Presentation of Depression and Response to Group Cognitive Therapy with Older Patients

Concerned with response prediction, this research examines the relationships between pre-treatment components of depressive symptomatology and outcome of short-term group cognitive therapy for depression with older adults. Aspects of depressive symptomatology under examination were initial intensity of self-reported depressive symptomatology, profile of melancholic depression, perceived health status, perceived social support, and intensity of negative view of self. Findings indicate that perceived social support is not related to outcome but that a more intense depressive symptomatology, a more negative health evaluation, and a more negative view of self are variables associated with a less favorable outcome. Despite showing a sizable decrease in depressive symptoms over the course of intervention, severely depressed subjects still presented residual depressive symptoms at the conclusion of intervention. There was a tendency for subjects with a melancholic profile to show a poorer response to this intervention.     

老年抑郁症的症状、诊断及测量

对老年抑郁症的症状、诊断和测量的探讨有利于寻找更有效的治疗方法。文章在简要讨论老年抑郁症主要症状以及诊断特点的基础上,重点介绍老年抑郁症的测量工具。文章指出,开展老年抑郁症研究的多学科研究,运用认知神经科学方法深入研究老年抑郁症,制订相对独立的老年抑郁症的分类标准,结合老年抑郁症患者身心特点开发更简便可靠的老年抑郁症量表,将有利于老年抑郁症的进一步研究。     

一种认知分析心理治疗模式对抑郁症患者的干预

为了探索基于"自我"与感受、需要、能力和角色交互相整合的认知分析心理治疗模式及其在抑郁症患者治疗中的效果,对7例门诊和8例住院抑郁症患者进行心理治疗,采用HAMD和CGI-GI评估治疗的效果,并追踪治疗1年后患者的社会功能及健康状况。所有患者治疗前后HAMD分值差异显著,配对t=8.08(P0.01),门诊与住院治疗患者HAMD分值和CGI-GI分值均无明显差异(P0.05),但产生治疗有效的平均时间差异显著,住院者(11.6±3.6)天,门诊者(60.6±25.0)天(P0.01)。该心理治疗模型能够整合到抑郁症患者的药物治疗中,产生整体治疗效果。     

社会隔离对老年人认知功能的影响：有调节的链式中介效应

基于5162名老年被试,探究社会隔离对老年人认知功能的影响、孤独感和抑郁的中介作用以及认知储备的调节作用。研究发现：（1）社会隔离显著负向预测认知功能,朋友隔离的预测作用较家庭隔离突出;（2）抑郁在其间发挥独立中介作用,孤独感和抑郁在其间发挥链式中介作用;（3）认知储备显著调节社会隔离、孤独感和抑郁对认知功能的影响,低认知储备是孤独感独立中介作用成立的条件,且低认知储备下抑郁的独立中介作用以及孤独感和抑郁的链式中介作用更强。研究结论对于老年人认知功能的保护工作具有积极意义。     

Treating Hypochondriasis with Interpersonal Psychotherapy

The treatment of hypochondriacal patients can be conceptualized as taking one of three approaches. These typically address one of the following questions: 1) “Should the patient be preoccupied?” 2) “Why is the patient preoccupied?” 3) “What are the interpersonal consequences of being preoccupied?” Interpersonal Psychotherapy (IPT) is specifically designed to address the last of these questions. IPT focuses on understanding the patient’s real distress, exploring the patient’s maladaptive communications, and modifying those communications so that others are more able to meet the patient’s attachment needs. With a focus on communication in a time-limited frame, fostered by a strong collaborative relationship, IPT appears to be an effective method of reducing hypochondriacal behavior.     

