Cognitive Behavioral Therapy for Late-Life Depression: Evidence, Issues, and Recommendations

Bilbrey, Ann Choryan; Laidlaw, Ken; Cassidy-Eagle, Erin; Thompson, Larry W.; Gallagher‐Thompson, Dolores

doi:10.1016/j.cbpra.2020.02.003

Cited by 36 publications

(12 citation statements)

References 78 publications

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“…For treatment of depression, CBT has been found to be either superior to a control condition or not significantly different than another EBT with older adults (Shah et al, 2012). Improvement in depressive symptoms has been observed in many studies with older adults over the years (Bilbrey et al, 2020;Campbell, 1992;Floyd et al, 2004;Gallagher & Thompson, 1982;Karlin et al, 2015) utilizing CBT. In addition to late life depression, CBT has also been shown to be effective in treating anxiety disorders (Andreescu & Varon, 2015;Ayers et al, 2007;Bower et al, 2015;Gorenstein et al, 2005;Hall et al, 2016), insomnia (Ludwin et al, 2018;McCurry et al, 2007;Rybarczyk et al, 2005;Vitiello et al, 2009), and chronic pain (Niknejad et al, 2018;Vitiello et al, 2009) in older adults.…”

Section: Cognitive-behavioral Therapymentioning

confidence: 99%

“…Behavioral and CBT interventions can be used with individuals with mild cognitive impairment, in addition to those with more significant dementia. Behavioral activation is considered a good starting point in late life depression treatment for older adults who may be experiencing cognitive difficulties (Bilbrey et al, 2020; Teri et al, 1997). Early literature has shown that both older adults and their caregivers demonstrate significant improvement in depressive symptoms, with gains maintained at 6-month follow up (Teri et al, 1997).…”

Section: Theory Research and Practice Of Intervention With Older Adultsmentioning

confidence: 99%

“…Environmental modifications, such as sitting closer to the older adult, speaking slowing and in a low tone, and using a voice/sound amplifier can also be helpful (APA, 2014). As persons with dementia progress into the later stages with more significant cognitive deficits, behavioral interventions are effective in managing behavioral symptoms associated with dementia (APA, 2014; Bilbrey et al, 2020; Segal et al, 2018).…”

Section: Theory Research and Practice Of Intervention With Older Adultsmentioning

confidence: 99%

“…Adaptations that address memory deficits may include presenting material at a slower pace and over a longer period, frequent demonstrations of the therapeutic technique with more opportunities for in-session practice (i.e. increased repetition), encouraging the client to write information down during session, use of memory aids (e.g., calendars, alarms, phone reminders), and engaging family members or formal caregivers to assist with implementing treatment interventions, such as completing activity schedules (Bilbrey et al, 2020). Adaptations that address executive dysfunction may involve using more simple and concrete examples, multiple-choice questions as opposed to open-ended questions, and providing treatment summaries in bullet points.…”

Section: Theory Research and Practice Of Intervention With Older Adultsmentioning

confidence: 99%

See 3 more Smart Citations

Intervention, consultation, and other service provision: A foundational geropsychology knowledge competency.

Lind¹,

Poon²,

Birdsall³

2022

Clinical Psychology: Science and Practice

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To address the shortage in geriatric behavioral health professionals, it is crucial for more psychologists to become competent in working with older adults. This article will provide an overview of foundational geropsychology knowledge regarding intervention, consultation, and related services. We will begin by reviewing general and specialized psychological interventions with older adults, as well as adaptations based on aging-related changes and diverse care settings. Next, we will review health and medical factors that can impact service delivery. We will highlight characteristics of different treatment settings and interdisciplinary collaboration in providing consultation services, as well as services such as health promotion and illness prevention. We will summarize administrative best practices when psychologists work with older clients, including documentation of medical necessity for psychological services, billing, and reimbursement procedures compliant with state and federal laws and regulations. Finally, we will end with a discussion of ethical and legal considerations such as informed consent, confidentiality, substitute or end-of-life decision-making and potential conflicts of interest, diminished capacities, and elder abuse and neglect. Public Health Significance StatementGiven the growing population of older adults aged 65 and older, there is a need for psychologists who are competent to provide psychological services to older adults. Psychologists who find themselves working with older adults are encouraged to enhance their knowledge and competencies specific to diverse older adult populations and treatment settings to ensure high quality care of older clients. The authors hope that information provided within this article will serve as a guide to providing foundational knowledge competencies related to providing interventions and consultation services with older adult clients.

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Section: Cognitive-behavioral Therapymentioning

confidence: 99%

Section: Theory Research and Practice Of Intervention With Older Adultsmentioning

confidence: 99%

Section: Theory Research and Practice Of Intervention With Older Adultsmentioning

confidence: 99%

Section: Theory Research and Practice Of Intervention With Older Adultsmentioning

confidence: 99%

See 2 more Smart Citations

Intervention, consultation, and other service provision: A foundational geropsychology knowledge competency.

