Interpersonal Psychotherapy for Late Life Depression: Current Status and New Applications

Interpersonal Psychotherapy (IPT) is an empirically-supported treatment for depression and other mental disorders. This article discusses the structure of IPT, its use with older adults, and research that supports its efficacy with depressed older people. Depressed older persons with significant health problems or cognitive impairment present special challenges for those conducting IPT and other psychotherapies. Promising new psychotherapies developed for depressed older adults with cognitive impairment and those living in nursing homes are reviewed. Recommendations are made for use of IPT with older adults in nursing homes.     

Technology-Assisted Psychotherapy (TAP): Adapting Computerized Treatments into Traditional Psychotherapy for Depression

Technology may be changing the process of psychotherapy. Unfortunately, some therapists lack the computer skills or financial resources needed for the newest technology. The literature is reviewed for journal articles on the treatment of depression published during the past 7 years in which treatments have been guided by technology. Six findings are summarized that may be helpful when therapists lack skills or resources for advanced technology. (1) The assessment of depression can be facilitated by technology, whether using standardized questionnaires or simple ratings of mood submitted each day. (2) Technology tools can be used to send daily reminders to help clients develop more adaptive habits in thoughts or actions. (3) Clients can confront their problems through therapeutic dialogue, whether conducted in person, over the telephone, or via videoconference. (4) Depressed clients can confront their negative attitudes, often triggered by some form of loss, failure, or rejection, whether real, imagined, or anticipated. (5) Clients can use writing assignments to identify, label, explore and express their thoughts and feelings. These writing assignments can be conducted via email, or internet forms. (6) Clients value rapport with a therapist, and this bond seems important to ensure participation and adherence with treatment. Therapists can strengthen the treatment of depression using basic technology tools to extend, or supplement traditional sessions. However, it is important to protect the rapport needed for sustained participation in psychotherapy sessions.     

The Behavioral Activation for Depression Scale (BADS): Psychometric Properties and Factor Structure

In Behavioral Activation (BA) for depression (Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001)), which has recently received empirical support in a large randomized trial, therapists pay close attention to the function of behavior and the role of aversive controlling stimuli and escape and avoidance behavior in depression. A key variable to measure in studies of BA is when and how clients become more activated over the course of treatment. This study sought to develop an initial set of items for the Behavioral Activation for Depression Scale (BADS), submit these items to an exploratory factor analysis in an initial administration (Study 1, N = 391), and submit the resulting scale to a confirmatory factor analysis in a second administration (Study 2, N = 319). Results indicated four factors (Activation, Avoidance/Rumination, Work/School Impairment, and Social Impairment) with good factor structure, internal consistency, and test-retest reliability. Evidence for construct and predictive validity is presented.     

Expiation,Substitution and Surrender: Levinasian Implications for Psychotherapy

This essay will build on Emmanuel Levinas’s rejection of ontology as foundational and draw out the implications for psychotherapy. We will explore Levinas’s concept of substitution (in both his more Jewish writings and his philosophical treatises) and consider its meaning in relationship to the role of a psychotherapist. Levinas understands the Other as a calling for substitution of the self and of a taking on of responsibility. We explore the notion of surrender in the work of the psychoanalyst Emmanuel Ghent and argue that his position is ultimately lacking in ethical injunction; requiring nothing of the self in relationship to the Other. It remains within the confines of the conventional, self-reflexive models that Levinas critiques. Following Levinas, we suggest that the therapist bear the burden of ethical responsibility by being exposed to the client’s ethical call and by responding out of a kenotic self-emptying.

Ethics,Alterity, and Psychotherapy: A Levinasian Perspective

Current psychologies of religion reflect the modernist context in which they are situated. Religion is reduced to what is researchable, generalizable, individual and “thin.” This essay suggests that a psychology of religion which takes seriously the implications of Emmanuel Levinas’s emphasis on ethics and the alterity of the Other would result in a different model of psychotherapy. Levinas’s view of the Other as the trace of the transcendent radically changes our understanding of the client within the therapeutic relationship. Levinas begins with ethics and so healing would be, by implication, an ethical enterprise. In a highly secularized, individualized, objectivized culture, a therapy which recognizes the sacred, which models how to view the Other as transcendent, and which does not presume to know, is a gift to the client.     

