The role of client choice and target selection in self-management therapy for depression in older adults.

Abstract

In a study designed to maximize the effectiveness of treatment by allowing participants to select the target of treatment, 40 depressed older adults were randomly assigned to a waiting-list control condition or to conditions in which the target of treatment was either chosen or assigned. All participants received self-management therapy and the choice was between changing behavior or changing cognition. It was found that individually administered self-management therapy was effective in treating depression for older adults. There were no differences in outcome between versions of self-management therapy that targeted behavioral or cognitive change. Among those who completed treatment, there were no differences in outcome between those who received a choice and those who did not. Individuals who were given a choice of treatment options, however, were less likely to drop out of treatment prematurely.

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

“…Behavioral activation was found to be comparable in effectiveness to cognitive therapy (Gallagher & Thompson, 1982;Rokke et al, 1999;Thompson et al, 1987) and problemsolving therapy (Teri et al, 1997). Single-subject design studies demonstrated significant decreases in depression following baseline (Lazzari et al, 2011;Yon & Scogin, 2009) and previous exposure to cognitive therapy (Bottonari et al, 2008), decreases in depression and anxiety (Turner & Leach, 2009), and significant increases in positive affect (Lazzari et al, 2011;Meeks et al, 2006).…”

“…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.…”

“…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). 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).…”

“…Although these measures may be meaningful in assessing progress, self-reports may be limited in terms of reliability. Several studies used ratings from other individuals such as family caregivers (Teri et al, 1997), clinicians (Rokke et al, 1999), and two independent evaluators (Gallagher & Thompson, 1982). In addition to client self-report, inclusion of ratings from independent observers or individuals who have frequent contact with older clients may improve the reliability of these measures.…”

“…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).…”