Lind¹,

Poon²,

Birdsall³

2022

Clinical Psychology: Science and Practice

View full text Add to dashboard Cite

show abstract

“…By seeing outcomes of life experiences as a psychological resource individuals develop and draw upon in times of stress and challenge, Laidlaw (Bilbrey et al, 2020;Laidlaw, 2010;Laidlaw, 2021) theorises this is hindered in depression through mood-congruent biases and an overgeneralised, vague autobiographical memory, consistent with the CaR-FA-X model of Williams (2006). Wisdom enhancement may function as a vehicle for change within CBT, by encouraging individuals to reflect on difficult life experiences in a structured way that promotes a wise perspective on past experiences (recognising life's complexities, co-existing positive and negative outcomes, challenges as opportunities for growth), towards practical, present-focused applications.…”

Section: Personal Wisdom and Depressionmentioning

confidence: 99%

Wisdom enhancement and life skills to augment CBT outcomes for depression in later life: a series of N-of-1 trials

Kadri

Leddy

Gracey

et al. 2022

Behav. Cogn. Psychother.

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Background: It has been suggested that cognitive behavioural therapy for older adults be augmented with age-appropriate methods to enhance outcomes for depression treatment. Aims: This study investigated whether a CBT wisdom enhancement timeline technique for older adults reduced depression, as well as increase self-compassion and self-assessed wisdom. Method: An N-of-1 series trial with non-concurrent multiple-baseline AB design was conducted. Older adults experiencing depression, recruited from mental health service waiting lists, were randomly assigned to baseline conditions. Participants received five individual sessions of the examined intervention, offering a structured way of utilising one’s life experiences to evolve the psychological resource of wisdom within a cognitive behavioural framework, in order to improve mood. Participants completed idiographic daily measures and self-report standardised measures of depression, anxiety, self-compassion and wisdom during baseline and intervention phases, and at 1 month follow-up. Results: Six participants competed the study and were subject to standardised and single-case data analyses. Four participants were deemed responders with reliable changes in depression post-intervention with idiographic changes coinciding with intervention onset. Two participants saw clinically significant changes in depression scores at follow-up. One responder saw significant changes in measures of self-compassion and self-assessed wisdom. Conclusions: The examined technique shows promise as an effective technique for reducing depression in older adults. There is insufficient evidence to implicate wisdom and/or self-compassion as significant mechanisms of change. Clinical and theoretical implications are discussed.

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Cognitive‐behavioral and mindfulness‐based interventions for distress in patients with advanced cancer: A meta‐analysis

Krueger,

Secinti,

Stewart

et al. 2023

Psycho-Oncology

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ObjectiveVarious psychosocial interventions have been developed to reduce distress and improve quality of life (QoL) in patients with advanced cancer, many of which are traditional cognitive‐behavioral interventions (CBIs) or mindfulness‐based interventions (MBIs). The aims of this meta‐analysis were to determine and compare the overall effects of traditional CBIs and MBIs on distress and QoL in this population and to explore potential moderators of intervention efficacy.MethodsA systematic search was conducted in CINAHL, Embase, PsycINFO, PubMed, and Web of Science. Randomized controlled trials (RCTs) comparing CBIs or MBIs to controls on distress and QoL outcomes were eligible for inclusion. Random effects meta‐analyses using standardized baseline to post‐intervention mean differences were calculated using Hedges's g. Meta‐regressions were used to compare intervention effects and examine potential moderators.ResultsAcross 37 RCTs (21 CBIs, 14 MBIs, 2 combination therapies), there was a small decrease in distress (Hedges's g = 0.21) and a minimal improvement in QoL (Hedges's g = 0.15). Traditional CBIs and MBIs did not differ in effect sizes. Heterogeneity was significant across distress effect sizes but not across QoL effects. Interventions delivered to individuals (vs. dyads/group) had larger effects on QoL. No moderators of intervention effects on distress were found.ConclusionsFindings suggest traditional CBIs and MBIs produce small reductions in distress compared to controls in patients with advanced cancer, although effects on QoL appear minimal. Given limitations in the number of studies and their quality, rigorous trials are needed to directly compare the impact of traditional CBIs and MBIs in this population.

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Cognitive Behavioral Therapy for Late-Life Depression: Evidence, Issues, and Recommendations

Cited by 36 publications

References 78 publications

Intervention, consultation, and other service provision: A foundational geropsychology knowledge competency.

Intervention, consultation, and other service provision: A foundational geropsychology knowledge competency.

Wisdom enhancement and life skills to augment CBT outcomes for depression in later life: a series of N-of-1 trials

Cognitive‐behavioral and mindfulness‐based interventions for distress in patients with advanced cancer: A meta‐analysis

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