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

Abstract

Late-life depression (LLD) is a major public health concern that can have devastating effects on older individuals and their families. Behavioral theories predict that decreases in responsecontingent positive reinforcement and increases in negatively reinforced avoidance behaviors, often accompanied by aversive life events, result in the selection and maintenance of depression. Based on these theories, behavioral activation treatments for depression are designed to facilitate structured increases in enjoyable activities that increase opportunities for contact with positive reinforcement. We discuss the applicability of behavioral models for LLD, and we briefly review current behavioral activation interventions for LLD with an emphasis on implications for future behavior-analytic research. Behavioral activation has been demonstrated to be effective in reducing depression and increasing healthy behavior in older adults. Potential challenges and considerations for future research are discussed. We suggest that applied behavior analysts and clinical behavior analysts are particularly well suited to improve and expand on the knowledge base and practical application of behavioral activation interventions with this population.

Effects of a Behavioral and Exercise Program on Depression and Quality of Life in Community-Dwelling Older Adults: A Controlled, Quasi-Experimental Study

“…A previous study claimed that psychosocial interventions were effective in managing stress-related disorders, specifically depression, by improving perceived social support, facilitating problem-focused coping, and changing cognitive appraisals (Schneiderman, Ironson, & Siegel, 2005). Recently, behavioral activation has been shown to be an effective strategy for reducing depression severity in older adults (Polenick & Flora, 2013). Exercise has been shown to enhance positive mood and cognitive function in older adults with depression (Langlois et al, 2013).…”

Volunteer-led behavioural activation to reduce depression in residential care: a feasibility study

“…This study adds to a growing body of literature demonstrating the applicability of behavioural activation in diverse settings where traditional psychological treatments of depression such as CBT may be less suitable [17] or prohibitive due to cost [31,32]. A novel aspect of this study is that the behavioural activation intervention was delivered by trained volunteers, whereas prior behavioural activation interventions have primarily been delivered by specialist or non-specialist healthcare professionals [13].…”

“…Given the novelty of this study, there was no suitable pre-existing training manual. Rather, the training was developed primarily by author CB, an experienced clinical psychologist, drawing on BA principles [21] and literature relevant to BA for depression in older adults [23,31]. The workshops included a combination of didactic and experiential learning using roleplays where volunteers were required to demonstrate key behavioural activation techniques.…”

Comprendiendo el impacto de los síntomas depresivos en la funcionalidad de las personas mayores

“…Diversos modelos conductuales que explican la depresión en edad tardía resaltan la importancia de las actividades diarias como un factor mediador o precursor de la presentación de síntomas depresivos en la adultez mayor 41 . Por ejemplo, autores como Dimidjian, y Jacobson et al, proponen que la depresión se origina a partir de la falta de refuerzos positivos acompañado de eventos adversos o estresantes de vida, que interrumpen las actividades diarias y las rutinas 42,43 .…”

“…La persona y sus actividades se convierten en la interfaz entre los factores de riesgo, los comportamientos que sirven para evadir estímulos aversivos (como evitar participar de eventos sociales), y la manifestación de los síntomas depresivos y ansiosos 41 . Cuando la persona mayor (por situaciones intrínsecas o extrínsecas) comienza a exponerse a los diversos factores de riesgo o situaciones que favorecen la manifestación de depresión y ansiedad, el sentido y las formas de desempeñarse en actividades comienzan a modificarse (por ejemplo la viudez o la jubilación llevan a un cambio de roles que puede ser drástico; situaciones de salud pueden hacer que la persona tenga dificultades para seguir realizando algunas actividades por sí solo) 8 .…”