心理治疗与普通医疗的平等性

心理治疗与普通医疗的平等性是美国心理健康服务系统面临的一个主要政策问题,强调健康保险应为心理健康和物质滥用障碍提供与普通医疗相同的承保范围。近20年来,平等性立法在美国得到了较快发展,并取得了一定效果。但由于立法本身存在的局限性及心理健康服务需求与提供双方的多重因素影响,平等性立法的实施及对其效果的评估仍存在一定困难。借鉴平等性立法的经验,得出了一些关于我国心理健康服务发展的启示。     

Anxiety and Depression in Medically Ill Older Adults

Anxiety and depression are extremely common in the elderly with medical problems. They can manifest not only as symptoms of a primary psychiatric illness, but also as physiologic sequelae of medical illnesses and medical treatments. Recognition and treatment of depression and anxiety in the medically ill is especially difficult. If these states go untreated, they result in higher morbidity and mortality, higher health care costs and utilization, and poorer functional status and outcomes. Three of the most common medical illnesses that afflict geriatric patients, cardiovascular disease, pulmonary disease, and rheumatoid arthritis, will be presented to illustrate the difficulty in recognizing depression and anxiety and the impact of treating these symptoms in the medically ill elderly. Multidisciplinary approaches combining optimal medication regimens and psychosocial interventions can be effective for treatment of anxiety and depression in the medically ill elderly.     

Counselling Older Adults Living in Residential Aged Care Settings: Four Illustrative Case Studies

The role of psychologists and other mental health professionals in long‐term care settings is undefined in Australia. Graduate psychology students receive little training in clinical geropsychology, and residential aged care providers do not routinely employ psychologists within such settings. Further, despite high rates of depression, neurocognitive problems, and other mental health problems, residents are rarely referred for evidence‐based psychological treatment. This article presents four case studies showing how psychology services may be employed in such settings within the context of a postgraduate psychology placement programme. These case studies emphasise the importance of engagement, the use of flexible and individualised treatment approaches, and the involvement of family and professional carers in the provision of psychological services. Psychology services in residential settings can have a positive impact on the care of older adults and their families.     

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.     

Behavioral Activation Treatment for Depression in Older Adults Delivered via Videoconferencing: A Pilot Study

Depression affects up to 25% of older adults. Underdetection and subsequent undertreatment of depression in older adults has been attributed in part to difficulties in older adults being able to access treatment. This uncontrolled pilot study, N = 3, explored the acceptability and efficacy of a brief behavioral activation treatment delivered via videoconferencing to 3 participants, aged 64 to 73 years, diagnosed with major depressive disorder. The results indicate that a 5-session behavioral activation treatment delivered via videoconferencing produced clinically significant and reliable decreases in depression. The results also showed clinically significant and reliable decreases in negative affect and clinically significant and reliable increases in positive affect. Treatment gains were maintained at 1-month follow-up. Videoconferencing can be a valuable and effective tool in increasing accessibility to psychological treatment for older adults.     

用现代医学模式看心血管疾病合并抑郁症的诊疗

随着社会进步,生活节奏日益加快,抑郁症及抑郁情绪已经悄无声息地蔓延开来,心血管疾病已成为城乡居民的第一位死因,分别为心理、生理疾病,从传统医学模式的角度看两者互不相干,但从生理-心理-社会的现代医学模式理解以及各种研究表明它们其实有着密切的联系。     

Treatment of Chronic Major Depression Using the Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

This article presents data from an ABAB single case design study of a 60-year-old Caucasian male diagnosed with chronic major depressive disorder. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was utilized throughout treatment, and both BDI scores and diagnostic interviews revealed states of partial, and ultimately full remission during the course of treatment. A focus was ultimately placed on generalizing what the patient learned in-session to his outside life. Additionally, the unique design of this case illustrated that the patient experienced a moderate reduction in depressive symptoms, prior to the long-term alteration of his coping style. A stable change in his coping style was necessary before full and sustained recovery was evidenced.     

