Skip to main content
PMC home page
American Journal of Alzheimer's Disease and Other Dementias logoLink to American Journal of Alzheimer's Disease and Other Dementias
. 2008 Dec;23(6):528–539. doi: 10.1177/1533317508323571

Group, Individual, and Staff Therapy: An Efficient and Effective Cognitive Behavioral Therapy in Long-Term Care

Lee Hyer 1, Catherine A Yeager 2, Nathan Hilton 3, Amanda Sacks 4
PMCID: PMC10846160  PMID: 19001352

Abstract

Objective. Depression is a major problem in long-term care (LTC) as is the lack of related empirically supported psychological treatments. This small study addressed a variant of cognitive behavioral therapy, GIST (group, individual, and staff therapy), against treatment as usual (TAU) in long-term care.

Method. 25 residents with depression were randomized to GIST (n = 13) or TAU (n = 12). Outcome measures included geriatric depression scale-short form (GDS-S), life satisfaction index Z (LSI-Z), and subjective ratings of treatment satisfaction. The GIST group participated in 15 group sessions. TAU crossed over to GIST at the end of the treatment trial.

Results. There were significant differences between GIST and TAU in favor of GIST on the GDS-S and LSI-Z. The GIST group maintained improvements over another 14 sessions. After crossover to GIST, TAU members showed significant improvement from baseline. Participants also reported high subjective ratings of treatment satisfaction. Discussion. This trial demonstrated GIST to be more effective for depression in LTC than standard treatments.

Keywords: behavior therapy, clinical trial, group therapy, long-term care, aging and depression, dementia, depression treatment

Full Text

The Full Text of this article is available as a PDF (222.8 KB).

Contributor Information

Lee Hyer, Georgia Neurosurgical Institute, Macon, Georgia, Robert Wood Johnson Medical School, Piscataway, New Jersey.

Catherine A. Yeager, Essex County Hospital Center, Institute for Mental Health Policy, Research, and Treatment, Cedar Grove, New Jersey, yeager.catherine@gmail.com, Robert Wood Johnson Medical School, Piscataway, New Jersey.

Nathan Hilton, Rutgers University, Robert Wood Johnson Medical School, Piscataway, New Jersey.

Amanda Sacks, Robert Wood Johnson Medical School, Piscataway, New Jersey.

