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Is group psychotherapy effective in older adults with depression? A systematic review
- Authors:
- KRISHNA Murali, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(4), April 2011, pp.331-340.
- Publisher:
- Wiley
The evidence from earlier reviews and meta-analyses lead to the conclusion that psychological treatment of depression is effective in older adults. The authors conducted a systematic review specifically looking at group psychotherapy. Electronic databases were searched to identify randomised controlled trials, selected studies were quality assessed and data extracted by two reviewers. Six trials met the inclusion criteria. These trials examined group interventions based on the cognitive behavioural therapy model with active therapeutic interventions (such as reminiscence therapy) or waiting list controls. The analyses indicate that group psychotherapy is an effective intervention in older adults with depression in comparison to waiting list controls but the overall effect size is very modest. The reported benefits of group intervention in comparison to other active interventions did not reach statistical significance. The benefits of group psychotherapy were maintained at follow-up. The authors note that the quality of the studies was variable, and not always optimal, and that most of the work involved the younger old so may not be transferable to the very elderly. Overall they conclude that group cognitive behavioural therapy is effective in older adults with depression.
Effects of psychotherapy and other behavioral interventions on clinically depressed older adults: a meta-analysis
- Authors:
- PINQUART M., DUBERSTEIN P. R., LYNESS J. M.
- Journal article citation:
- Aging and Mental Health, 11(6), November 2007, pp.645-657.
- Publisher:
- Taylor and Francis
The goal of the present study was to assess the effects of psychotherapy and other behavioural interventions on depressive symptoms in clinically depressed older patients. Meta-analysis was used to examine the effects of 57 controlled intervention studies. On average, self-rated depression improved by d=0.84 standard deviation units and clinician-rated depression improved by d=0.93. Effect sizes were large for cognitive and behavioural therapy (CBT) and reminiscence; and medium for psychodynamic therapy, psychoeducation, physical exercise and supportive interventions. Age differences in treatment effects were not observed. Weaker effects were found in studies that used an active control group and in studies of physically ill or cognitively impaired patients. Studies of samples comprised exclusively of patients suffering from major depression (versus other mood disorders) also yielded weaker intervention effects. On average, 18.9% of participants did not complete the intervention, with higher dropout rates reported in group (versus individual) interventions and in longer interventions. It is concluded that cognitive-behavioural therapy and reminiscence are particularly well-established and acceptable forms of depression treatment. Interventions with 7-12 sessions may optimize effectiveness while minimizing dropout rates. For physically and cognitively impaired patients, modifications in treatment format and/or content might be useful, such as combining psychotherapy with social work interventions and pharmacotherapy.
Acceptability and effects of tele-delivered behavioral activation for depression in low-income homebound older adults: in their own words
- Author:
- CHOI Namkee G.
- Journal article citation:
- Aging and Mental Health, 25(10), 2021, pp.1803-1810.
- Publisher:
- Taylor and Francis
Objectives: To examine experiences and perspectives of low-income homebound older adults (N = 90) who participated in tele-delivered behavioral activation (Tele-BA) treatment for depression by bachelor’s-level lay counselors. Methods: We used the 11-item Treatment Evaluation Inventory (TEI) to measure participants’ acceptability of Tele-BA. We used inductive thematic analysis to explore participants’ Tele-BA session goals and activities and unsolicited and solicited comments about their Tele-BA experience. Results: Participant’s TEI score averaged 70 out of maximum possible 77. The most frequently chosen Tele-BA goals were to improve self-care management of physical and mental health, engage in self-enrichment/self-enjoyment, improve living environment and daily routine, and to increase social connectedness. The themes that emerged from participants’ comments about Tele-BA were: (1) benefits of psychoeducation; (2) importance of and gratitude for working with a counselor; (3) benefits of activity planning; (4) understanding of behavior and mood connection; (5) positive effects of increased activity on health and self-enjoyment; (6) sense of being productive and useful from accomplishing goals; (7) hope for the future; and (8) pride in tele-treatment. Conclusion: Participants’ comments show that Tele-BA aimed at reinforcing healthy behaviors that improve both physical functioning and mood is well aligned with these older adults’ perception of what treatment should be. The findings also provide support for lay counselors’ clinical capacity. Given geriatric mental health workforce shortages, lay counselors may be able to effectively supplement existing professional mental health service systems. (Edited publisher abstract)
Activity scheduling as a core component of effective care management for late-life depression
- Authors:
- RIEBE Genevieve, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(12), December 2012, pp.1298-1304.