Panacea or Placebo: The Historical Quest for Medications to Treat Depression

Background: Over the years, there have been many advances in contemporary medicine and the ability to treat depression with medications. However, some innovative practices in medical treatments appear less than ideal when viewed from a historical perspective. Aims: It is important for health care professionals to appreciate the risks and limitations of a biological approach to an emotional disorder. Conclusions: If professionals can learn from past mistakes, they can better evaluate the merits of contemporary treatments.     

Validation of the Behavioral Activation for Depression Scale (BADS) in a Community Sample with Elevated Depressive Symptoms

The Behavioral Activation for Depression Scale (BADS) was previously developed to measure changes in avoidance and activation over the course of Behavioral Activation for depression. Initial scale development, definition of the factor structure and confirmation of the factor structure was performed with a non-depressed undergraduate sample. These prior results revealed four factors (Activation, Avoidance/Rumination, Work/School Impairment, and Social Impairment) with good factor structure, internal consistency, and test–retest reliability. The purpose of the current study was to evaluate the psychometric properties, factor structure and construct validity of the BADS with a community sample with elevated depressive symptoms (N = 193). Results indicated good psychometric properties, additional evidence for construct validity of the total scale and subscales, and adequate fit of the data to the original factor structure. Normative data are also provided separately for depressed men and women, and for Caucasians and African Americans.     

Psychotherapy: Definitions, Mechanisms of Action, and Relationship to Etiological Models

In this paper, we define psychotherapy as a modality of treatment in which the therapist and patient(s) work together to ameliorate psychopathologic conditions and functional impairment through focus on the therapeutic relationship; the patient's attitudes, thoughts, affect, and behavior; and social context and development. The possible mechanisms of action and active ingredients of psychotherapy in children and adolescents are discussed, with an emphasis on the above-noted domains. The adult psychotherapy literature strongly supports the central roles of the therapeutic relationship and therapeutic empathy; this has been much less intensively explored in the child and adolescent psychotherapy literature. Similarly, there have been few studies examining the mediation of treatment effects by impact on specific domains. Ideally, treatment studies should gather data that can be informative about the impact of putative mediating and moderating psychosocial and biological variables on outcome and course. The results of such studies can aid further refinements in both theories of etiology and improvement in treatments for children and adolescents.     

Residual Geriatric Depression Symptoms: A Place for Psychotherapy

Geriatric depression is a relatively commonly occurring mental disorder. A subpopulation of depressed older adults are those who have engaged in or completed pharmacotherapy, yet continue to experience depressive symptoms. We review the prevalence, psychosocial effects, and treatment of residual symptoms of depression in older adults. Data from previous studies conducted by our group are presented to support our contention that residual symptoms of geriatric depression are treatable through psychosocial means.     

Randomized trial of a brief depression prevention program: an elusive search for a psychosocial placebo control condition

This trial compared a brief group cognitive-behavioral (CBT) depression prevention program to a waitlist control condition and four placebo or alternative interventions. High-risk adolescents with elevated depressive symptoms (N=225, M age=18, 70% female) were randomized to CBT, supportive-expressive group intervention, bibliotherapy, expressive writing, journaling, or waitlist conditions and completed assessments at baseline, termination, and 1- and 6-month follow-up. All five active interventions showed significantly greater reductions in depressive symptoms at termination than waitlist controls; effects for CBT and bibliotherapy persisted into follow-up. CBT, supportive-expressive, and bibliotherapy participants also showed significantly greater decreases in depressive symptoms than expressive writing and journaling participants at certain follow-up points. Findings suggest there may be multiple ways to reduce depressive symptoms in high-risk adolescents, although expectancies, demand characteristics, and attention may have contributed to the observed effects.     

