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

The Later Life Depression Knowledge Questionnaire (LLD-KQ): Development and Initial Validation

OBJECTIVES

Later life depression is an important mental health concern requiring knowledge and skill competencies for behavioral health providers. This study developed and evaluated the initial validity of the Later Life Depression Knowledge Questionnaire (LLD-KQ) as a measure of clinical knowledge of later life depression.

METHODS

Domain identification, item generation, and content validity were first explored with five geropsychologists. Initially drafted questions were pre-tested with 10 additional geropsychologists. A pool of prospective survey items was administered to licensed masters-level social workers (n = 300) for individual item examination, confirmatory factor analyses testing 1- and 3-factor models, and initial estimates of reliability and validity.

RESULTS

From the pool of items pertaining to three identified domains (i.e. psychopathology, assessment/diagnosis, and treatment), 25 items were retained for the final LLD-KQ. The three-factor CFA model did not demonstrate adequacy above that of the single factor CFA model. The results provide initial support for internal consistency and construct validity.

CONCLUSIONS

Initial psychometric support for the LLD-KQ was observed while further research on scale dimensionality is warranted.

CLINICAL IMPLICATIONS

The LLD-KQ may advance research on behavioral health providers' knowledge of later life depression to evaluate the current state of specialized knowledge in mental health and aging.

Umbrella review of nonpharmacological interventions for intrinsic capacity in older adults

PURPOSE

This study aims to synthesize existing evidence on the effectiveness of nonpharmacological interventions designed to increase the intrinsic capacity (IC) of community-dwelling older adults.

METHODS

An umbrella review of systematic reviews from 2015 to October 31, 2024, with no language restrictions, was conducted. The review included five databases, including Embase, Ovid MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Joanna Briggs Institute (JBI) Library. Studies followed the preferred reporting items for overviews of reviews (PRIOR) statement. Eligible studies were systematic review and meta-analysis (SRMAs) that included any type of research aimed at enhancing IC in community-dwelling older adults (aged ≥60 years). The interventions covered seven domains: locomotion, vitality, cognitive function, psychological health, sensory function, sleep, and continence. Risk of bias and study quality were extracted via the AMSTAR tool, and GRADE approach was applied to assess the certainty of evidence.

FINDINGS

Out of 6407 initially identified articles, 29 SRMAs comprising 400 studies with a total sample size of 43,849 participants were included. Mobility-focused interventions were the most studied among the seven domains of IC. Moderate to low-quality evidence supports the effectiveness of intrinsic foot muscle strengthening and gait/muscle training for improving locomotor functions in older adults with frailty or acute functional decline. Nonpharmacological interventions targeting cognitive and psychological functions ranked second in the volume of available evidence. No effective sensory or continence interventions were identified. Overall, interventions have demonstrated varying effectiveness, with impacts ranging from moderate to very low across the domains of IC.

INTERPRETATIONS

This umbrella review provides a comprehensive assessment of nonpharmacological interventions for enhancing IC in older adults, highlighting the effectiveness of mobility/muscle strength training for improving locomotor function among frail older adult or those experiencing functional decline. However, the evidence for interventions targeting other IC domains remains limited, particularly for sensory function, and continence management. Future research should prioritize high-quality trials evaluating interventions in these areas to develop evidence-based guidelines for improving overall IC and promoting healthy aging in older adults.

Effectiveness of enhanced group cognitive behaviour therapy for older adults (CBT-OA) with depression and anxiety: A replication study

OBJECTIVES

Enhanced cognitive behavioural therapy for older adults (CBT-OA) modifies standard CBT to better address the needs of older adults, considering age-related impacts on learning. This study evaluated the effectiveness of Cassidy's manualized CBT-OA protocol (Cassidy, 2016a, 2016b) for late-life depression or anxiety in a larger sample at a different center.

DESIGN

This retrospective observational study used a within-subject pre-/post-data design to evaluate the CBT-OA group for seniors with depression or anxiety. Outcome measure were compared before and after the CBT-OA intervention. A post-hoc analysis examined differential effects of age ('young-old' versus 'old-old').

SETTING

CBT-OA groups were held in an urban, community-based geriatric psychiatry outpatient setting from 2015-2019.

PARTICIPANTS

The analysis included forty community-dwelling outpatients over 65 years old with symptoms of late-life depression and/or anxiety.

INTERVENTION

Cassidy's manualized CBT-OA protocol for late-life depression or anxiety was used. Five CBT-OA series were held, each lasting 7-9 weeks (average of 8 weeks) with 2-h weekly sessions, involving 6-9 participants per series.

