Group cognitive therapy (CT), focused expressive psychotherapy (FEP; a form of group experiential psychotherapy), and supportive, self-directed therapy (S/SD) were compared among 63 patients with major depressive disorder (MDD). Variation among patients' coping styles (externalization) and defensiveness (resistance potential) was used in a prospective test of hypothesized differential treatment-patient interactions. Results suggest that patient characteristics can be used differentially to assign psychotherapy types. Externalizing depressed patients improved more than nonexternalizing depressed patients in CT, whereas nonexternalizing (internalizing) patients improved most in S/SD. Conversely, high defensive (resistant) patients improved more in S/SD than in either FEP or CT, whereas low defensive patients improved more in CT than in S/SD.

To determine the extent that muscle mass is predictive of muscle strength in the elderly, anthropomorphic estimates of muscle area and impedance measurements of muscle mass and peak isometric muscle strength were obtained in a relatively healthy older population over 65 years of age (mean age = 71.7; n = 218). Midarm muscle area correlated strongly with upper arm strength (r = 0.68, P less than 0.0001) while midthigh muscle area had a much lower correlation with thigh muscle strength (r = 0.29, P less than 0.0001). These muscle area calculations also include bone area. Lean body mass calculated by bioelectric impedance correlated highly with cumulative muscle strength measured by summing all muscle groups (r = 0.79, P less than 0.0001). To determine whether aging alters muscle strength per unit of muscle mass, additional middle-aged subjects were included, and three groups, middle-aged (55-64) (n = 78), young-old (65-74) (n = 161), and old-old (75+) (n = 57), were compared. A significant age-related trend of decreasing muscle strength per unit of lean body mass was noted. It is concluded that although muscle mass correlates with muscle strength in a healthy older population, use of simple age-independent clinical measurements of body mass should not be used to predict muscle strength.

This study was designed to explore the relative and combined effectiveness of alprazolam (Xanax) and group cognitive therapy among elderly adults experiencing major affective disorder. Fifty-six subjects with Diagnostic and Statistical Manual of Mental Disorders (DSM-111; American Psychiatric Association, 1980) diagnoses of major, unipolar depression were treated over a 20-week period in one of four groups: alprazolam support, placebo support, cognitive therapy plus placebo support, and cognitive therapy plus alprazolam support. The results revealed that individuals assigned to group cognitive therapy showed consistent improvement in subjective state and sleep efficiency relative to non-group-therapy subjects. No differences between alprazolam and placebo were noted, regardless of whether individuals received group cognitive therapy. Subjects assigned to group cognitive therapy were less likely than their counterparts to prematurely terminate treatment.

Both personality and biology have been proposed as linkages in the relatively strong correlation between depression and chronic pain. We propose that difficulty expressing anger and difficulty controlling intense emotions are predisposing factors linked to these two conditions. Chronic pain and depression may be disturbances or failures to process intensely emotional information, with concomitant disturbances both in the body's immune system and in interpersonal relationships. Depletions of amines and neurotransmitters and dysfunctions of the endogenous opioid system may be variable actions that contribute to both pain and depression. From an exploration of diverse models and proposals, we present a unifying theory of arousal with a view toward developing research questions and paradigms.It is estimated that from 13% to 20% of the U.S. population has clinically significant symptoms of depression and that 3% of the men and nearly 10% of the women have diagnosahle, full blown depressive syndromes (Romano & Turner, 1985). Among patients with medical problems, however, these prevalence rates are consistently higher, reaching their most critical levels among patients with chronic pain. For example, studies suggest that 50% of medical patients have significant depressive symptoms (Nielsen & Williams, 1980) and that well over 20% warrant a diagnosis within the spectrum of depressive syndromes (Raft, Davidson, Towney, Spencer, & Lewis, 1975); additionally, among chronic pain patients a major depressive syndrome can be ruled out only in one-third of the cases (Romano & Turner).Whereas a relation between chronic pain and depression has often been observed, the source, strength, and nature of the linkage between these two conditions remains uncertain. Numerous mechanisms have been proposed as causal links, and the empirical evidence that is available has been invoked as support with various amounts of certitude. Indeed, Romano and Turner (1985) concluded that there is research support for virtually all (often contradictory) hypotheses about the nature of the pain-depression relation: depression provokes pain by increasing pain sensitivity and by lowering pain tolerance thresholds; pain becomes an interchangeable equivalent of depression among patients with certain dispositions; pain serves as a stressor that evokes subsequent depression; and finally, pain and depression are simultaneously occurring experiences that are related only because of coincidentally similar psychological or biological foundations.

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