Positive psychiatry comes of age

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.

Psychosocial correlates of flourishing in the late lifespan

BACKGROUND

Flourishing is a primary dimension of psychological well-being that contributes massively to the development of an active, purposeful, and respectful life, full of meaning, values, and personal interests that nurture social ties.

AIMS

This study primarily intended to examine the contribution of satisfaction with family relations, resilience, metacognitive efficiency, and crystallized intelligence in predicting a flourishing measure in cognitively healthy older adults. Moreover, the impact of gender was investigated on flourishing, satisfaction with family ties, resilience, and metacognitive efficiency.

METHODS

One hundred and eighty 65-94-year-old community dwellers were recruited in Sardinia (Italy). Participants self-rated their flourishing, satisfaction with their family connections, psychological hardness (i.e., a dimension of resilience), and cognitive function, whereas global cognitive efficiency and vocabulary were assessed through two internationally validated objective tests.

RESULTS

A hierarchical regression analysis revealed that 30% of the variance in the flourishing condition was explained by satisfaction with family ties, resilience, and metacognitive efficiency. In addition, males exhibited higher flourishing and satisfaction with family ties than females, and the former group also reported being more autonomous and acting proactively to influence its destiny.

CONCLUSION

Emotional support and rewarding relations with family members, the ability to face stressful events, and a good perception of one's cognitive efficiency play a crucial role in promoting flourishing in late adulthood.

Cosmetic psychiatry: A concept in urgent need of consideration

OBJECTIVE

To explore the concept of, ethics surrounding, and arguments for and against cosmetic psychiatry.

CONCLUSIONS

Cosmetic psychiatry may be defined as the science and practice of interventions that subjectively enhance the mental states of healthy people. Cosmetic medicine (including surgery) is a professionally and socially accepted part of contemporary medical practice; cosmetic psychiatry is not. Like cosmetic medicine, there are significant risks associated with cosmetic psychiatry. There is an urgent need for a broader conversation about this emerging clinical reality.

Longevity is not an ingredient of successful aging as self-reported by community-dwelling older adults: a scoping review

OBJECTIVES

There has been a long-standing debate in gerontology about what constitutes successful aging (SA). This scoping review investigated older adults' perspectives on longevity as part of SA to promote developing a standardized conceptual model.

METHOD

The current review followed the JBI methodological guidelines and used Rowe & Kahn's SA framework and Baltes' selection, optimization, and compensation model as the foundational theoretical framework. Five electronic databases (PubMed, Scopus, PsycInfo, CINAHL, and Web of Science) were searched using specific inclusion criteria (participants, concept, and context) to identify original studies that evaluated SA.

RESULTS

Eighteen studies, including 9,360 individuals (aged 60 years and older), were selected. Main indicators involved six primary domains: Psychological, physical, social, environmental, spiritual, and behavioral. Physical activity, basic aspects of wellbeing, positive outlook, satisfaction with life, interpersonal relationship, participation in meaningful activities, and financial security emerged as the most important factors. The findings suggest that older adults do not consider longevity a primary component of SA.

CONCLUSION

We identified multidimensional self-reported SA components without longevity being emphasized, guiding further improvement of older adults' wellbeing. The study outlines an updated conceptual framework that can be applied to real-life scenarios to test how older adults can best adapt to the challenges of aging.

Four-Year Trajectories of Internal Strengths and Socioemotional Support Among Middle-Aged and Older Adults with HIV

Positive psychological attributes are associated with better health outcomes, yet few studies have identified their underlying constructs and none have examined their temporal trajectories in clinical vs. non-clinical samples. From data collected over 4 years from people with HIV (PWH) and HIV-uninfected (HIV-) participants, we identified two latent factors (internal strengths; socioemotional support) based on responses to seven positive psychological attributes. Internal strengths increased over 4 years for PWH, but not for HIV- comparisons. Socioemotional support did not change significantly in either group. Lower internal strengths and worse socioemotional support were related to greater depressive symptoms. We speculate that improvement in internal strengths in PWH could reflect their being in care, but this requires further study to include PWH not in care. Given the apparent malleability of internal strengths and their association with improved health outcomes, these attributes can serve as promising intervention targets for PWH.

