The effectiveness of psychotherapeutic interventions for bereaved persons: a comprehensive quantitative review

Previous quantitative reviews of research on psychotherapeutic interventions for bereaved persons have yielded divergent findings and have not included many of the available controlled outcome studies. This meta-analysis summarizes results from 61 controlled studies to offer a more comprehensive integration of this literature. This review examined (a) the absolute effectiveness of bereavement interventions immediately following intervention and at follow-up assessments, (b) several of the clinically and theoretically relevant moderators of outcome, and (c) change over time among recipients of the interventions and individuals in no-intervention control groups. Overall, analyses showed that interventions had a small effect at posttreatment but no statistically significant benefit at follow-up. However, interventions that exclusively targeted grievers displaying marked difficulties adapting to loss had outcomes that compare favorably with psychotherapies for other difficulties. Other evidence suggested that the discouraging results for studies failing to screen for indications of distress could be attributed to a tendency among controls to improve naturally over time. The findings of the review underscore the importance of attending to the targeted population in the practice and study of psychotherapeutic interventions for bereaved persons.     

The psychotherapeutic utility of the five-factor model of personality: a clinician's experience.

This article summarizes experience using the five-factor model of personality, operationalized by the NEO Personality Inventory (NEO-PI), to facilitate psychotherapy treatment with 119 private-practice, outpatient, psychotherapy patients and their family members over a period of 2 years. Trait theories such as the five-factor model implicitly challenge the premises of much clinical theory, yet they can be useful to clinicians, as they provide a detailed, accurate portrait of the client's needs, feelings, proximate motives, and interpersonal style. I suggest that: Neuroticism (N) influences the intensity and duration of the patient's distress, Extraversion (E) influences the patient's enthusiasm for treatment, Openness (O) influences the patient's reactions to the therapist's interventions, Agreeableness (A) influences the patient's reaction to the person of the therapist, and Conscientiousness (C) influences the patient's willingness to do the work of psychotherapy. Fundamental questions raised by the five-factor model about the nature of psychopathology and psychotherapy are discussed.     

Care of elderly persons in the family: an approach based on a developmental model

Care-giving as an act of decision-making, as a reciprocal action, and based on sex of the care-giver, are reviewed. It is suggested that the care of elderly parents, a long-term commitment, should be viewed from a developmental perspective, beginning from childhood for an adult care-giver to be better adjusted to this role and for better outcomes.     

Television news and elderly persons.

Previous studies concerning elderly people have examined either use of all media by older adults or their depiction in television entertainment programs. What has been overlooked has been television news and its effects on elderly people. Careful research is needed to gauge this.     

Mental slowing in elderly persons: a cognitive psychophysiological analysis

In recent attempts to formulate an integrative model of mental slowing in elderly persons, regression analyses have been done in which reaction-time data from a large number of studies spanning a broad range of speeded decision-making tasks were combined. The results of these meta-analyses were then used to support the conclusion that there is a generalized, proportional decline in mental processing speed among elderly adults that affects all elements of mentation equally. We present a series of similar regression analyses in which both reaction time and the latency of the P300 component of the event-related brain potential are included. The results of these analyses indicate that there are elements of mental processing that may be slowed additively, not proportionately, in older persons. Furthermore, the results raise some questions about the logic underlying the interpretation of the meta-regression analysis.     

Depression in elderly persons and its correlates in family practice: a Canadian study.

Depression was studied in a Canadian community sample of 582 men and 906 women over the age of 65 years. The Center for Epidemiological Studies Depression Scale (CES-D) provided the measure of depressive symptomatology. The Diagnostic Interview Schedule was used to confirm clinical diagnosis. A total of 8% of the sample (4.3% of men and 10.4% of women) were at or above the cut-off point of 16 on the Depression Scale. Significant Pearson correlations with depression were found for gender and education. The married and never married persons showed low depression while the widowed, separated, or divorced appeared to be at high risk. The relationship of marital status to depression is primarily a woman's issue as most elderly men are married. This finding may have implications for policy and program planning for this population.     

