Interventions: Treating Later Life Depression
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Author Name:
Ann M. Steffen, Leah P. Dick-Siskin, Ann Choryan Bilbrey, Larry W. Thompson, and Dolores Gallagher-Thompson
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Author phone:
steffena@umsystem.edu
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Author affiliation:
University of Missouri-St. Louis
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Year Developed:
2nd edition (2022)
Synopsis:
Clinician Guide: One of the greatest challenges for providers treating later-life depression is the wide variability of life circumstances that accompany depressive symptoms for clients across outpatient mental health, integrated primary care, and inpatient psychiatric settings. This thoroughly revised Clinician Guide for Treating Later-Life Depression: A Cognitive-Behavioral Therapy Approach outlines culturally responsive practices that target the contexts and drivers/antecedents of depression in middle-aged and older adults. Clinicians choose research-supported modules from the accompanying workbook that fit the needs of their clients (i.e., changes in brain health, chronic pain, sleep problems, anxiety, experiences of loss, family caregiving issues). This practical guide reflects continuing international scientific and clinical advances in applying CBT to age-related problems using individual and group formats, with clinician-tested recommendations for telehealth practice. Flexible use of these clinical tools enhances the personalized application of change strategies, including behavioral activation, problem solving, relaxation training, attention to personal strengths and positive emotional experiences, self-compassion, cognitive reappraisal, and communication skills training, among others. Case examples are provided to support the efforts of practitioners from a range of disciplines (e.g., clinical psychology, psychiatry, social work, counseling, marriage and family therapy, nursing, occupational therapy and recreational specialists) in busy clinical practices. The appendices in this guide include aging-friendly assessment tools and other resources to support ongoing professional development. Because the practical techniques presented in this Clinician Guide have empirical support accumulated over decades, Treating Later-Life Depression is an indispensable resource for all behavioral health providers who wish to effectively and efficiently help diverse aging clients thrive in a daily life that is true to their values and personal strengths.
Workbook: This culturally responsive workbook uses the evidence-based methods of cognitive behavioral therapy to help middle-aged and older adults build on existing strengths and reduce symptoms of depression, whether they are feeling “a little blue” or are very depressed. The culmination of more than four decades of research, this empirically supported and effective treatment program helps clients learn how to develop and use healthy habits to improve mood and quality of life. This workbook is intended to be used as an adjunct to clinician-provided CBT and is not a self-help book to be used on its own. The personalized approach used in this workbook means that, together with their clinician, individuals decide which of the modules are a good fit for their specific life circumstances. Each module includes easy to read, large-print Learn pages that therapists can use to help clients learn specific depression management skills, along with Practice forms to use between sessions to practice, remember, and use these skills. Complete with information and practical strategies for improving depression and related concerns (e.g., anxiety, sleep, chronic pain, brain health, caregiving, grief and personal relationships), this thoroughly revised second edition of Treating Later-Life Depression: A Cognitive-Behavioral Therapy Approach provides indispensable resources to help culturally diverse aging individuals thrive in a daily life that is true to their values and personal strengths.
This 2nd edition (2022) of Treating Later-Life Depression is an adapted version of the 1st edition (2010). The key cultural factors that inform this adaptation include the importance of (a) taking a strengths-based approach that emphasizes personal values, (b) including family involvement in treatments for culturally diverse older adults who are depressed, (c) addressing the many contextual factors that influence later-life depression. The most important supports for this culturally responsive treatment include facilitating discussion of most salient cultural identities early on in treatment, increased emphasis on personal strengths and values, attention to the role of chosen family, strategies and case examples that reflect individuals from diverse communities. Currently available in English only.
English
Alaskan Native, Asian, Black or African American, Latino/Latina/Latinx, Middle Eastern/North African, Native American, Native Hawaiian or Pacific Islander
This workbook and accompanying clinician guide target both major depression and subclinical depressive symptoms in culturally diverse middle-aged and older adults. The materials have been designed to be compatible with a range of community and clinical settings, including traditional individual and group counseling and psychotherapy, integrated primary care, and case management.
Depressive Symptoms and Conditions
Less than 2% of all counseling and clinical psychologists identify themselves as specialists in aging, yet 30-50% of all counseling and clinical psychologists report that they frequently or very frequently provide clinical services to middle-aged and older adults (Moye et al., 2019). There is a desperate need for easy to use and flexible materials that facilitate evidence-based treatment of later-life depression in a range of community, clinical and primary care settings. This workbook (and accompanying clinician guide) target both major depression and subclinical depressive symptoms in culturally diverse middle-aged and older adults.
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This intervention is grounded in Cognitive Behavioral (CBT) conceptual models. This 2nd edition (2022) has carefully attended to the ongoing evolutions of CBT theory and practice, and has incorporated the most current research on CBT interventions (i.e., stronger attention to strategies to cultivate positive emotional experiences; self-compassion exercises; clinicians’ desire for flexible and modular formats and materials; process-based therapy focused on targeting specific drivers of depression; de-emphasized scheme change methods which can be iatrogenic in some clients).
Groups, Individuals
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This workbook and clinician guide are published within Oxford University Press’ Treatments That Work Series. This means that the scientific basis of these works have been thoroughly revised by the advisory board of that series (David Barlow, senior editor). See the attached pdf file for the list of grants and publications that form the basis of this work, particularly the efforts in Mexican American, Chinese American, Japanese American, Indian American, African American communities that influenced our work on this 2nd edition.
The core modules of this workbook have been evaluated and supported in research within both individual psychotherapy and psychoeducational groups. We engaged in additional pilot testing in Spring 2020, right as COVID-19 pandemic led to the transition to telemental health. Thus, we have been able to identify within the the clinician guide the materials that clinicians indicated were most helpful for telehealth practice.
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See the attached pdf file for the list of grants and publications that form the basis of this adapted work. One of the senior authors, Dr. Dolores Gallagher-Thompson, is a pioneer in ethnogerontology, and has devoted her career to working with ethnically diverse middle-aged and older adults. In particular, her efforts in developing family caregiving interventions within Mexican American, Chinese American, Japanese American, Indian American, African American communities have greatly influenced this 2nd edition.
Our primary challenge currently is to create sufficient professional training guidelines and resources for clinicians to be able to choose from the wide range of modules and clinical materials. This workbook is designed to function similarly to Linehan’s DBT Handouts and Worksheets, so no one client would receive all modules or all materials within any given module. The advantage of this is a high degree of choice and flexibility, which is what the clinicians we’ve been consulting with over the past 10 years have asked for. On the other hand, the large number of Learn and Practice pages can feel daunting for a clinician who is new to the work.
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