Attitudes and Beliefs on Aging Among Middle-Aged and Older Adults With Serious Mental Illness

Older adults with serious mental illness (SMI) experience increased medical comorbidities, disability, and early mortality, but little is known about how they perceive the process of aging. This study explored attitudes and beliefs about aging among n = 20 middle aged and older adults (M = 59.8 years; range 47-66) with SMI in a state psychiatric hospital. We conducted semistructured interviews using the Attitudes to Ageing Questionnaire (AAQ) and analyzed narrative accounts using a grounded theory approach. The mean scores of overall attitudes toward aging and of the subscale of perception of psychological growth were both positive compared to a neutral rating (p = 0.026 and p = 0.004, respectively). Study participants rated their experience on the subscales of psychosocial loss and physical health change as neutral. Despite substantial psychiatric, medical, and functional disabilities, older adults with SMI in this study of psychiatric inpatients perceived the process of aging as generally positive, suggesting resilience and potential positive emotional growth in older age.

A pragmatic trial of a group intervention in senior housing communities to increase resilience

BACKGROUND

Aging is associated with numerous stressors that negatively impact older adults' well-being. Resilience improves ability to cope with stressors and can be enhanced in older adults. Senior housing communities are promising settings to deliver positive psychiatry interventions due to rising resident populations and potential impact of delivering interventions directly in the community. However, few intervention studies have been conducted in these communities. We present a pragmatic stepped-wedge trial of a novel psychological group intervention intended to improve resilience among older adults in senior housing communities.

DESIGN

A pragmatic modified stepped-wedge trial design.

SETTING

Five senior housing communities in three states in the US.

PARTICIPANTS

Eighty-nine adults over age 60 years residing in independent living sector of senior housing communities.

INTERVENTION

Raise Your Resilience, a manualized 1-month group intervention that incorporated savoring, gratitude, and engagement in value-based activities, administered by unlicensed residential staff trained by researchers. There was a 1-month control period and a 3-month post-intervention follow-up.

MEASUREMENTS

Validated self-report measures of resilience, perceived stress, well-being, and wisdom collected at months 0 (baseline), 1 (pre-intervention), 2 (post-intervention), and 5 (follow-up).

RESULTS

Treatment adherence and satisfaction were high. Compared to the control period, perceived stress and wisdom improved from pre-intervention to post-intervention, while resilience improved from pre-intervention to follow-up. Effect sizes were small in this sample, which had relatively high baseline resilience. Physical and mental well-being did not improve significantly, and no significant moderators of change in resilience were identified.

CONCLUSION

This study demonstrates feasibility of conducting pragmatic intervention trials in senior housing communities. The intervention resulted in significant improvement in several measures despite ceiling effects. The study included several features that suggest high potential for its implementation and dissemination across similar communities nationally. Future studies are warranted, particularly in samples with lower baseline resilience or in assisted living facilities.

Artificial Intelligence for Mental Health and Mental Illnesses: an Overview

PURPOSE OF REVIEW

Artificial intelligence (AI) technology holds both great promise to transform mental healthcare and potential pitfalls. This article provides an overview of AI and current applications in healthcare, a review of recent original research on AI specific to mental health, and a discussion of how AI can supplement clinical practice while considering its current limitations, areas needing additional research, and ethical implications regarding AI technology.

RECENT FINDINGS

We reviewed 28 studies of AI and mental health that used electronic health records (EHRs), mood rating scales, brain imaging data, novel monitoring systems (e.g., smartphone, video), and social media platforms to predict, classify, or subgroup mental health illnesses including depression, schizophrenia or other psychiatric illnesses, and suicide ideation and attempts. Collectively, these studies revealed high accuracies and provided excellent examples of AI's potential in mental healthcare, but most should be considered early proof-of-concept works demonstrating the potential of using machine learning (ML) algorithms to address mental health questions, and which types of algorithms yield the best performance. As AI techniques continue to be refined and improved, it will be possible to help mental health practitioners re-define mental illnesses more objectively than currently done in the DSM-5, identify these illnesses at an earlier or prodromal stage when interventions may be more effective, and personalize treatments based on an individual's unique characteristics. However, caution is necessary in order to avoid over-interpreting preliminary results, and more work is required to bridge the gap between AI in mental health research and clinical care.

Improving images of aging

The present issue of International Psychogeriatrics is the second one conveying data and reflections related to positive psychiatry (see Editorial: Jeste, 2018).