Professional relationships in dangerous times: C. G. Jung and the Society for Psychotherapy

Relying in part on previously unpublished documents of the 1930s, this paper(1) describes the origins and mission of the General Medical Society for Psychotherapy, both as it existed before Hitler's rise to power and as it was transformed afterward. Jung accepted the Society's presidency in 1933-34, on condition that it be restructured as an international, politically neutral organization, free from the laws of Gleichschaltung (Nazi conformity). The paper also contains a close study of Jung's collaboration with one interesting German colleague, Walter Cimbal. Cimbal, a neurologist, was briefly a member of the Nazi Party and, judging from his early letters to Jung, a Hitler enthusiast. Yet he also seems to have tried, together with Jung, to alleviate the difficulties of German Jewish colleagues whose lives were disrupted by the Hitler revolution. The paper includes translated passages from Cimbal's previously unpublished letters from 1933-36 and the post-war years. It also includes a first-person account by Wladimir Rosenbaum, the Zurich lawyer who assisted Jung in 1934, when Jung tried to mitigate the impact of anti-Jewish laws on his German Jewish colleagues. In the primary materials of this period one discovers more evidence of moral shadow-and also less-than is sometimes assumed.     

Enhancing Interpersonal Psychotherapy for Mothers and Expectant Mothers on Low Incomes: Adaptations and Additions

Intervening with depressed women during their childbearing years, especially with those on low incomes, is critically important. Not only do mothers and expectant mothers suffer unnecessarily, but their untreated depression has critical negative consequences for their families. Despite this, these women have proven especially difficult to engage in psychotherapy. In this paper we describe several adaptations and additions we have made to a brief form of Interpersonal Psychotherapy (IPT) to meet the needs of mothers and expectant mothers living on low incomes in the community who suffer from depression, but face significant practical, psychological, and cultural barriers to engaging in and staying in treatment. In addition, we present some preliminary data on the extent to which our enhanced, brief IPT approach promotes improvements in treatment engagement and retention relative to usual care for expectant mothers on low incomes.     

Cognitive and Behavioral Treatments for Anxiety and Depression in a Patient with an Implantable Cardioverter Defibrillator (ICD): A Case Report and Clinical Discussion

Implantable cardioverter-defibrillators (ICDs) are the treatment of choice for patients at risk for potentially life threatening arrhythmias. The associated stress of living with an implanted device and receiving ICD shock therapy has been noted to exert a psychological toll on the individual patient and family. Anxious and depressive symptomatology is frequently reported by these patients, thus creating a demand for tailored psychological interventions for this population. The current case report describes the components, delivery, and effectiveness of a targeted treatment approach for anxiety and depression in an individual with an ICD. Test results and interview data revealed significant improvements in multiple domains of cognitive, emotional, and behavioral functioning. Improvements in marital relations were also achieved. These treatment effects were maintained at follow-up and in the context of acute, medical stressors. Future clinical and research directions are also discussed.     

Internet-Based and Other Computerized Psychological Treatments for Adult Depression: A Meta-Analysis

Computerized and, more recently, Internet-based treatments for depression have been developed and tested in controlled trials. The aim of this meta-analysis was to summarize the effects of these treatments and investigate characteristics of studies that may be related to the effects. In particular, the authors were interested in the role of personal support when completing a computerized treatment. Following a literature search and coding, the authors included 12 studies, with a total of 2446 participants. Ten of the 12 studies were delivered via the Internet. The mean effect size of the 15 comparisons between Internet-based and other computerized psychological treatments vs. control groups at posttest was d = 0.41 (95% confidence interval [CI]: 0.29–0.54). However, this estimate was moderated by a significant difference between supported (d = 0.61; 95% CI: 0.45–0.77) and unsupported (d = 0.25; 95% CI: 0.14–0.35) treatments. The authors conclude that although more studies are needed, Internet and other computerized treatments hold promise as potentially evidence-based treatments of depression.     