Predicting Treatment Response in Older Adults with Insomnia

This study examined potential predictors of treatment outcome in late-life insomnia. Fifty-four older adults with chronic insomnia were treated with cognitive–behavior therapy (CBT), pharmacotherapy (PCT), or combined CBT plus PCT. Pretreatment characteristics such as demographic, clinical, psychometric, and sleep variables were examined as correlates or potential predictors of treatment response. Treatment response was defined by posttreatment sleep efficiency as measured subjectively by daily sleep diary and objectively by polysomnography. The results indicate that age, insomnia duration, medical illness, and previous use of sleep medications can moderate subjective or objective treatment outcome or both of these in late-life insomnia. However, there are no reliable predictors of outcome across all treatment and assessment modalities. The implications of these findings for the treatment of insomnia in older adults seen in primary care settings are discussed.     

A Primer on Psychotherapy Process Research: A Review of Cognitive Therapy of Depression

Researchers conducting psychotherapy process research aim to understand the process by which efficacious psychotherapies achieve therapeutic benefits. A key challenge in this research is how to maximise what can be learned from naturalistic longitudinal data. We provide a selective overview of research examining the process of change in cognitive therapy of depression. While the efficacy of this treatment is widely recognised, a consensus regarding how the treatment reduces depressive symptoms and provides protection from relapse and recurrence has yet to be reached. We review the current state of the research addressing the process of change in cognitive therapy, highlighting how specific methodological features can be used to better understand the process by which this treatment achieves its effects. We highlight the importance of two key challenges to making causal inferences from a process–outcome relation: (a) establishing the temporal precedence of predictors to outcome variables, and (b) evaluating whether any relations identified could be spurious. We argue that methodologically rigorous studies tend to support key claims of the model underlying cognitive therapy of depression. We conclude by considering future directions. For example, we highlight the importance of efforts to understand patient characteristics that may moderate process–outcome relations and could ultimately prove useful in tailoring treatment to best suit individual patients.     

Counseling Older Adults with Dementia: A Survey of Therapists in Massachusetts

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.     

Cognitive-Behavioral Therapy for Insomnia in Older Adults

Sleep is disturbed by a range of factors across the lifespan. However, older adults experiencing disruptions in their sleep are often simultaneously contending with a range of comorbid medical and psychiatric conditions that compound the biological changes in sleep that commonly occur with age. Cognitive behavioral therapy for insomnia (CBT-I) is the gold-standard, nonpharmacological intervention for sleep disturbances, and is a cost-effective treatment approach that can occur in either individual or group format. It has also been shown effective in older adults with medical, psychiatric, and cognitive comorbid disorders. This review highlights the success of CBT-I with older adults, as well as studies that illustrate the use of alternative delivery methods and treatment modifications for complex clinical presentations.     

When Psychologists Work with Older Adults: A Survey of Ethical Beliefs and Practices

Despite the number of publications concerning legal and ethical issues faced by psychologists, and despite the increased interest in addressing specific concerns related to aging, little is known about the actual beliefs and practices of psychologists when they work with older adults. Given the changing demographics in the United States, many mental health professionals will have contact with older adult clients, and the focus of the present study was to examine the extent to which psychologists are prepared to work competently with older adult clients. Survey data were collected from 156 APA Division 12 (Clinical Psychology) and 17 (Counseling Psychology) members regarding the degree to which they engaged in each of 50 behaviors and the degree to which they considered each behavior ethical. Findings are presented in terms of percentages of responses to items on the questionnaire, and ANOVAs were performed on important demographic items to identify statistically significant differences among variables. Coursework in geropsychology or aging, specialization with older adults, and working with a high percentage of older adults were related to higher scores on the Overall Ethical Behavior scale. Females scored higher than males on the Overall Ethical Belief scale.     

The Impact of Spirituality on Wellness for Appalachian Older Adults

The authors examined the role spirituality can play as a protective factor in the wellness of older adults residing in the Appalachian region of the United States. Analysis of participants' interviews identified 4 themes. These themes and implications for counselors working with Appalachian older adults are discussed.     

Counseling for Wellness With Older Adults

Resulting from the assumption that older adulthood is a time of decline, there is a dearth of research on the application of wellness counseling with older adults. This article reviews the literature on wellness and older adults, synthesizes wellness with adult development theory, and describes wellness counseling with older adults.