“Do More,Feel Better”: Pilot RCT of Lay-Delivered Behavioral Activation for Depressed Senior Center Clients

This pilot randomized control trial (RCT) tested “Do More, Feel Better” (DMFB), a lay-delivered Behavioral Activation intervention for depressed senior center clients. The study examined: (1) the feasibility of training older lay volunteers to fidelity; and (2) the acceptability, safety, and impact of the intervention. Twenty-one lay volunteers at four senior centers were trained in DMFB. Fifty-six depressed clients were randomized to receive 9 sessions of DMFB or Behavioral Activation delivered by social workers (MSW BA). Research assessments of overall client activity level (BADS) and depression severity (HAM-D) were conducted at baseline and Weeks 3, 6, and 9. Eighty-one percent of lay volunteers who underwent training were formally certified in DMFB. Depressed clients receiving each intervention reported high levels of satisfaction and showed large and clinically significant changes in 9-week activity level (d ≥ 1.35) and depression severity (d ≥ 3.34). Differences between treatment groups were very small for both activity level (d_MSW = 0.16; 95% CI, -0.70 to 1.02) and depression (d_MSW = 0.14; 95% CI, -0.63 to 0.91). Increases in activity level were associated with decreases in depression (β = -0.42; 95% CI, -0.55 to -0.30). Both interventions appeared to work as intended by increasing activity level and reducing depression severity. “Do More, Feel Better” shows the potential of evidence-based behavioral interventions delivered by supervised lay volunteers, and can help address the insufficient workforce available to meet the mental health needs of community-dwelling older adults.     

Efficacy of brief guided self-help cognitive behavioral treatment for perfectionism in reducing perinatal depression and anxiety: a randomized controlled trial

Perfectionism has been proposed as a transdiagnostic process that maintains depression and anxiety through shared cognitive and behavioral processes. The purpose of this study was to investigate the efficacy of a brief, guided cognitive behavioral treatment (CBT) for perfectionism delivered via a self-help booklet in reducing perfectionism and symptoms of depression and anxiety during the antenatal period. Pregnant women in their third trimester were randomly allocated to self-help (n = 30) or waitlist control (n = 30). There were significant reductions in perfectionism and symptoms for participants who received CBT for perfectionism from pre- to post-treatment, which were maintained at 3-month follow-up, while the waitlist control group demonstrated no significant changes. Path analysis demonstrated a significant indirect effect of treatment condition on post-treatment depression and anxiety scores via perfectionism, controlling for pre-treatment scores, suggesting changes in perfectionism were associated with decreases in symptoms. The findings suggest that it would be useful for future research with larger samples to further investigate the efficacy of CBT for perfectionism for perinatal depression and anxiety.     

Cognitive behavioral therapy in practice: treatment delivered by trainees at an outpatient clinic is clinically effective

Cognitive–behavioral therapy (CBT) is known to be effective for a number of disorders, and can be delivered effectively by trainees in controlled settings. However, the effectiveness of trainee therapists in general practice compared to that of more experienced therapists is unknown. In this study, the authors used a benchmarking strategy to compare the outcomes of naturalistic CBT delivered by trainee therapists to those of efficacy and effectiveness studies using primarily professional therapists. Patients (N = 249) with mood and anxiety disorders were treated by trainees (primarily by interns and postdocs) using nonstandardized nonmanualized CBT at an outpatient clinic in an urban academic medical center. Changes in anxiety and depression were assessed using effect sizes, reliable and clinically significant change, and benchmarked to efficacy and effectiveness studies. Symptoms of anxiety and depression significantly improved from start to end of treatment. Rates of improvement and recovery compared favorably to those achieved in other studies, with the exception of recovery rates in severe depression. Effect sizes were in the medium to large range, but generally lower than those achieved in other studies. Results suggest that CBT can be delivered effectively by trainees in an outpatient setting.     