- Publisher:
- Wiley
Activity scheduling is an established treatment for late-life depression in primary care. This observational mixed method analysis examined participant records from the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial to identify activity scheduling strategies used in the context of successful depression care management (CM), associations of activity scheduling with self-reported activity engagement, and depression outcomes. A total of 4335 CM session notes for 597 participants in the intervention arm were examined. Grounded theory was used to identify 17 distinct activity categories from CM notes and associations between activity scheduling, activity engagement, and depression outcomes evaluated at 12 months. Most patients worked on at least one social and one solitary activity during their course of treatment. Common activity categories included physical activity (32%), medication management (22%), active–non-physical (19%), and passive (14%) activities. Significant positive associations were found between activity scheduling, self-reported engagement in activities at 12 months, and depression outcomes at 12 months. The data indicate a benefit for intentional social engagement versus passive social and solitary activities. The authors suggest that care managers should encourage patients to balance instrumental activities (e.g., attending to medical problems) with social activities targeting direct interpersonal engagement.
A self-help behavioral activation treatment for geriatric depressive symptoms
- Authors:
- MOSS Kathryn, et al
- Journal article citation:
- Aging and Mental Health, 16(5), July 2012, pp.625-635.
- Publisher:
- Taylor and Francis
This study investigated behavioural activation (BA) bibliotherapy as a treatment for late-life depressive symptoms. BA bibliotherapy was administered using Addis and Martell's Overcoming depression one step at a time as a stand-alone treatment that was completed by 26 participants over a 4-week period in Alabama, United States. Results of an immediate intervention group were compared with those of a delayed treatment control group and treatment response for both groups was evaluated at 1-month follow-up. Findings indicated that symptoms on a clinician-rated measure of depressive symptoms were significantly lower at post-treatment for those who received immediate BA bibliotherapy compared with those who were in the delayed treatment control condition. However, self-reported depressive symptoms were not significantly different. Self-reported depressive symptoms were significantly lower from pre-treatment to 1-month follow-up. The authors concluded that BA could be useful in treating mild depressive symptoms in older adults.
The effectiveness of behavioural therapy for the treatment of depression in older adults: a meta-analysis
- Authors:
- SAMAD Zara, BREALEY Stephen, GILBODY Simon
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(12), December 2011, pp.1211-1220.
- Publisher:
- Wiley
This review examined the effectiveness of behavioural therapy in depressed older adults over 55 years. Four Randomised controlled trials (RCTs) of behavioural therapy compared with waiting list controls or other psychotherapies in older adults with clinical depression were included in the review. For post-treatment self-rated depression symptoms, behavioural therapy was not significantly more effective than a waiting list control, cognitive therapy or brief psychodynamic therapy. For post-treatment clinician-rated depression, behavioural therapy was not significantly more effective than cognitive therapy or brief psychodynamic therapy but was significantly more effective than a waiting list control. Behavioural therapy in depressed older adults appeared to have comparable effectiveness with alternative psychotherapies. The authors concluded that further research was required with larger sample sizes, more clarity on trial design and the intervention, longer term follow-up and concomitant economic evaluations
Cognitive behavioural therapy with older people: interventions for those with and without dementia
- Author:
- JAMES Ian Andrew
- Publisher:
- Jessica Kingsley
- Publication year:
- 2010
- Pagination:
- 256p., bibliog.
