Nancy L. McKendree-Smith

Cognitive Therapy for Depression: A Comparison of Individual Psychotherapy and Bibliotherapy for Depressed Older Adults

Thirty-one community-residing older adults age 60 or over either received 16 sessions of individual cognitive psychotherapy (Beck, Rush, Shaw, & Emery, 1979) or read Feeling Good (Burns, 1980) for bibliotherapy. Posttreatment comparisons with the delayed-treatment control indicated that both treatments were superior to a delayed-treatment control. Individual psychotherapy was superior to bibliotherapy at posttreatment on self-reported depression, but there were no differences on clinician-rated depression. Further, bibliotherapy participants continued to improve after posttreatment, and there were no differences between treatments at 3-month follow-up. Results suggest that bibliotherapy and that individual psychotherapy are both viable treatment options for depression in older adults.

Central nervous system mechanisms of pain in fibromyalgia and other musculoskeletal disorders: behavioral and psychologic treatment approaches.

Pain is one of the most important and challenging consequences of musculoskeletal disorders. This article examines the role of central nervous system structures in the physiology of pain. It also describes the neuromatrix, a construct that provides a framework for understanding the interaction between physiologic mechanisms and psychosocial factors in the development and maintenance of chronic pain. This construct suggests that behavioral and psychologic interventions may alter the pain experience primarily through their effects on emotional states and cognitive processes. The literature on cognitive-behavioral interventions for patients with rheumatoid arthritis and osteoarthritis indicates that they are well-established treatments for these disorders. However, the efficacy of these interventions for patients with fibromyalgia has not been established. It is anticipated that the development of valid measures of readiness for behavioral change may allow investigators to identify the patients with musculoskeletal disorders who are most likely to benefit from cognitive-behavioral intervention.

Cognitive-behavioral therapy interventions for pain associated with chronic illnesses

Abstract Cognitive-behavioral therapy (CBT) interventions are often used as adjunct treatments with standard medical care to help patients with chronic illnesses better manage their pain and distress or improve function. We review the primary assumptions and the four essential components that underlie all CBT interventions. We then examine the outcomes produced by CBT interventions for patients with two chronic illnesses for which the source of pain is well understood (rheumatoid arthritis and osteoarthritis of the knee) and three disorders characterized by “medically unexplained” pain and other symptoms (fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome). We employed American Psychological Association criteria for empirically validated treatments to evaluate the CBT intervention outcomes. Using these criteria, we conclude that CBT is a well-established adjunct treatment for patients with rheumatoid arthritis and is probably efficacious for patients with knee osteoarthritis, chronic fatigue syndrome, and irritable bowel syndrome. However, CBT interventions must be considered as an experimental therapy for patients with fibromyalgia. The negative findings associated with CBT for fibromyalgia may be due to several factors such as high levels of psychiatric morbidity or abnormal pain sensitivity among the patients. It is necessary for investigators to devote effort to identifying the factors that account for poor CBT outcomes and to modify current CBT protocols to address these factors.

Residual Geriatric Depression Symptoms: A Place for Psychotherapy

Geriatric depression is a relatively commonly occurring mental disorder. A subpopulation of depressed older adults are those who have engaged in or completed pharmacotherapy, yet continue to experience depressive symptoms. We review the prevalence, psychosocial effects, and treatment of residual symptoms of depression in older adults. Data from previous studies conducted by our group are presented to support our contention that residual symptoms of geriatric depression are treatable through psychosocial means.