Treating Young Adult Depression With Text-Delivered Cognitive Behavioral Therapy: A Pilot Randomized Clinical Trial

Young adults (ages 18 to 25) in the U.S. suffer from the highest rates of past-year major depressive episode and are the least likely to receive treatment compared to other age groups. As such, we examined the feasibility, acceptability, and efficacy of a text-message delivered cognitive behavioral therapy: CBT-txt with young adults. The study was a 2-month pilot RCT to test a 4-week intervention for depression that contained 197 text messages (average 12 texts every other day). The sample, recruited via Facebook and Instagram, was 102 U.S. young adults who presented with at least moderate depressive symptomatology. Assessments occurred at baseline prior to randomization and at 1 and 2 months post enrollment. The primary outcome, severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Feasibility benchmarks were met and participants reported high levels of engagement with and acceptability of the intervention. Logistic regression indicated that treatment participants were three times as likely to have minimal or mild depression symptoms at 2 months compared to waitlist control participants. Latent change score modeling found that the strongest significant treatment effect appeared at the 1-month follow-up period, particularly for participants who began with severe depressive symptoms. Mediation analysis revealed significant indirect treatment effects of increases in behavioral activation on reducing depressive symptoms, suggesting a mechanism of change. Limitations were that the sample was relatively small and consisted of primarily women. These results provide initial evidence for the feasibility, acceptability, and efficacy of a text-delivered treatment for young adult depression.     

Aging effects on memory encoding in the frontal lobes

Functional magnetic resonance imaging (fMRI) was used to compare frontal-lobe activation in younger and older adults during encoding of words into memory. Participants made semantic or nonsemantic judgments about words. Younger adults exhibited greater activation for semantic relative to nonsemantic judgments in several regions, with the largest activation in the left inferior frontal gyrus. Older adults exhibited greater activation for semantic judgments in the same regions. but the extent of activation was reduced in left prefrontal regions. In older adults, there was a significant association between behavioral tests of declarative and working memory and extent of frontal activation. These results suggest that age-associated decreases in memory ability may be due to decreased frontal-lobe contributions to the initial encoding of experience.     

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。     

Pilot Randomized Trial of a Self-Help Behavioral Activation Mobile App for Utilization in Primary Care

Mobile technologies can be leveraged to meet the need for evidence-based psychological depression treatment via primary care. The purpose of the present study was to preliminarily examine the feasibility and efficacy of a self-help brief behavioral activation mobile application (app; “Moodivate”) for depressive symptoms among adults treated via primary care. Participants (N = 52) were recruited from primary care practices between January and December 2017 and were randomized 2:2:1 to receive (a) Moodivate, (b) an active control cognitive-behavioral therapy-based mobile app (“MoodKit”), or (c) treatment as usual (TAU; no app). Participants completed assessments of depressive symptoms weekly for 8 weeks. App analytics data were captured to examine Moodivate feasibility (analytics unavailable for control app). Moodivate participants on average had 46.76 (SD = 30.10) app sessions throughout the trial duration, spent 3.50 (2.76) minutes using the app per session, and spent 120.76 (101.02) minutes using the app in total throughout the trial. Nearly 70% of Moodivate participants continued to use the app 1 month after trial enrollment and 50% at the end of the 8-week follow-up period. A generalized estimating equation model examining change in depressive symptoms over time by treatment condition indicated a significant interaction between time and treatment condition (χ² = 42.21, df = 14, p < .001). As compared to TAU, participants in both app conditions evidenced significant decreases in depressive symptoms over time, and these treatment gains were sustained across the trial period. These results preliminarily indicate feasibility of Moodivate as well as efficacy of both Moodivate and MoodKit for the treatment of depression among adults recruited via primary care. Future studies should focus on larger-scale examinations of treatment efficacy and effectiveness across primary care settings.     

