Comparative effectiveness of psychotherapies for depressed elders.

Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. Background. Depression is a common, disabling condition for which psychological treatments, in particular cognitive behavioural therapies are recommended. Promising results in recent randomized trials have renewed interest in behavioural therapy. This systematic review sought to identify all randomized trials of behavioural therapy for depression, determine the effect of such interventions and examine any moderators of such effect.Method. Randomized trials of behavioural treatments of depression versus controls or other psychotherapies were identified using electronic database searches, previous reviews and reference lists. Data on symptom-level, recovery/ dropout rate and study-level moderators (study quality, number of sessions, severity and level of training) were extracted and analysed using meta-analysis and meta-regression respectively.Results. Seventeen randomized controlled trials including 1109 subjects were included in this meta-analysis. A random-effects meta-analysis of symptom-level post-treatment showed behavioural therapies were superior to controls [standardized mean difference (SMD) x0.70, 95 % CI x1.00 to x0.39, k=12, n=459], brief psychotherapy (SMD x0.56, 95 % CI x1.0 to x0.12, k=3, n=166), supportive therapy (SMD x0.75, 95 % CI x1.37 to x0.14, k=2, n=45) and equal to cognitive behavioural therapy (SMD 0.08, 95 % CI x0.14 to 0.30, k=12, n=476).Conclusions. The results in this study indicate behavioural therapy is an effective treatment for depression with outcomes equal to that of the current recommended psychological intervention. Future research needs to address issues of parsimony of such interventions.

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“…Behavioural therapy ( Behavioural (8) Cognitive ( [11] Thompson (1987) Older adults community 67.07 (5.8) 67…”

Section: Resultsmentioning

confidence: 99%

A meta-analysis of randomized trials of behavioural treatment of depression

2007

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“…This study also collected data from a pedometer as an objective measure of the client's physical activity. Several studies assessed self-rated engagement in terms of frequency and pleasantness of activities (Meeks et al, 2006(Meeks et al, , 2008Rokke et al, 1999;Thompson et al, 1987;Yon & Scogin, 2009) and frequency and duration of social and physical activity (Quijano et al, 2007). Only two studies included staff-reported activity participation and direct observation of activity participation and affective responses (Meeks et al, 2006(Meeks et al, , 2008.…”

Section: Dependent Measuresmentioning

confidence: 99%

“…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.…”

Section: Participant and Setting Characteristicsmentioning

confidence: 99%

“…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).…”

Section: Participant and Setting Characteristicsmentioning

confidence: 99%

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

Polenick

Flora

2013

BEHAV ANALYST

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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.

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“…The Beck, Hollon, Young, Bedrosian, and Budenz (1985) and Rush, Beck, Kovacs, and Hollon (1977) studies (data from these two studies were combined), the Luborsky andCrits-Christoph (1988) and the Thompson, Gallagher, and Breckenridge (1987) studies all yielded estimates of therapist effects equal to zero. Most of the other studies had modest therapist main effects (in the 5-10% of variance range).…”

Section: Therapist Effects In 10 Treatment Outcome Studiesmentioning

confidence: 99%

Implications of therapist effects for the design and analysis of comparative studies of psychotherapies.

Crits‐Christoph¹,

Mintz²

1991

Journal of Consulting and Clinical Psychology

339

292

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Technical reasons are presented as to why therapist should be included as a random design factor in the nested analysis of (co)variance (AN[C]OVA) design commonly used in psychotherapy research. Incorrect specification of the ANOVA design can, under some circumstances, result in incorrect estimation of the error term, overly liberal F ratios, and an unacceptably high risk of Type I errors. Review of studies indicates that the great majority of investigators continue to ignore this issue. Computer simulation studies revealed that considerable bias can be introduced by not specifying therapist as a random term. Finally, a reanalysis is presented of data from 10 psychotherapy outcome studies that indicated that therapist effects vary considerably and at times can be large. More recent studies that implement better quality controls appear to demonstrate less variance due to therapist. The implications of these results for the design of future studies are discussed.In most psychotherapy research studies, each participating psychotherapist sees more than one patient. Over 10 years ago, Martindale (1978) presented evidence that this apparently minor methodological detail was an important statistical consideration. On the basisof reanalysesofseveral examplesdrawn from the published literature, he concluded that the failure to include the therapist as a blocking or stratification factor in the statistical design could seriously distort testsof statistical significance.The implications of Martindale's paper were sobering. His methodological opinion was that, strictly speaking, almost all of the published findings in the psychotherapy research literature applied only to the specific samples of therapists used in each study. If researchers want to generalize their results to a larger population of therapists, he argued, then they must treat therapists as a random factor in the statistical analyses. His own review of the literature, however, indicated that this practice was very much the exception rather than the rule. Unhappily, adoption of his methodological counsel would result in serious reductions in statistical power in most studies. Furthermore, Martindale's statistical reanalyses suggested strongly Preparation of this article was supported in part by National Institute of Mental Health (NIMH) Grant MH-40472 and NIMH Career Development Award MH-00756 to Paul Crits-Christoph.We wish to acknowledge the generosity of the investigators who lent us their data, including Aaron T. Beck, Tom Borkovec, Robert DeRubeis, Dolores Gallagher, Steve Hollon, Stan Imber, Bernard Liberman, Lester Luborsky, Tom McLellan, Paul Pilkonis. William Piper, Larry Thompson, George Woody, and Charlotte Zitrin. We also thank David Kenny for his helpful suggestions and comments on a draft of this article.Correspondence concerning this article should be addressed to Paul Crits-Christoph, Hospital of the University of Pennsylvania, 308 Piersol Building. 3400 Spruce Street, Philadelphia, Pennsylvania 19104-4283 that the erroneous statistical desig...

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Comparative effectiveness of psychotherapies for depressed elders.

Cited by 417 publications

References 16 publications

A meta-analysis of randomized trials of behavioural treatment of depression

A meta-analysis of randomized trials of behavioural treatment of depression

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

Implications of therapist effects for the design and analysis of comparative studies of psychotherapies.

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