- Place of publication:
- London
The use of Cognitive Behavioural Therapy (CBT) with older people both with and without cognitive difficulties is discussed. The book is divided into three main parts. The first orientates the reader, examines potential adaptations and discusses CBT from a practical and conceptual perspective. The second section reviews older people’s therapy in terms of assessment, formulation and interventions. The final part offers practical advice, using case examples in both dementia and depression. The text is aimed at trainees and experienced therapists alike and is expected to be of value to anybody using CBT in their work with older people, regardless of their clients' levels of cognitive ability.
Using spiritually modified cognitive behavioral therapy to help clients wrestling with depression: a promising intervention for some older adults
- Authors:
- HODGE David R., BONIFAS Robin P.
- Journal article citation:
- Journal of Religion and Spirituality in Social Work, 29(3), July 2010, pp.185-206.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
It has been suggested that the efficacy of cognitive behavioural therapy (CBT) in the treatment of older adults with depression may be enhanced by incorporation of beliefs and values drawn from clients’ spiritual narratives. Research is reviewed on the effectiveness of spiritually modified CBT in the treatment of depression. Four overlapping rationales relating to the salience of spirituality, ethnic diversity, gender and religious diversity are discussed. Research suggests that, relative to traditional CBT, spiritually modified CBT may result in faster recovery, improved treatment adherence, lower posttreatment relapse, and reduced treatment disparity. It may therefore offer an alternative to the use of medication. The process of constructing spiritually modified CBT self-statements for use with older adults with depression is described and illustrated and basic guidelines are given to ensure ethical and professional practice. The authors comment that, given the promise inherent in spiritually modified CBT, further research on this modality should be prioritised to ensure that older adults receive the most efficacious treatment for depression.
Do improvements in emotional distress correlate with becoming more mindful? A study of older adults
- Authors:
- SPLEVINS Kate, SMITH Alistair, SIMPSON Jane
- Journal article citation:
- Aging and Mental Health, 13(3), May 2009, pp.328-335.
- Publisher:
- Taylor and Francis
The study aimed (1) to investigate changes in older adults' emotional wellbeing (specifically depression, anxiety and stress levels) and mindful ability following a mindfulness-based cognitive therapy (MBCT) course; (2) to explore correlations between mindfulness (measured as an overall ability and as individual components; observe, describe, act with awareness and accept without judgement) and changes in depression, anxiety and stress levels. Twenty-two participants took an eight-week MBCT course. Levels of depression, anxiety and stress were recorded pre- and post-intervention, as was mindfulness ability (measured both as an overall ability and as individual components). Significant improvements in emotional wellbeing and mindfulness were reported post-MBCT, with large to moderate effect sizes. Increased mindfulness was moderately and significantly associated with improved emotional wellbeing. Increases on all four components of mindfulness were positively associated with greater emotional wellbeing, however only act with awareness and accept without judgement were significantly correlated (with reduced depression). Older adults in the sample reported higher scores on observe and act with awareness than other populations.
A pilot randomised controlled trial of a brief cognitive behavioural group intervention to reduce recurrence rates in late life depression
- Authors:
- WILKINSON Philip, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(1), January 2009, pp.68-75.
- Publisher:
- Wiley
A brief group cognitive behaviour therapy intervention (CBT-G) therapy manual was produced and the Cognitive Therapy Rating Scale (CTS-R) modified to assess therapy delivery. Forty-five adults aged 60 and over who had met ICD-10 criteria for major depression in the previous year and were still taking antidepressant medication were randomly allocated to CBT-G/antidepressant combination or antidepressant alone. Depression severity was measured at baseline, randomisation and 6 and 12 months after start of CBT-G using the Montgomery Åsberg Rating Scale for Depression (MADRS). One-year recurrence rates on the MADRS were encouragingly lower in participants receiving CBT-G compared with controls although this did not achieve statistical significance. In contrast, overall scores on the secondary outcome measure, the Beck Depression Inventory, increased in participants receiving CBT-G. The CBT-G manual was successfully implemented and therapy delivery achieved an overall satisfactory level of competence.