Feasibility of Pairing Behavioral Activation With Exercise for Women With Type 2 Diabetes and Depression: The Get It Study Pilot Randomized Controlled Trial

Major depressive disorder is often comorbid with diabetes and associated with worse glycemic control. Exercise improves glycemic control and depression, and thus could be a parsimonious intervention for patients with comorbid diabetes and major depression. Because patients with diabetes and comorbid depression are often sedentary and lack motivation to exercise, we developed a group exercise intervention that integrates strategies from behavioral activation therapy for depression to increase motivation for and enjoyment of exercise. We conducted a 6-month pilot randomized controlled trial to test the feasibility of the behavioral activation exercise intervention (EX) for women with diabetes and depression. Of the 715 individuals who contacted us about the study, 29 participants were randomized to the EX condition or an enhanced usual care condition (EUC), which represents 4.1% of participants who initially contacted us. Inclusion criteria made recruitment challenging and limits the feasibility of recruiting women with diabetes and depression for a larger trial of the intervention. Retention was 96.5% and 86.2% at 3 and 6 months. Participants reported high treatment acceptability; use of behavioral activation strategies and exercise class attendance was acceptable. No condition differences were observed for glycemic control, depressive symptoms, and physical activity, though depressive symptoms and self-reported physical activity improved over time. Compared to participants in the EUC condition, participants in the EX condition reported greater exercise enjoyment and no increase in avoidance behavior over time. Using behavioral activation strategies to increase exercise is feasible in a group exercise setting. However, whether these strategies can be delivered in a less intensive manner to a broader population of sedentary adults, for greater initiation and maintenance of physical activity, deserves further study.     

Audio and Computer Cognitive Behavioral Therapy for Depressive Symptoms in Older Adults: A Pilot Randomized Controlled Trial

The purpose of this study was to develop and explore the feasibility of audio-based (ACBT) and computer-based (CCBT) cognitive behavioral therapies for older adults with depressive symptoms. The audio program consisted of 8 compact discs and a workbook while the computer program consisted of 11 modules of similar duration provided on a tablet PC. Both interventions consisted of the following topics: identifying and changing unhelpful thoughts, addressing feelings, relaxation, engaging in pleasant events, assertiveness, and problem-solving. Fifty-one older adults were recruited from medical settings and rural communities. Participants were randomly assigned to immediate treatment (ACBT or CCBT) or delayed treatment control condition. Analyses were conducted to examine change on interviewer-based and self-reported depression. A significant interaction effect between time and condition was found on the interviewer-based depression scale. This suggests that both types of treatments decreased depressive symptoms over time when compared to a delayed treatment control. Computer-based and audio-based cognitive behavioral treatments may be valuable low-cost modalities to deliver psychotherapy to older adults with depressive symptoms.     

Asthma-Specific Quality of Life in Older Adolescents and Young Adults with Long-Standing Asthma: The Role of Anxiety and Depression

The present study examined the influence of psychological comorbidity (i.e., anxiety and depression) on asthma-specific quality of life (QOL). Sixty-four older adolescents and young adults with childhood onset asthma completed measures of anxiety, depression, and asthma-specific QOL. Objective assessments of illness severity were obtained via a semistructured interview and pulmonary function test. Results revealed that the combination of anxiety and depression severity contributed significant variance to asthma QOL after statistically controlling demographic and disease covariates. Moreover, anxiety demonstrated a significant main effect on asthma QOL. Findings suggest that assessment of anxiety may help identify individuals who are at risk for poorer asthma-specific quality of life. Such early interventions can be effectively incorporated into comprehensive biopsychosocial treatment and behavioral self-management programs for individuals with asthma.     

Life review therapy using autobiographical retrieval practice for older adults with clinical depression

The aim of this experiment was to examine the efficacy of life review based on autobiographical retrieval practice for treating depression in older adults. Thirty-seven clinically depressed older adults aged 64-83, who were also receiving pharmacological treatment, were randomly assigned to life review therapy or to a placebo condition with supportive therapy. Results indicated decreased depression for both conditions, with no significant differences between the two therapies. There was some indication of greater gain in production of specific memories among those in life review therapy. Patients who produced higher numbers of specific memories decreased their depression scores at a faster rate.     

