Research AppraisalRandomised Controlled Trial

Emotion-focused therapy and forgiveness in the older population: Protocol for a feasibility randomized controlled trial

PloS oned'Almeida, Bernardo Corrêa, Cunha, CarlaDOI

Clinical Snapshot

25CEBM
Evidence: WeakRandomised Controlled Trial

PICO Framework

P — PopulationAdults aged 65 and older with unresolved emotional injuries from interpersonal offenses
I — InterventionEmotion-Focused Therapy delivered over 12 weekly sessions
C — ComparatorWaiting list control group (delayed intervention)
O — OutcomesFeasibility (recruitment and retention rates, protocol adherence) and acceptability (treatment credibility, outcome expectations, engagement levels, satisfaction)

Bottom Line

This protocol outlines a feasibility study for Emotion-Focused Therapy targeting forgiveness in older adults - an understudied but potentially important intervention. While the research question addresses a genuine clinical need, the protocol lacks sufficient methodological detail for robust evaluation. Key concerns include inadequate randomisation description, absence of validated outcome measures, and limited consideration of potential harms. The waiting-list control design is appropriate for feasibility testing but precludes blinding. Before implementation, researchers should strengthen the protocol by specifying randomisation procedures, incorporating validated psychological measures, and addressing potential adverse effects. If successful, this work could inform larger trials, but current evidence is insufficient to guide clinical practice. Australian clinicians should await results while noting that cultural adaptation would be necessary for local implementation.

Evidence: Weak

Key Findings

  • P Value: Not applicable - protocol stage

  • Effect Size: Not applicable - protocol stage

  • Primary Outcome: Feasibility (recruitment/retention rates, protocol adherence)

  • Nnt Or Sensitivity: Not applicable - feasibility study design

  • Confidence Interval: Not applicable - protocol stage

Clinical Application

Limited by requirement for 12 weekly sessions and specialised EFT training Would require adaptation for Australian cultural context; potential Medicare rebates under Better Access scheme if delivered by qualified psychologists Community-dwelling older adults with unresolved interpersonal grievances

Abstract

Over recent decades, Emotion-Focused Therapy, aging, and forgiveness have garnered significant attention in the field of psychology. However, there is a lack of studies on Emotion-Focused Therapy and forgiveness specifically tailored for older adults. This article presents a protocol designed to assess the feasibility and acceptability of a randomized controlled trial of Emotion-Focused Therapy aimed at resolving emotional injuries in individuals aged 65 and older, within the context of interpersonal offenses. Feasibility will be evaluated through recruitment and retention rates, as well as adherence to the intervention protocol. Acceptability will be assessed based on perceived treatment credibility, participants' expectations regarding outcomes, levels of engagement, and overall satisfaction with the intervention. The study is structured as a two-arm, parallel-group randomized trial with a waiting list control. We propose recruiting a sample of 70 participants, randomly assigned to either an immediate intervention group, which will receive Emotion-Focused Therapy over twelve weekly sessions, or a control group that will receive the same therapy after a twelve-week waiting period. Data will be collected in the beginning, middle, and at the end of therapy, and in two planned follow-ups (three and six months after therapy). Once this protocol is implemented, if the therapy proves to be feasible, acceptable, and shows promising results, the findings will inform a large-scale randomized clinical trial to advance the understanding of this treatment for individuals aged 65 + .

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