Review Of Efficacy Research

After 16 sessions of CT, Mr. Z noticed a considerable decrease in depression and reported that he felt physically better; thus, he was able to engage in social activities he had been avoiding because of his disability and depression. In addition, he was able to provide his son with shelter, but he developed a plan to set limits on his son's behavior and the length of his stay. Through problem solving and behavioral rehearsal, Mr. Z was able to set appropriate limits that his son respected (much to Mr. Z's surprise). CT was a successful treatment for Mr. Z, particularly in the long run. One year after treatment, Mr. Z wrote his therapist to tell her that he was using the cognitive strategies he had learned in treatment, and that he continued to feel happy, productive, and healthy.

The empirical evidence for treatment in older populations is broad, including several small trials, larger randomized clinical studies, and case examples. Recent evidence from the literature suggests that Mr. Z's experience with CT is a common reaction for a majority of older adults treated with this intervention. Not only is there a reduction in depressive symptoms, but patients also report improved health and functioning, and a greater purpose in life. A number of reviews are available in the CT literature on late life depression, and three meta-analyses have been based upon this literature (Engels & Vermey, 1997; Pinquart & Sorensen, 2001; Scogin & McElreath, 1994). For instance, Koder, Brodaty, and Anstey (1996) examined the literature from 1981 to 1994 and reviewed seven empirical examinations of CT in older depressed adults. These studies included comparisons to other types of therapy (e.g., psychotherapy, pharmacotherapy), and the authors computed effect sizes for four of these studies. Results indicated that CT was more effective than psychodynamic therapy, behavioral therapy, and waiting-list control in pre- posttreatment self-reported depression with the BDI (Koder et al., 1996).

In a more recent review, Mackin and Arean (2005) reviewed evidenced-based psychotherapies in older adults with late-life depression, covering the time period of 1840 to 2005. The authors found only 17 studies that met the criteria for an empirically supported treatment using the Chambless and Hollon (1998) criteria, which requires that there be at least 30 participants per treatment arm in the study, and that the intervention be compared to a gold standard, care as usual, or a waiting-list control. Of these, 10 studies evaluated CT in older adults with major depressive disorder, minor depression, or dysthymia. The authors concluded that for all reviewed studies, cognitive therapy resulted in better depression outcomes than did usual care, wait list control, no treatment, and placebo. In addition, several reviews found supporting evidence that treatment gains are maintained over time, for as long as 1-year posttreatment termination (e.g., Koder et al., 1996; Thompson, Coon, Gallagher-Thompson, Sommer, & Koin, 2001), concluding that CT is an evidence-based method for treating late-life depression.

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