Perceived functional health of disabled elderly persons in a follow-up program for primary care.

180 disabled elderly persons were followed in a home care program after acute care rehabilitation in order to correlate subjective and objective ratings of medical, physical, and social functioning. To assess the benefits of case management services, 95 test patients receiving such care at home were compared with 85 controls who did not receive services. Both groups reported gains in functional health and their reports were verified with objective measures. There was no difference, however, between the groups in outcome. Our findings indicated that self-assessments correlate highly with measures of functional health. Procedures for self-ratings should be developed as important complements to objective functional health measures.     

Progressive and imaginal relaxation training for elderly persons with subjective anxiety.

Elders exposed to either progressive or imaginal relaxation procedures reported significant relaxation effects and showed improvement on measures of personal functioning. The results of the Physical Assessment Scale of the Relaxation Inventory indicated that relaxation responses were acquired within and across sessions. Large, consistent changes in relaxation occurred in all 4 sessions. The Symptom Checklist-90-R, which measures self-reported personal adjustment, showed significant positive changes following relaxation training and at 1-month follow-up. Elders who imagined muscle tension release profited as much as those engaged in actual muscle tension-release activities. This finding is of importance for older adults who may experience physical limitations that contraindicate muscle-tension-release procedures.     

Group psychotherapy in chronic psychiatric outpatients: a Toronto model.

Seventy to 80 chronic psychiatric patients are treated in an aftercare clinic with a goal of tertiary preventive care. The major component of the treatment approach is reality-oriented group psychotherapy with an emphasis on interpersonal relationships. Attention to three factors in group psychotherapy with this population of patients has facilitated our work and outcome. These are the concept of the core group, diagnostic heterogeneity, and staff structure.     

Self-perceived information needs and concerns of elderly persons.

The research was intended to identify the dimensions underlying self-perceived information needs and concerns of an elderly population. The spontaneously mentioned needs and concerns expressed in 271 letters from a sample of the population were extracted and a multidimensional scaling procedure was used to represent the 58 most frequently mentioned items in configurations of varying dimensionality. To interpret the multidimensional spaces, another sample of 176 elderly subjects was asked to rate the 58 concerns on eight properties. These ratings were then regressed onto the multidimensional configurations. The results indicate that the most frequently mentioned information needs and concerns of elderly persons can be parsimoniously understood in terms of three underlying dimensions: (1) Improving the Quality of Life vs Securing the Necessities of Life, (2) Health-related vs Not Health-related, and (3) Individual vs Societal Responsibility.     

Suicide survivors: psychotherapeutic implications of egocide.

Interviews with seven of ten known survivors of jumps from the Golden Gate Bridge and San Francisco-Oakland Bay Bridge revealed that all of them experienced transcendence and spiritual rebirth phenomena. The psychotherapeutic implications of these findings lie in helping depressed and suicidal individuals confront death in a symbolic and meaningful way. The issue is one of "egocide" (symbolic suicide) and aiding individuals in the rebirth process. In this way actual suicides can be prevented. When individuals experience partial "deaths" (like loss, failure, rejection, depression, suicidal states, or negative parts of their egos), there is opportunity for "rebirth" (positive transformation, creative change, growth, and significant spiritual reawakening). The therapeutic task is to help individuals differentiate between "ego death" and total death and to discover through the creative process of psychotherapy that overt suicide need not be a solution.     

Group therapy for depressed elderly women

We describe and evaluate a group therapy program targeting depression among elderly residents (N=303) of subsidized high-rise apartments in Nashville, TN. This eclectic program was comprised of 12 sessions (a total of 24 hours) that included modules on exercise and preventive health behaviors, cognitive and re-motivation therapy, reminiscence and grief therapy, and social skills development. Our multivariate regression analyses of pre-post measures using the Geriatric Depression Scale (GDS) showed that the effects of the group therapy varied by race, age, and level of initial depression among the participants. The program was effective in reducing depression, but only among Caucasian women who reported at least moderate depression prior to the program, and it yielded greater benefits for women between 55 and 75 years of age.