Elizabeth A. DiNapoli

Telehealth cognitive behavior therapy for co-occurring insomnia and depression symptoms in older adults.

OBJECTIVE Telehealth has proven effective with a wide range of disorders, but there is a paucity of data on the use of telehealth using cognitive-behavior therapy (CBT) with late-life insomnia and depression. This pilot study was designed to examine the feasibility and effectiveness of using telehealth to treat older adults with comorbid insomnia and depression living in rural Alabama. METHOD Five patients received 10 sessions of CBT for insomnia and depression. Patients were engaged in treatment via Skype from their primary care physicians office. Assessments were conducted at baseline, posttreatment, and 2-month follow-up. RESULTS Patients exhibited clinically significant improvement in both insomnia (sleep diaries and Insomnia Severity Index) and depression (Hamilton Rating Scale for Depression) at posttreatment, and these gains were well maintained at 2-month follow-up. CONCLUSIONS These preliminary data suggest that telehealth may be an effective means of providing treatment to older adults, including underserved populations.

The Effects of Behavioral Activation Therapy With Inpatient Geriatric Psychiatry Patients

This study examined the effects of Behavioral Activation (BA) treatment on depressive symptoms and quality of life among older adult patients in a geriatric psychiatry facility. There were 50 participants with mild to moderate cognitive impairment, each being 65 years of age or older. A 2 (between)×3 (time of measurement) design was used in this study comparing control (treatment-as-usual) and experimental (BA) conditions at pre-, mid-, and posttreatment. BA consisted of eight 30- to 60-minute sessions across 4 weeks. Intent-to-treat analyses indicated a significant Group×Time interaction on depressive symptoms, with this effect remaining when only completer data were included. Further analyses indicated that this effect was due to significant change early in treatment in both the full and completer samples. There was no evidence of a significant effect on the quality-of-life measure. Cognitive status was not related to change in depressive symptoms, suggesting that BA may be useful across a range of older adults.

Social Isolation and Cognitive Function in Appalachian Older Adults

Objective: Investigating the relation between social isolation and cognitive function will allow us to identify components to incorporate into cognitive interventions. Method: Data were collected from 267 Appalachian older adults (M = 78.5, range 70–94 years). Overall cognitive functioning and specific cognitive domains were assessed from data of a self-assembled neuropsychological battery of frequently used tasks. Social isolation, social disconnectedness, and perceived isolation were measured from the Lubben Social Network scale-6. Results: Results indicated a significant positive association between all predictor variables (e.g., social isolation, social disconnectedness, and perceived isolation) and outcome variables (e.g., overall cognitive function, memory, executive functioning, attention, and language abilities). Perceived isolation accounted for nearly double the amount of variance in overall cognitive functioning than social disconnectedness (10.2% vs. 5.7%). Discussion: Findings suggest that social isolation is associated with poorer overall cognitive functioning and this remains true across varied cognitive domains.

Do Manualized Treatments for Depression Reduce Insomnia Symptoms

OBJECTIVE Researchers evaluated the effect of manualized treatments for depression on comorbid symptoms of insomnia. METHOD Hierarchical linear modeling was used to analyze archival data collected from 14 studies (N = 910) examining the efficacy of psychological treatments for depression in adults. RESULTS Participants receiving a psychological treatment for depression experienced significantly more relief from symptoms of insomnia with overall, early-, middle-, and late-night sleep than those not receiving such treatment. CONCLUSION Symptoms of insomnia in those with an average (or lower) level of depression can be reduced through psychological treatment for depression. However, more severe depressive symptoms do not receive great relief from sleep disturbance and may require an additional treatment component targeting symptoms of insomnia.

Pleasant Events, Hopelessness, and Quality of Life in Rural Older Adults

PURPOSE Rural older adults are susceptible to depression and reduced quality of life. This study explored contrasting explanations (behavioral vs cognitive route) for the relation of emotional distress with quality of life. METHODS This retrospective study included rural older adults (N = 134) with reduced quality of life and increased psychological symptoms. Multiple mediation analysis was conducted to test the indirect effect of engagement in pleasant events and hopelessness on the emotional distress and quality of life relation. FINDINGS Both engagement in pleasant events and hopelessness were found to partially mediate the relation between emotional distress and quality of life. CONCLUSIONS Targeting both hopelessness and engagement in pleasant events may be helpful in improving the quality of life of vulnerable, rural older adults.

Effects of integrated telehealth-delivered cognitive-behavioral therapy for depression and insomnia in rural older adults.