MEASUREMENTS

Outcome measures included the self-reported Beck Depression Inventory-II, Beck Anxiety Inventory, and Perceived Quality of Life Questionnaire.

RESULTS

CBT-OA significantly improved mood, anxiety, and perceived quality of life, with the greatest gains in 'young-old' participants.

CONCLUSION

This first replication study of Cassidy's CBT-OA protocol for late-life depression or anxiety showed similar positive findings. Future research should use a randomized-controlled design to examine CBT-OA's efficacy, considering different age groups, longer-term follow-up, and well-being measures aligned with positive psychiatry.

Next-Generation Cognitive-Behavioral Therapy for Depression: Integrating Digital Tools, Teletherapy, and Personalization for Enhanced Mental Health Outcomes

Background and Objectives: This systematic review aims to present the latest developments in next-generation CBT interventions of digital support tools, teletherapies, and personalized treatment modules in enhancing accessibility, improving treatment adherence, and optimizing therapeutic outcomes for depression. Materials and Methods: This review analyzed 81 PRISMA-guided studies on the efficacy, feasibility, and applicability of NG-CBT approaches. Other important innovations include web-based interventions, AI-operated chatbots, and teletherapy platforms, each of which serves as a critical challenge in delivering mental health care. Key messages have emerged regarding technological readiness, patient engagement, and the changing role of therapists within the digital context of care. Results: Findings indicate that NG-CBT interventions improve treatment accessibility and engagement while maintaining clinical effectiveness. Personalized digital tools enhance adherence, and teletherapy platforms provide scalable and cost-effective alternatives to traditional therapy. Conclusions: Such developments promise great avenues for decreasing the global burden of depression and enhancing the quality of life through novel, accessible, and high-quality therapeutic approaches.

Feasibility and Acceptability of a Remote Group Intervention for Depression, Social Isolation, and Loneliness in Older Adults

OBJECTIVES

This mixed-methods study examines the acceptability, feasibility, and preliminary effect of a novel, remotely delivered group intervention (Empower@Home: Connected) targeting depression, social isolation, and loneliness in older adults (≥ 60).

METHODS

Acceptability was assessed via participant satisfaction, and feasibility was measured by attrition rates and session attendance. Participants completed pre- and posttest measures of depression, social isolation, and loneliness, with depression also assessed biweekly. Post-intervention, participants completed semi-structured qualitative interviews about their experiences.

RESULTS

31 participants completed the intervention. The intervention had high acceptability and feasibility. Depressive symptoms significantly decreased. Reductions in loneliness and social isolation were observed but not statistically significance. Linear mixed modeling revealed a significant reduction in depressive symptoms during the intervention. Qualitative interviews highlighted participants' beliefs in the intervention's impact. They appreciated the convenience of remote delivery and valued shared experiences and emotional support from group interactions.

CONCLUSIONS

This uncontrolled pilot intervention was acceptable, feasible, and reduced depressive symptomatology. Future research should refine social isolation and loneliness components and explore the intervention's long-term impact.

CLINICAL IMPLICATIONS

This pilot remote group-based interventions to address depression, social isolation, and loneliness in older adults was acceptable and feasible, making it a potentially valuable option for improving mental health care.

Problem Adaptation Therapy (PATH) to Treat Depression in Older Adults With Cognitive Impairment: A Systematic Review of Treatment Effects

OBJECTIVES

Problem adaptation therapy (PATH) is a relatively new psychotherapy that recognises the importance of simultaneously targeting cognitive impairment and functional disability in the treatment of late-life depression. This is the first systematic review to examine the effectiveness of PATH.

METHODS

Ageline, Embase, Medline, PsycINFO, Scopus and ProQuest databases were searched from 2010 until 5 April 2024, for studies that evaluated PATH for older people. Where possible, effect sizes (Hedges' g) with 95% confidence intervals and p values were calculated and pooled using a random effects model. The reporting quality of included studies was assessed using Joanna Briggs Institute Critical Appraisal tools and certainty of the evidence behind each result assessed with The Grading of Recommendations Assessment, Development and Evaluation method.

RESULTS

Twelve papers, from seven independent studies and a pooled sample of 579 older adults with multiple comorbidities, were included in this review. PATH participants experienced immediate reductions in depression symptom ratings (gw = 0.72, p < 0.01, Nstudies = 5), alongside small improvements in disability (gw = 0.61, p = 0.04, Nstudies = 4) compared to peers that received supportive therapy, brief psychoeducation, or usual care. The overall evidence quality was, however, characterised by bias, inconsistency, and imprecision in effect estimates. Positive participant feedback and low dropout rates (15%-31%) suggested treatment satisfaction, although these data were not routinely provided.