Treatment of sleep-maintenance insomnia in older adults: sleep period reduction, sleep education, and modified stimulus control

We evaluated a behavioral treatment package consisting of sleep period restriction, sleep education, and modified stimulus control in the treatment of sleep-maintenance insomnia in older adults. A multiple baseline design was used with 4 chronic insomniac subjects, ages 59, 65, 65, and 72. Sleep diaries and an objective behavioral measure of sleep were used to monitor improvement. Results revealed clinically significant reductions in time awake after sleep onset in 3 subjects, coincident with the initiation of treatment. These improvements were maintained at 2- and 6-month follow-ups. The 4th subject showed little improvement; however, a polysomnogram conducted on this subject at the end of the study revealed a fragmented sleep pattern secondary to periodic movements of sleep (nocturnal myoclonus). These encouraging but preliminary results call for further controlled evaluations of the efficacy of this behavioral treatment package for sleep-maintenance insomnia. The importance of conducting polysomnographic studies on elderly insomniacs is discussed.     

Competitive Memory Training for treating depression and rumination in depressed older adults: a randomized controlled trial

Although rumination is an important mediator of depressive symptoms, there is insufficient proof that an intervention that specifically targets rumination ameliorates the clinical condition of, depressed patients. This study investigates whether a time-limited cognitive behavioral intervention (Competitive Memory Training, or COMET for depressive rumination) is an effective treatment for depression and rumination. This intervention was tested in older adult depressed outpatients. A total of 93 patients (aged ≥65 years with major depression and suffering from rumination) were treated in small groups according to the COMET protocol in addition to their regular treatment. Patients were randomized to two treatment conditions: 7 weeks of COMET + treatment-as-usual (TAU) versus TAU only. COMET + TAU showed a significant improvement in depression and rumination compared with TAU alone. This study shows that the transdiagnostic COMET protocol for depressive rumination might also be successful in treating depression and rumination in older adults.     

Depression Among Transgender Older Adults: General and Minority Stress

This study aims to (a) examine the direct and indirect effects internalized heterosexism, disclosure of gender identity, and perceived general stress in association with depression among transgender older adults; and (b) to assess the relative contribution of each relationship. Secondary analyses of data from a large community‐based study of older sexual and gender minorities were conducted utilizing structural equation modeling with a subsample (n = 174) of transgender adults aged 50 to 86‐years old. Disclosure of gender identity had no significant direct or indirect effects on either perceived general stress or depression. Internalized heterosexism did not have a direct effect on depression, but did have a significant indirect effect through perceived general stress. Finally, perceived general stress had an additional significant direct effect on depression, over and above internalized heterosexism. Total effect sizes appear to be considerable with standardized betas greater than 5.0. Perceived general stress and internalized heterosexism independently and cumulatively have significant direct and indirect effects on depression among transgender older adults. Implications for depression among transgender older adults and the role of community psychology are discussed.     

Exposure therapy for PTSD delivered to veterans via telehealth: predictors of treatment completion and outcome and comparison to treatment delivered in person

Recent research has focused on the effectiveness of evidence-based psychotherapy delivered via telehealth services. Unfortunately to date, the majority of studies employ very small samples and limited predictor and moderator variables. To address these concerns and further replicate and extend the literature on telehealth, the present study investigated the effectiveness of 12-session exposure therapy delivered either via telehealth (n = 62) or in person (n = 27) in veterans with posttraumatic stress disorder (PTSD). Findings demonstrated that although older veterans and Vietnam veterans were more likely to complete the telehealth treatment, telehealth findings were not influenced by patient age, sex, race, combat theater, or disability status. Exposure therapy delivered via telehealth was effective in reducing the symptoms of PTSD, anxiety, depression, stress, and general impairment with large effect sizes. Interestingly, exposure therapy via telehealth was less effective than exposure therapy delivered in person; however, lack of random assignment to condition limits conclusions of differential effectiveness. Overall, these findings support the utility of telehealth services to provide effective, evidence-based psychotherapies.     