We examined the effects of integrated cognitive-behavioral therapy for depression and insomnia (CBT-D + CBT-I, respectively) delivered via videoconference in rural middle-aged and older adults. Forty patients with depressive and insomnia symptoms were randomized to receive either 10 sessions of CBT-D + CBT-I or usual care (UC). Patients in the integrated CBT condition were engaged in telehealth treatment through Skype at their primary care clinic. Assessments were conducted at baseline, posttreatment, and 3-month follow-up. CBT-D + CBT-I participants had significantly greater improvements in sleep at posttreatment and 3-month follow-up as compared with the UC participants. The Time × Group interaction for depression was not significant; participants in both the CBT-D + CBT-I and UC conditions showed a decrease in depressive symptoms over time. Although integrated CBT benefits both depression and insomnia symptoms, its effects on depression are more equivocal. Further research should consider expanding the depression treatment component of integrated CBT to enhance effectiveness. Efectos de la Terapia Cognitivo-Conductual Integrada, Telesalud Entregada para la Depresión y el Insomnio en Adultos Rurales, Medianos y Mayores Examinamos los efectos de la terapia cognitiva-conductual integrada para la depresión y el insomnio (CBT-D _ CBT-I, respectivamente) administrados por videoconferencia en adultos de mediana edad y adultos de zonas rurales. Cuarenta pacientes con síntomas depresivos e insomnio fueron aleatorizados para recibir 10 sesiones de CBT-D _ CBT-I o atención habitual (UC). Los pacientes en la condición CBT integrada se dedicaron al tratamiento de telesalud a través de Skype en su clínica de atención primaria. Las evaluaciones se realizaron al inicio, después del tratamiento y a los 3 meses de seguimiento. Los participantes CBT-D _ CBT-I tuvieron mejoras significativamente mayores en el sueño en el post-tratamiento y en el seguimiento de 3 meses en comparación con los participantes con CU. La interacción Time _ Group para la depresión no fue significativa; los participantes en las condiciones CBT-D _ CBT-I y UC mostraron una disminución en los síntomas depresivos a lo largo del tiempo. Aunque la terapia cognitiva-conductualintegrada beneficia tanto a la depresión como a los síntomas del insomnio, sus efectos sobre la depresión son más equívocos. La investigación adicional debería considerar expandir el componente de tratamiento de la depresión de la terapia cognitiva-conductualintegrada para mejorar la efectividad.

Audio and Computer Cognitive Behavioral Therapy for Depressive Symptoms in Older Adults: A Pilot Randomized Controlled Trial

The purpose of this study was to develop and explore the feasibility of audio-based (ACBT) and computer-based (CCBT) cognitive behavioral therapies for older adults with depressive symptoms. The audio program consisted of 8 compact discs and a workbook while the computer program consisted of 11 modules of similar duration provided on a tablet PC. Both interventions consisted of the following topics: identifying and changing unhelpful thoughts, addressing feelings, relaxation, engaging in pleasant events, assertiveness, and problem-solving. Fifty-one older adults were recruited from medical settings and rural communities. Participants were randomly assigned to immediate treatment (ACBT or CCBT) or delayed treatment control condition. Analyses were conducted to examine change on interviewer-based and self-reported depression. A significant interaction effect between time and condition was found on the interviewer-based depression scale. This suggests that both types of treatments decreased depressive symptoms over time when compared to a delayed treatment control. Computer-based and audio-based cognitive behavioral treatments may be valuable low-cost modalities to deliver psychotherapy to older adults with depressive symptoms.

Effect of individualized social activities on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility

Objectives: The study examined the effect of an individualized social activities intervention (ISAI) on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility. Method: This randomized control trial consisted of 52 older adults (M = 70.63, SD = 5.62) with mild to moderate cognitive impairment in a geriatric inpatient psychiatry facility. A 2 (group condition) × 2 (time of measurement) design was used to compare the control (treatment-as-usual) and intervention (treatment-as-usual plus ISAI) conditions at pre- and post-treatment. ISAI consisted of 30- to 60-minute sessions for up to 15 consecutive days. The Dementia Quality of Life instrument and Neurobehavioral Rating Scale – Revised were used to examine quality of life and behavioral and psychological symptoms of dementia at pre- and post-treatment. Results: Intent-to-treat analyses indicated a significant time × group condition interaction on quality of life, with this effect remaining when only completer data were included. There was no evidence of a significant treatment effect on behavioral and psychological symptoms of dementia. Conclusion: Findings suggest that individualized social activities are a promising treatment for cognitively impaired geriatric inpatients.

Specific depressive symptoms predict remission to aripiprazole augmentation in late‐life treatment resistant depression

To identify which specific depressive symptoms predict remission to aripiprazole augmentation in late‐life treatment resistant depression.

Effect of insomnia treatments on depression: A systematic review and meta‐analysis

Insomnia is frequently co‐morbid with depression, with a bidirectional relationship between these disorders. There is evidence that insomnia‐specific interventions, such as cognitive behavioral therapy for insomnia, may lead to improvements in depression. The purpose of this systematic review and meta‐analysis is to determine whether treatment of insomnia leads to improved depression outcomes in individuals with both insomnia and depression.