CONCLUSIONS

PATH may be a viable treatment for older people living with mental and cognitive disorders, however there is a need for more rigorous research incorporating follow-up assessments to consolidate the effectiveness of PATH relative to other treatments. Incorporating measures of treatment fidelity are also critical to interpreting and generalising these data. The protocol for this study was prospectively published on the Open Science Framework (https://osf.io/gx57a).

Engage! a pilot study of a brief behavioural activation program to promote engagement and well-being in older adults

Previous research has indicated the suitability of behavioural activation (BA) as an intervention for reducing depression in older adults. However, little research has investigated the potential of BA to increase active engagement and well-being in older adults. The current pilot study sought to investigate the usefulness and acceptability of BA to promote well-being in a group of non-clinical older adults. Participants (N = 18) aged between 65 and 86 (M = 77.82, SD = 5.59) who were retired and living independently in the community were provided a 6-week BA program predominantly delivered online. Treatment retention, self-ratings, and participants' compliance to treatment principles indicate preliminary feasibility for the use of BA as an approach for increasing active engagement in older adult populations. Participants also provided feedback on their experiences with the program post-intervention via individual structured interviews. Thematic analysis of these data revealed that participants found the program to be beneficial in terms of increased self-awareness and social engagement, and provided several recommendations for improving acceptability of the program and workbook. The unexpected events relating to the first wave of the novel coronavirus (COVID-19) led to necessary adaptations to delivery modalities, and provided the researchers with an opportunity to investigate the use of a structured well-being program on a high-risk population during a pandemic. Our findings support the proposition that BA is a suitable intervention for increasing engagement and well-being in older adults, provide insight into adapting programs for older adults, and suggest next steps for testing intervention efficacy.

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

OBJECTIVE

Various 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.

METHODS

A 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.

RESULTS

Across 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.

CONCLUSIONS

Findings 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.

A meta-analysis of CBT efficacy for depression comparing adults and older adults

INTRODUCTION

This meta-analysis investigates CBT treatment efficacy fordepression, and compares outcomes between adults (young and middle aged) and older adults (OA).

METHODOLOGY

Effect sizes (Hedges' g) were obtained from 37 peer-reviewed RCTs, 25 adult papers (participant n = 2948) and 12 OA papers (participant n = 551), and analysed with the random effects model.

RESULTS

No significant difference between age groups is reported in terms of CBT efficacy for depression compared to other treatments (Q_between (1) = 0.06, p = .89), with the overall effect favouring CBT over any other treatments (g = 0.48, 95 % CI = 0.29-0.68). The same pattern of results was found when restricting studies to those which used active control conditions (Q_between (1) = 0.03, p = .86) or passive control conditions (Q (1) = 2.45, p = .12).

DISCUSSION

No significant differences in efficacy for CBT treatment for depression are found when comparing adults and OA. CBT is as efficacious with OA as with adults.

Cognitive reappraisal, emotional suppression, and depressive and anxiety symptoms in later life: The moderating role of gender

OBJECTIVES

Although socioemotional selectivity (SST) suggests that people experience more positive affect as they age, symptoms of anxiety and depression persist and are often greater in older women than men. Coping strategies may influence the extent to which older adults experience these symptoms. The purpose of the current study is to examine possible gender differences in the use of an adaptive (cognitive reappraisal (CR) and a maladaptive (emotive suppression (ES) emotion regulation strategy in relation to depressive and anxiety symptoms.

METHOD

Our study uses cross-sectional data drawn from a community sample of older adults (60+; n = 906). We used OLS regression and moderation analyses to test our study hypotheses.

RESULTS

Gender moderated the association between CR in both depressive and anxiety symptoms. Women reported greater use of CR relative to men. Further, CR use was negatively related to symptoms of anxiety and depression in women, but not men. In contrast, men used ES more frequently than women, though older men and women's use of ES was unrelated to anxiety or depressive symptoms.

CONCLUSION

Our findings provide initial evidence that greater CR use in older women is related to lower symptoms of both anxiety and depression relative to older men. Age-related increases in CR use (e.g. SST) among women may serve to decrease anxiety and depression symptoms. Findings suggest decreasing anxiety and depressive symptoms via CR may benefit older women more than older men. Future research is needed to identify the coping strategies that are most beneficial for men.