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NEW YORK – For elderly individuals with depression exacerbated by physical limitations and personal losses, cognitive-behavioral therapy is a powerful tool for improving quality of life, according to the faculty of a workshop on this topic at the annual meeting of the American Psychiatric Association.
“The focus is on coping skills. It is about how to persevere in the face of adversity,” explained David A. Casey, MD, professor and chair of the department of psychiatry and behavioral sciences at University of Louisville (Ky.).
“It is not always a fair characterization, but CBT is often perceived as a strategy to address negative thoughts that are not real – but many of my elderly patients have losses and difficulties that are very real,” Dr. Casey said.
In the elderly who become increasingly isolated because of the loss of spouses, friends, and siblings while contending with medical problems that cause pain and limit activities, depression can engender withdrawal, a common coping mechanism, he said.
“Withdrawal may be an unexamined response to a sense of helplessness created by the problems of aging, but it can create a vicious cycle when depression contributes to lack of physical activity and further withdrawal,” explained Dr. Casey, who believes that mild cognitive impairment does not preclude the use of CBT.
CBT provides a “here-and-now” approach in which patients are reconnected to daily life by first identifying the activities that once provided pleasure or satisfaction and then developing a plan to reintroduce them into daily life. Except for its value in identifying activities meaningful to the patient, the history that preceded depression or psychological distress is less important than developing an immediate strategy to rebuilding an active life.
“Some patients are essentially immobilized by their withdrawal and convinced that their problems are unsolvable, but most will improve their quality of life through CBT,” he maintained.
There are data to support this contention, according to Jesse H. Wright III, MD, PhD, director of the Depression Center at the University of Louisville. He cited controlled studies demonstrating the efficacy of CBT relative to no CBT in relieving depression in the elderly.
“The evidence suggests that combining CBT with pharmacotherapy is better than either alone for managing depression in this age group,” Dr. Wright said.
In developing a therapeutic plan through CBT, patients are given assignments designed to develop participation in meaningful activities. These must be realistic within physical limitations and within the patient’s readiness to engage. Small steps toward a goal might be needed. At each therapeutic encounter, goals are set, and progress should be evaluated at the subsequent therapeutic encounter.
Dr. Casey cautioned. He said a rehearsal of the actions needed to achieve the assigned goals might be helpful before the patient leaves the treatment session. This allows the clinician to recognize and address potential obstacles, including practical issues, such as mobility, or psychological issues, such as fear of physical activities.
Developing persistence in the face of high levels of negativity can be a challenge not only for the patient but also for the physician. According to Dr. Casey, maintaining a positive attitude can be challenging after treating a series of highly withdrawn and discouraged patients. But he emphasized the need for a professional orientation, recognizing that incremental gains in patient well-being, not cure, should be considered a reasonable goal.
“If I can improve the patient’s quality of life, this is a significant success,” he said. He believes it is sometimes necessary to distract patients from potential problems to focus on expected benefits.
“Patients can have a view of their limitations that is accurate but unhelpful,” Dr. Casey said. The goal of CBT is to move the focus to strategies that can restore lost interest and pleasure in daily life.
Dr. Casey and Dr. Wright reported no potential conflicts of interest related to this topic.
NEW YORK – For elderly individuals with depression exacerbated by physical limitations and personal losses, cognitive-behavioral therapy is a powerful tool for improving quality of life, according to the faculty of a workshop on this topic at the annual meeting of the American Psychiatric Association.
“The focus is on coping skills. It is about how to persevere in the face of adversity,” explained David A. Casey, MD, professor and chair of the department of psychiatry and behavioral sciences at University of Louisville (Ky.).
“It is not always a fair characterization, but CBT is often perceived as a strategy to address negative thoughts that are not real – but many of my elderly patients have losses and difficulties that are very real,” Dr. Casey said.
In the elderly who become increasingly isolated because of the loss of spouses, friends, and siblings while contending with medical problems that cause pain and limit activities, depression can engender withdrawal, a common coping mechanism, he said.
“Withdrawal may be an unexamined response to a sense of helplessness created by the problems of aging, but it can create a vicious cycle when depression contributes to lack of physical activity and further withdrawal,” explained Dr. Casey, who believes that mild cognitive impairment does not preclude the use of CBT.
CBT provides a “here-and-now” approach in which patients are reconnected to daily life by first identifying the activities that once provided pleasure or satisfaction and then developing a plan to reintroduce them into daily life. Except for its value in identifying activities meaningful to the patient, the history that preceded depression or psychological distress is less important than developing an immediate strategy to rebuilding an active life.
“Some patients are essentially immobilized by their withdrawal and convinced that their problems are unsolvable, but most will improve their quality of life through CBT,” he maintained.
