2.91, p=.011], with a trend at one-month follow-up [t (Wolitzky-Taylor et al. 2015) = 1.78, p=.096]. Both groups thought the treatment was logical (MTD_1week=8.13, SD = 1.13; MSG_1week=7.88, SD = 1.13), but Therapist-Delivered participants had higher confidence that the treatment improved their emotional well-being (M_{TD_1week=}8.50, SD = 0.54) than Self-Guided participants (M_{SG_1week=}5.88, SD = 1.96).

Primary Clinical Endpoint

According to mixed model results, the expected mean improvement [95% confidence interval] in functioning (PSFS scores) was 0.11 points ([−1.67, 1.41]) higher in the Self-Guided group than in the Therapist-Delivered group. This treatment-by-time interaction effect had a high degree of uncertainty (pd = 55.52%), was not significant (ROPEfull = 11.68%), and was negligible (d = 0.10).

Regarding within-person change over time, there was strong evidence of improvments in functioning (PSFS) for both treatments. The expected mean ΔPSFS over 10.5 weeks was 3.46 [2.35, 4.63] points in the Self-Guided group (pd = 100%, d = 3.16) and 3.35 [2.29, 4.41] points in the Therapist-Delivered group (pd = 100%, d = 3.06). To estimate the mean improvement in functioning across groups, we calculated a posterior predictive distribution of within- person change scores, comparing time fixed at 0 and - 1. The predicted average change in functioning (ΔPSFS) for a trial participant was 3.40 [2.32, 4.49] points (pd = 100%; d = 3.11). There was an 86.61% probability that the mean ΔPSFS exceeded the minimal clinically important difference (MCID) value of 2.8. Alignment between the treatment preference and treatment received did not influence the changes in activity levels.

Secondary Clinical Endpoints

Self-report Measures

Multivariate model results indicated no differences in secondary outcomes between Self-Guided and Therapist-Delivered groups over time. The differences between conditions in change scores from treatment onset to 1-month follow-up are not significant and correspond to the following effect sizes: d = 0.19 (PROMIS-Anxiety), d = 0.20 (PROMIS-Depression), d = 0.11 (PROMIS Physical Functioning), d = 0.17 (CFS), d = 0.18 (BEAQ), and d = 0.29 (SMQ).

We estimated the average within-person change across the sample for each outcome variable by calculating a posterior distribution of differences in predicted values between time 0 and time - 1 for each participant (i.e., as we did with PSFS scores). Results showed evidence of changes in the expected directions for all outcomes (p-values ≥ 97.9%), except for the PROMIS Physical Functioning, which did not change over time. There was a mean decrease of −4.38 points in PROMIS Anxiety (95% CI=[−7.73, −1.03], pd = 99.42%, d = 1.14), −4.25 points in PROMIS Depression (95% CI=[−8.03, −0.39], pd = 98.44%, d = 0.81), and - 8.17 points in BEAQ (95% CI=[−14.64, −1.77], pd = 99.25%, d = 0.81). There was a mean increase of 4.45 points in CFS (95% CI=[0.18, 8.66], pd = 97.91%, d = 0.58), 10.97 points in SMQ (95% CI=[0.84, 21.13], pd = 98.26%, d = 0.87).

Level-1 residual correlations showed evidence of relations between four (out of 15) pairs of variables (pd-val- ues ≥ 95.86%); however, a single effect was significant per the ROPE-full method using a range of −0.2–0.2 to define negligible magnitudes. PROMIS Anxiety and PROMIS Depression residuals were positively correlated, with possible effect sizes ranging from small to large (r =.62, 95% CI=[0.35, 0.82], ROPE-full = 0.31%). This relation indicates that on occasions in which anxiety scores were higher or lower than expected from the temporal trend, depression scores tended to follow a similar pattern of deviation within individuals.

Within the Therapist-Delivered group, therapist-rated clinical global improvement indicated that all participants showed improvement by session 5, ranging from minimal to much improved (Fig. 1).

Fig. 1.

The figure illustrates the number of participants in the therapist-delivered condition only who received the same rating on the Clinical Global Improvement (CGI) scale (ranging from ‘much worsened’ to ‘much improved’) at the end of each treatment session

Weekly Average Daily Steps

The multiple-group mixed- effects latent basis growth model revealed no significant changes in the weekly average daily steps over time. Within the Self-Guided group, the estimated total growth between pre-treatment activity levels and the 1-month follow-up was 8.49% ( g1 SG=345.9, t₍₇₄₎ = 0.74, p=.46, d = 0.17). Within the Therapist-Delivered group, the estimated total growth in activity was 9.47% ( g1 TD= 370.5, t₍₇₄₎₌0.43, p=.667, d = 0.18). The estimated baseline-adjusted difference in average steps was 24.7 (SE = 974.9, p=.980, d = 0.01) more steps in the Self-Guided group (Fig. 2).