A comparison of problem identification interviews conducted face-to-face and via videoconferencing using the consultation analysis record

School psychologists who experience challenges delivering face-to-face consultation may utilize videoconferencing to facilitate their consultation activities. Videoconferencing has been found to be an effective method of service delivery in related fields and emerging research suggests that it may be effective for providing teacher training and support in school settings. In this exploratory investigation, we used the Consultation Analysis Record (Bergan & Tombari, 1975) and its four indices to assess the effectiveness of conducting problem identification interviews via videoconferencing versus face-to-face. Overall, findings indicated significant differences across these two conditions, with videoconference interviews coded as having higher indices of content relevance, process effectiveness, and message control, but lower content focus, compared to face-to-face interviews. As these indices have been positively associated with favorable consultation outcomes, the results provide initial support for the effectiveness of consultation delivered via videoconferencing.     

Internet‐Based Self‐Help Versus One‐Session Exposure in the Treatment of Spider Phobia: A Randomized Controlled Trial

The authors compared guided Internet‐delivered self‐help with one session of live‐exposure treatment in a sample of spider‐phobic patients. A total of 30 patients were included following screening on the Internet and a structured clinical interview. The Internet treatment consisted of five weekly text modules, which were presented on a web page, a video in which exposure was modelled, and support provided via Internet. The live‐exposure treatment was delivered in a 3‐hr session following a brief orientation session. The main outcome measure was the behavioural approach test (BAT), and as secondary measures the authors used questionnaires measuring anxiety symptoms and depression. Results showed that the groups did not differ at posttreatment or follow‐up, with the exception of the proportion showing clinically significant change on the BAT. At posttreatment 46.2% of the Internet group and 85.7% in the live‐exposure group achieved this change. At follow‐up the corresponding figures were 66.7% for the Internet group and 72.7% for the live treatment. Within‐group effect sizes for the spider phobia questionnaire were large (d = 1.84 and 2.58 for the Internet and live‐exposure groups, respectively, at posttreatment). The authors conclude that guided Internet‐delivered exposure treatment is a promising new approach in the treatment of spider phobia.     

THE TOTALITARIAN STATE OF MIND

The paper describes the development of Dynamic Interpersonal Therapy for use with complex depression (DITCC), and a pilot study testing DITCC’s effectiveness. The pilot found large pre-post improvements in well-being and distress; moderate rates of reliable improvement and clinically significant change; and curvilinear declines in depression and anxiety. Treatment completers and near-completers (N= 19) showed a significant curvilinear decline in symptoms of depression (PHQ-9) and anxiety (GAD-7). The results provide preliminary evidence that DITCC can be used as an effective treatment approach for complex depression. However, further research is needed to test its effectiveness in different settings with a larger sample size, using appropriate comparison groups under controlled conditions to further elaborate the short-term and long-term effects.     

Internal Consistency and Test-Retest Stability of the Geriatric Depression Scale-Short Form in African American Older Adults

The Geriatric Depression Scale (GDS) is one of the most widely used self-rated mood questionnaires for older adults. It is highly correlated with clinical diagnoses of depression and has demonstrated validity across different patient populations. However, the reliability of the GDS among African American older adults remains to be firmly established. In a baseline sample of 401 African American adults age 51 and over, the GDS-15 item short form demonstrates good internal consistency (KR20 = .71). Stability over a 15-month interval in a retest sample of 51 adults is deemed adequate (r = .68). These findings support the use of the GDS-15 item short form as a reliable mood questionnaire among African American older adults.