Disconnection, Depression, and Spirituality: A Study of the Role of Spirituality and Meaning in the Lives of Individuals with Severe Depression

This qualitative study explores the role of spirituality and meaning among 15 participants suffering from severe depression. During the time of this study, all the participants were in treatment at Loma Linda University Behavioral Medicine Center. The emerging themes are: (1) depression creates a sense of spiritual disconnection. Participants indicated feeling disconnected from God, the community, and oneself; (2) spirituality plays an important role in coping with the pain of depression; (3) there exists a deep yearning for a sense of meaning and a struggle to make sense of one’s pain; and (4) coming to terms with one’s circumstances and one’s depression at some level assists in the healing process.     

Depression, impulsivity and health-related disability: A moderated mediation analysis

The goal of the current study is to examine how impulsivity affects the relationship between depression and health-related disability. Specifically, we examined impulsivity as a possible moderator of this relationship, as well as alcohol use, smoking, and binge eating as possible mediators. The study utilized the Collaborative Psychiatric Epidemiological Surveys (N = 20,013, mean age = 43.38, female = 57.3%). We conducted a series of moderated mediation analyses to test hypotheses. In all analyses, the relationship between depression and health-related disability was mediated by each maladaptive coping behavior, and the relationship between depression and the behavior was moderated by impulsivity. The study supports the utility of examining the individual difference mechanisms that might drive the relationship between depression and health-related disability.     

Depression for college students in a traditional Christian culture context: the role of attachment,spirituality and social support

The role of attachment, perceived social support, and perceived discrepancy from spiritual ideal were assessed in their association with depression in college students in a Christian culture environment. Participants (N?=?155) at a small Christian university completed the Center for Epidemiological Studies Depression Scale, the Experiences in Close Relationships questionnaire, and questions about satisfaction with social support and discrepancy of their spiritual well-being to an ideal spiritual well-being. Results showed that social support, insecure attachment and discrepancy from spiritual ideal were all significant predictors of depression. Attachment was found to moderate the association between perceived spiritual well-being and depression, with insecurely attached individuals more at risk for depression if they evaluate their spiritual development as lacking. Implications are discussed.     

An Opportunity for Genetic Counseling Intervention: Depression in Parents of Individuals with Proteus Syndrome

Depression is common, affecting 2–5% of the general population. Parental depression can confound adjustment to, and caring for, a child with a genetic condition. As part of a study on psychosocial issues of parents caring for children with Proteus syndrome, 31 parents (20 mothers and 11 fathers) completed a depression screening tool, the Beck Depression Inventory. Approximately 23% (4/20 mothers and 3/11 fathers) scored positive on the tool. Pessimism, sense of failure, general lack of satisfaction, sense of punishment, self-dislike, social withdrawal, indecisiveness, work inhibition, somatic preoccupation, and loss of libido were reported more frequently by the group of parents with positive screen results than those with normal results. These data suggest that symptoms of depression may be prevailing among parents of individuals with Proteus syndrome. Because effective interventions for depression are readily available, genetic counselors working with families affected with rare, overgrowth disorders should specifically assess parents for physical and affective symptoms of depression and refer them for appropriate clinical treatment.     

Maternal and Paternal Parenting Styles in Adolescents: Associations with Self-Esteem,Depression and Life-Satisfaction

Our study examined variations in adolescent adjustment as a function of maternal and paternal parenting styles. Participants included 272 students in grades 9 and 11 from a public high school in a metropolitan area of the Northeastern US. Participants completed measures of maternal and paternal parenting styles and indices of psychological adjustment. Authoritative mothering was found to relate to higher self-esteem and life-satisfaction and to lower depression. Paternal parenting styles was also related to psychological adjustment, however, although the advantage of authoritative mothering over permissive mothering was evident for all outcomes assessed, for paternal styles the advantage was less defined and only evident for depression. Our study highlights the importance of examining process-oriented agents as part of the broader interest in well-being variations in adolescents.