Dolores Gallagher

Meta‐Analysis of Therapist Effects in Psychotherapy Outcome Studies

In a meta-analysis, we examined factors that could account for the differences in therapist efficacy evidenced in psychotherapy outcome studies. The factors investigated were: (1) the use of a treatment manual, (2) the average level of therapist experience, (3) the length of treatment, and (4) the type of treatment (cognitive/behavioral versus psychodynamic). Data were obtained from fifteen psychotherapy outcome studies that produced 27 separate treatment groups. For each treatment group, the amount of outcome variance due to differences between therapists was calculated and served as the dependent variable for the meta-analysis. Each separate treatment group was coded on the above four variables, and multiple regression analyses related the independent variables to the size of therapist effects. Results indicated that the use of a treatment manual and more experienced therapists were associated with small differences between therapists, whereas more inexperienced therapists and no treatment manual were a...

Assessment of Depression in Geriatric Medical Outpatients: The Validity of Two Screening Measures

The validity of two screening measures for depression was assessed in a geriatric medical outpatient population. Sixty‐eight patients completed both questionnaires; 31 also completed a clinical interview allowing for accurate diagnosis. Both screening measures were found to accurately identify those who were depressed. Clinical and research applications are discussed, including the complementary use of these screening measures with the physicians diagnosis.

Alliance Prediction of Outcome Beyond in-Treatment Symptomatic Change as Psychotherapy Processes

For older depressed adults treated in behavioral, cognitive, or brief dynamic therapy, we examined alliance-outcome associations over and above initial symptomatology and in-treatment symptomatic c...

Psychoeducational interventions for family caregivers: Preliminary efficacy data*

In this preliminary report, data are presented from the first 111 family member caregivers who participated in a psychoeducational program designed to teach specific skills for coping more effectively with caregiving. Results indicated that depression was reduced and morale was increased for those who were assigned to either of the two skill-building conditions compared to those assigned to the waiting-list condition. Our data suggest that family caregivers, who as a group experience a great deal of stress and stress-related disorders, are able to benefit substantially from structured programs designed to teach skills for better coping, despite adverse conditions of daily life.

Memory complaint and performance in normal and depressed older adults

The present study investigated the influence of depression on memory complaints and performance in a sample of community dwelling older adults (N = 41). Complaints were significantly more frequent in the clinically depressed subsample. However, their actual performance on tests of immediate and delayed recall did not differ significantly from the performance of nondepressed older adults. In addition, results indicated that depressives who responded favorably to a program of psychotherapy demonstrated significant reductions in levels of memory complaints at post-treatment assessment. Implications of these data for further research are discussed.

Psychosocial factors affecting adaptation to bereavement in the elderly.

A spouses death requires more readjustment on the part of the bereaved than any other stressful life event. This finding holds across the many age groups and cultural backgrounds that have been studied. Although it is unclear as to whether the stress of bereavement is greater for women than for men, for the young than for the old, for one socioeconomic level or for another, a critical review of the literature suggests the following: 1) Negative changes in physical health, mortality rate and mental health status usually accompany widowhood; 2) Complex social-psychological variables such as the individuals characteristic ways of coping with stress (coping strength), the adequacy of the social network — plus other factors such as income and religious commitment — may attenuate widowhoods negative impact. Suggestions for further research include studies exploring differential adaptation to widowhood across age groups and in elderly men and women, and longitudinal studies tracing the process of recovery from acute grief.

Retrospective assessment of marital adjustment and depression during the first 2 years of spousal bereavement.

Two hundred twelve bereaved elders rated marital adjustment using items drawn from the Locke and Wallace (1959) Marital Adjustment Test and completed the Beck Depression Inventory 2 months, 12 months, and 30 months after the loss of their spouses. Their responses were compared with those of 162 nonbereaved individuals of comparable age who were tested at the same times. More positive ratings of marital adjustment were made by bereaved subjects than by nonbereaved subjects. Among nonbereaved elders, more severe ratings of depression were associated with lower ratings of marital adjustment. In the bereaved sample, however, the opposite was found: More severe ratings of depression were associated with higher ratings of marital adjustment. This pattern of results changed only slightly over the 2.5-year course of bereavement and was not influenced by gender. These results are discussed in terms of cognitive processes (e.g., idealization) that influence retrospective assessments of marital adjustment during bereavement.

Reasons for the lack of association between changes in health behavior and improved health status: an exploratory study.

Persons with arthritis who attended a 12-hour self-management course generally showed improved health behaviors and improved health status. However, no association was found between the two. We therefore interviewed 54 course participants to determine factors that were associated with positive and negative health-status outcomes. Persons having positive outcomes indicated that they had more control over their disease and had a positive emotional status. Persons with negative outcomes indicated a lack of control and generally had a negative emotional status. These differences were statistically significant.

Interaction of depression and bereavement on mental health in the elderly

Three hundred ninety-three elderly adults aged 55 and older were divided into 1 of 9 subgroups in a 3 (bereavement group: survivors of spouses who died by natural death or by suicide and nonbereaved control Ss) x 3 (depression group: none, mild, and moderate-severe) design over 4 times of measurement--1 month, 6 months, 1 year, and 2.5 years after death of spouse. Significant Bereavement x Depression Group effects were obtained on Brief Symptom Inventory scores. The moderate-severe depression/suicide subgroup had the greatest psychiatric complications with bereavement. Results indicated that elderly persons with significant clinical depression at the time of a spouses death were at significant risk for psychological complications during the bereavement process, and survivors of spouses who had committed suicide were even more at risk within the greatest depression group.

Factor Analysis and Preliminary Validation of the Mini-Mental State Examination from a Longitudinal Perspective

The Mini-Mental State Examination (MMSE) is a commonly used instrument for assessing mental impairment. Previous proposals for its underlying structure have focused on scores obtained from a single administration of the test. Because the MMSE is widely used in longitudinal studies, we examined the pattern of relations among the rates of chance of the items. Data were obtained from 63 subjects for 1.5 years or more. The relations among the rates of change of the MMSE items were described by a five-factor solution that accounted for 75% of the variance and comprised factors pertaining to orientation and concentration, obeying commands, learning and repetition, language, and recall. This was in contrast to the structure of the scores obtained from a single administration of the MMSE, which was best described by a two-factor solution. In order to provide a clinical validation, factor scores derived from the MMSE factors were used to predict scores on the Memory and Behavior Problems Checklist and the Brief Cognitive Rating Scale.