Fig. 2.

Model-implied populationlevel trajectories (i.e., predicted values from fixed effects) of Average Daily Steps per week between interventions. Results showed no trends in activity levels over time Data availability statement: Data available upon request Data statement: [BLINDED] Declaration of generative AI: The authors used Grammarly and Microsoft Copilot to improve paragraph flow and shorten sections. The authors take full responsibility for the content of the published article

Exit interview data

Given the small sample size, qualitative analyses were not performed. Exit interview answers were transcribed and explored for themes by the first author. All participants in the Therapist-Delivered intervention found it helpful, with some requesting more sessions. Many noted unexpected benefits, such as increased comfort in discussing issues and improvements in mobility. They valued the structured approach, engaging dialogue, and effective exercises, although there were suggestions for minor enhancements. Participants in the self-guided group found the materials logical and effective, but struggled with accountability and thought the approach would not be suitable for high-acuity cases. While half thought the length was just right, 37.5% wanted longer sessions. They appreciated applicable reading materials and engaging examples, but desired more tailored support. Overall, both groups found the program beneficial for personal growth, though those with severe psychopathology may need therapist-guided interventions. Only 18% were interested in involving a loved one in treatment. Many suggested adding support checkpoints or a hotline.

Discussion

The study aimed to assess the feasibility of administering the Unified Protocol in five sessions via telehealth to older adults and adapting it to a self-guided format. The adapted UP-ST-5 intervention was found to be both feasible and acceptable, with positive outcomes across therapist-led and self-help approaches. Despite a small sample size, the self-guided method proved comparable to therapist-guided treatment in improving activity and well-being. Participants demonstrated reduced impairment in daily activity functioning and decreased depression and anxiety. However, no significant changes in physical functioning or step counts were noted. Participants expressed greater satisfaction and confidence after therapist-led sessions, often gaining more insights from this modality than from self-guided materials.

Several programs have been developed to promote activity through self-directed, internet-delivered, or telehealth modalities that are feasible for older adults (Dawson et al. 2024). Nevertheless, the benefit of telehealth-delivered exercise programs for older adults with mobility or cognitive disabilities is questionable, given only moderate improvements, no advantages over control groups, and no effects on self-reported quality of life (Dawson et al. 2024). Conversely, web-based physical activity promotion improves physical health (e.g., walking speed, muscle strength), though depression, anxiety, and loneliness do not improve (Granet et al. 2023). Another telehealth program for low-income older adults similarly found that depression and social isolation are not adequately addressed (VanRavenstein and Davis 2018). Together, these studies indicate that improving mobility and activity without simultaneously addressing mental health may be difficult, highlighting the need for approaches that incorporate both activity level and mental health targets.

While both approaches showed similar benefits, differences in confidence and satisfaction at the end of treatment are important to consider. Participants noted they would have appreciated a hotline or check-in with a trained provider to discuss challenging concepts. Although a selfguided method may be effective, it may not be suitable for everyone. Most participants who completed the self-paced approach emphasized the need for self-motivation, and across groups, there was concern that with higher psychopathology severity, the self-guided approach may not meet client needs. This approach could be helpful when there is a delay in accessing one-on-one support, or as a supplementary option for older adults who are temporarily unable to attend treatment. It may also introduce valuable concepts before therapy, helping older adults maximize their benefits. These themes highlight both the promise and areas for improvement, warranting future qualitative research.

Limitations of this study include a small sample size, the involvement of only one interventionist, limited development of the self-help platform, and limited diversity in the sample. While the participants interacted well with the materials, further developing the platform to incorporate professional videos, electronic worksheets, and additional visual aids and examples could enhance the user experience and increase satisfaction with the treatment. Research with more diverse samples is warranted.

In summary, this study investigated the feasibility of delivering an adapted 5-session version of the UP via telehealth and in a self-guided format to older adults. Both therapist-led and self-guided interventions showed preliminary evidence of effectiveness. Participants reported higher satisfaction and confidence in their skills in the therapist-guided approach. The study suggests that self-guided interventions could be a valuable option, but further development of the self-help platform is needed.

Supplementary Material

The online version contains supplementary material available at https://doi.org/10.1007/s10879-026-09727-8.

Data Availability

Data available upon request.