There are data to support this contention, according to Jesse H. Wright III, MD, PhD, director of the Depression Center at the University of Louisville. He cited controlled studies demonstrating the efficacy of CBT relative to no CBT in relieving depression in the elderly.
“The evidence suggests that combining CBT with pharmacotherapy is better than either alone for managing depression in this age group,” Dr. Wright said.
In developing a therapeutic plan through CBT, patients are given assignments designed to develop participation in meaningful activities. These must be realistic within physical limitations and within the patient’s readiness to engage. Small steps toward a goal might be needed. At each therapeutic encounter, goals are set, and progress should be evaluated at the subsequent therapeutic encounter.
Dr. Casey cautioned. He said a rehearsal of the actions needed to achieve the assigned goals might be helpful before the patient leaves the treatment session. This allows the clinician to recognize and address potential obstacles, including practical issues, such as mobility, or psychological issues, such as fear of physical activities.
Developing persistence in the face of high levels of negativity can be a challenge not only for the patient but also for the physician. According to Dr. Casey, maintaining a positive attitude can be challenging after treating a series of highly withdrawn and discouraged patients. But he emphasized the need for a professional orientation, recognizing that incremental gains in patient well-being, not cure, should be considered a reasonable goal.
“If I can improve the patient’s quality of life, this is a significant success,” he said. He believes it is sometimes necessary to distract patients from potential problems to focus on expected benefits.
“Patients can have a view of their limitations that is accurate but unhelpful,” Dr. Casey said. The goal of CBT is to move the focus to strategies that can restore lost interest and pleasure in daily life.
Dr. Casey and Dr. Wright reported no potential conflicts of interest related to this topic.
NEW YORK – For elderly individuals with depression exacerbated by physical limitations and personal losses, cognitive-behavioral therapy is a powerful tool for improving quality of life, according to the faculty of a workshop on this topic at the annual meeting of the American Psychiatric Association.
“The focus is on coping skills. It is about how to persevere in the face of adversity,” explained David A. Casey, MD, professor and chair of the department of psychiatry and behavioral sciences at University of Louisville (Ky.).
“It is not always a fair characterization, but CBT is often perceived as a strategy to address negative thoughts that are not real – but many of my elderly patients have losses and difficulties that are very real,” Dr. Casey said.
In the elderly who become increasingly isolated because of the loss of spouses, friends, and siblings while contending with medical problems that cause pain and limit activities, depression can engender withdrawal, a common coping mechanism, he said.
“Withdrawal may be an unexamined response to a sense of helplessness created by the problems of aging, but it can create a vicious cycle when depression contributes to lack of physical activity and further withdrawal,” explained Dr. Casey, who believes that mild cognitive impairment does not preclude the use of CBT.
CBT provides a “here-and-now” approach in which patients are reconnected to daily life by first identifying the activities that once provided pleasure or satisfaction and then developing a plan to reintroduce them into daily life. Except for its value in identifying activities meaningful to the patient, the history that preceded depression or psychological distress is less important than developing an immediate strategy to rebuilding an active life.
“Some patients are essentially immobilized by their withdrawal and convinced that their problems are unsolvable, but most will improve their quality of life through CBT,” he maintained.
There are data to support this contention, according to Jesse H. Wright III, MD, PhD, director of the Depression Center at the University of Louisville. He cited controlled studies demonstrating the efficacy of CBT relative to no CBT in relieving depression in the elderly.
“The evidence suggests that combining CBT with pharmacotherapy is better than either alone for managing depression in this age group,” Dr. Wright said.
In developing a therapeutic plan through CBT, patients are given assignments designed to develop participation in meaningful activities. These must be realistic within physical limitations and within the patient’s readiness to engage. Small steps toward a goal might be needed. At each therapeutic encounter, goals are set, and progress should be evaluated at the subsequent therapeutic encounter.
Dr. Casey cautioned. He said a rehearsal of the actions needed to achieve the assigned goals might be helpful before the patient leaves the treatment session. This allows the clinician to recognize and address potential obstacles, including practical issues, such as mobility, or psychological issues, such as fear of physical activities.
Developing persistence in the face of high levels of negativity can be a challenge not only for the patient but also for the physician. According to Dr. Casey, maintaining a positive attitude can be challenging after treating a series of highly withdrawn and discouraged patients. But he emphasized the need for a professional orientation, recognizing that incremental gains in patient well-being, not cure, should be considered a reasonable goal.
“If I can improve the patient’s quality of life, this is a significant success,” he said. He believes it is sometimes necessary to distract patients from potential problems to focus on expected benefits.
“Patients can have a view of their limitations that is accurate but unhelpful,” Dr. Casey said. The goal of CBT is to move the focus to strategies that can restore lost interest and pleasure in daily life.
Dr. Casey and Dr. Wright reported no potential conflicts of interest related to this topic.
EXPERT ANALYSIS FROM APA