Behavioral Activation and Therapeutic Exposure for Bereavement in Older Adults

Abstract

The development and clinical trial of a 5-session behavioral intervention for complicated bereavement (CB) is presented. We conceptualized CB in terms of Major Depression (MDD) and Post-traumatic Stress Disorder (PTSD) and consequently applied treatment components of Behavioral Activation and Therapeutic Exposure (BA-TE). In order to assure standardization of treatment, control costs, and engage patients, a multi-media, multi-context format was adopted to address avoidance and withdrawal behaviors conceptualized as central pathogenic responses in CB. Participants (N = 26) were assessed before and after BA-TE treatment via structured clinical interview and standardized questionnaires in terms of PTSD, MDD, CB, and health concerns. The number of days since the death of the loved one was widely variable and served as a covariate for all outcome analyses. ANCOVAS revealed statistically significant improvement, irrespective of how many days since death had elapsed prior to initiation of intervention, on structured interviews and self-report measures for most outcome variables.

Behavioral activation for depression in older adults: Theoretical and practical considerations

“…Acierno et al (2012) showed that individuals with varied levels of training and expertise (ranging from recent graduates of bachelor programs in psychology to experienced social workers) were able to implement behavioral activation. Moreover, behavioral activation interventions delivered via telephone Quijano et al, 2007) or videoconferencing (Lazzari et al, 2011) were also effective.…”

“…Other studies used collaborative activity selection based on individual goal setting (Bottonari et al, 2008;Lazzari et al, 2011;Quijano et al, 2007;Rokke et al, 1999;Snarski et al, 2011;Turner & Leach, 2009;Yon & Scogin, 2009). Scheduled activities based on clientrated levels of difficulty were also used (Acierno et al, 2012;Clignet et al, 2012;Lazzari et al, 2011;Snarski et al, 2011). Acierno et al (2012) incorporated social aspects into selected activities as often as possible, and included identifying activities that were negatively reinforcing (e.g., chores that reduced stress when finished) and activities that were incompatible with avoidance behavior.…”

“…Several studies described the use of measures such as activity inventories (Cernin & Lichtenberg, 2009;Meeks et al, 2006Meeks et al, , 2008Sood et al, 2003;Teri et al, 1997), activity lists included in treatment manuals (Clignet et al, 2012;Dozeman et al, 2011), and lists of community activities and resources (Acierno et al, 2012) to provide suggestions for planning activities. Other studies used collaborative activity selection based on individual goal setting (Bottonari et al, 2008;Lazzari et al, 2011;Quijano et al, 2007;Rokke et al, 1999;Snarski et al, 2011;Turner & Leach, 2009;Yon & Scogin, 2009).…”

“…They presented with major or minor depression, and comorbid anxiety was assessed in five studies (Acierno et al, 2012;Dozeman et al, 2011;Meeks et al, 2006;Thompson et al, 1987;Turner & Leach, 2009). Few studies included older adults with cognitive impairment (Snarski et al, 2011;Teri et al, 1997), chronic medical illness (Dozeman et al, 2011;Meeks et al, 2008;Quijano et al, 2007), chronic pain Meeks et al, 2006;Quijano et al, 2007), or diagnoses of psychiatric disorders such as schizophrenia (Snarski et al, 2011); thus, there is limited evidence for the effectiveness of behavioral activation with such individuals.…”

“…Studies in the community included outpatient clinics (Acierno et al, 2012;Bottonari, Roberts, Thomas, & Read, 2008;Gallagher & Thompson, 1982;Lazzari, Egan, & Rees, 2011;Rokke, Tomhave, & Jocic, 1999;Thompson, Gallagher, & Breckenridge, 1987;Turner & Leach, 2009) and the client's home (Quijano et al, 2007;Teri, Logsdon, Uomoto, & McCurry, 1997;Yon & Scogin, 2009). Studies in residential care settings included assisted living (Cernin & Lichtenberg, 2009;Dozeman et al, 2011), nursing homes (Meeks, Looney, Van Haitsma, & Teri, 2008;Meeks, Teri, Van Haitsma, & Looney, 2006), a shortterm rehabilitation unit (Sood, Cisek, Zimmerman, Zaleski, & Fillmore, 2003), and inpatient psychiatric care facilities (Clignet, Van Meijel, Van Straten, Lampe, & Cuijpers, 2012;Snarski et al, 2011).…”