References

  1. Hyer L., Blazer D. Depression in long term care facilities. In: Blazer D, ed. Depression in Later Life. St Louis, MO: Mosby; 1982:268-295. [Google Scholar]
  2. Duffy M., Karlin B. Treating depression in older adults: beyond the medical model. In: Hyer L, Intrieri R, eds. Geropsychological Interventions in Long Term Care. New York, NY: Springer; 2006:109-135. [Google Scholar]
  3. Hyer L., Intrieri R. Geropsychological Interventions in Long Term Care. New York, NY: Springer; 2006. [Google Scholar]
  4. Blazer DG Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci. 2003;58:249-265. [DOI] [PubMed] [Google Scholar]
  5. Gallo JJ, Lebowitz BD The epidemiology of common late-life mental disorders in the community: themes for the new century. Psychiatr Serv. 1999;50:1158-1166. [DOI] [PubMed] [Google Scholar]
  6. Parmelee P., Katz IR, Lawton MP Depression among institutionalized aged: assessment and prevalence estimation . J Gerontol. 1989;44:M22-M29. [DOI] [PubMed] [Google Scholar]
  7. Payne JL, Sheppard JM, Steinberg M., et al. Incidence, prevalence, and outcomes of depression in residents of a long-term care facility with dementia. Int J Geriatr Psychiatry. 2002;17:247-253. [DOI] [PubMed] [Google Scholar]
  8. Teresi J., Abrams R., Holmes D., Ramirez M., Eimicke J. Prevalence of depression and depression recognition in nursing homes . Soc Psychiatry Psychiatr Epidemiol. 2001. ;36:613-620. [DOI] [PubMed] [Google Scholar]
  9. Lyketsos CG, Steinberg M., Tschanz JT, Norton MC, Steffens DC, Breiter JC Mental and behavioral disturbances in dementia: findings from the Cache County study of memory in aging. Am J Psychiatry. 2000;157:708-714. [DOI] [PubMed] [Google Scholar]
  10. Starkstein SE, Jorge R., Mizrahi R., Robinson RG The construct of minor and major depression in Alzheimer's disease. Am J Psychiatry. 2005. ;162:2086-2093. [DOI] [PubMed] [Google Scholar]
  11. Devanand DP, Sano M., Tang MX, et al. Depressed mood and the incidence of Alzheimer's disease in the elderly living in the community. Arch Gen Psychiatry. 1996;53: 175-182. [DOI] [PubMed] [Google Scholar]
  12. Wragg RE, Jeste DV Overview of depression and psychosis in Alzheimer's disease. Am J Psychiatry. 1989;146: 577-587. [DOI] [PubMed] [Google Scholar]
  13. Wells KB, Golding JM, Burnam MA Chronic medical conditions in a sample of the general population with anxiety, affective, and substance use disorders. Am J Psychiatry . 1989;146:1440-1446. [DOI] [PubMed] [Google Scholar]
  14. Gabrel C. Characteristics of elderly nursing home current residents and discharges: Data from the 1997 National Nursing Home Survey. Advance data from vital and health statistics no. 312. Hyattsville, MD: National Center for Health Statistics; 2000. . [PubMed] [Google Scholar]
  15. Ruckdeschel K., Thompson R., Datto CJ, Streim JE, Katz IR Using the minimum data set 2.0 mood disturbance items as a self-report screening instrument for depression in nursing home residents. Am J Geriatr Psychiatry . 2004;12:43-49. [PubMed] [Google Scholar]
  16. Mitnitski AB , Song X., Rockwood K. The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. J Gerontol A Biol Sci Med Sci. 2004;59:M627-M632. [DOI] [PubMed] [Google Scholar]
  17. Murphy CF, Alexopoulos GS Longitudinal association of initiation/perseveration and severity of geriatric depression. Am J Geriatr Psychiatry. 2004;12:50-56. [PubMed] [Google Scholar]
  18. Parmelee PA , Katz IR, Lawton MP The relation of pain to depression among institutionalized aged. J Gerontol. 1991;46:P15-P21. [DOI] [PubMed] [Google Scholar]
  19. Parmelee PA , Katz IR, Lawton MP Incidence of depression in long-term care settings. J Gerontol. 1992;47: M189-M196. [DOI] [PubMed] [Google Scholar]
  20. Cohen CI, Hyland K., Kimhy D. The utility of mandatory depression screening of dementia patients in nursing homes. Am J Psychiatry. 2003;160:2012-2017. [DOI] [PubMed] [Google Scholar]
  21. Lichtenberg P., Duffy M. Psychological assessment and psychotherapy in long-term care. Clin Psychol Sci Pract. 2000;7:317-328. [Google Scholar]
  22. Meeks S., Depp C. Pleasant events-based behavioral intervention for depression in nursing home residents: a conceptual and empirical framework. Clin Gerontol . 2002;25:125-48. [Google Scholar]
  23. Spayd C., Smyer M. Psychological interventions in nursing homes. A Guide to Psychotherapy and Aging: Effective Clinical Interventions in a Life-stage Context. In: Zarit S, Knight B, eds. Washington, DC: American Psychological Association; 1996:241-268. [Google Scholar]
  24. Scogin F., McElreath L. Efficacy of psychosocial treatments for geriatric depression: a quantitative review. J Consult Clin Psychol. 1994;62:69-74. [DOI] [PubMed] [Google Scholar]
  25. Pinquart M. , Sorensen S. How effective are psychotherapeutic and other psychosocial interventions with older adults? A meta-analysis. J Aging Ment Health. 2001;7: 207-243. [Google Scholar]
  26. Engels G., Vermey M. Efficacy of nonmedical treatments of depression in elders: a qualitative analysis . J Clin Geropsychol. 1997;3:17-35. [Google Scholar]
  27. Gatz M., Fiske A., Fox L., et al. Empirically validated psychological treatments for older adults . J Ment Health Aging. 1998;4:9-46. [Google Scholar]
  28. Scogin F., Welsh D., Hanson A., Stump J., Coates A. Evidence-based psychotherapies for depression in older adults. Clin Psychol Sci Pract. 2005;12:222-237. [Google Scholar]
  29. Pinquart M. , Duberstein PR, Lyness JM Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy . Am J Psychiatry. 2006;163:1493-1501. [DOI] [PubMed] [Google Scholar]
  30. Brodaty H., Gresham M. Prescribing residential respite care for dementia: effects, side-effects, indications and dosage. Int J Geriatr Psychiatry. 2003;7:357-362. [Google Scholar]
  31. Gatz M. Commentary on evidence-based psychological treatments for older adults . Psychol Aging. 2007;22:52-55. [DOI] [PubMed] [Google Scholar]
  32. Chambless D. , Ollendick T. Empirically supported psychological interventions: controversies and evidence. Annu Rev Psychol . 2001;52:685-716. [DOI] [PubMed] [Google Scholar]
  33. Grant RW, Casey D. Adapting cognitive behavioral therapy for the frail elderly. Int Psychogeriatr. 1995;7:561-571. [DOI] [PubMed] [Google Scholar]
  34. Scazufca M. , Matsuda C. Review of the efficacy of psychotherapy vs. pharmacotherapy for depression treatment in old age. Rev Bras Psiquiatr. 2002;24:64-69. [Google Scholar]
  35. Arean PA, Cook BL Psychotherapy and combined psychotherapy/pharmacotherapy for late life depression . Biol Psychiatry. 2002;52:293-303. [DOI] [PubMed] [Google Scholar]
  36. Beutler LE, Scogin F., Kirkish P., et al. Group cognitive therapy and alprazolam in the treatment of depression in older adults. J Consult Clin Psychol. 1987. ;55:550-556. [DOI] [PubMed] [Google Scholar]
  37. Reynolds C. , Frank E., Houck P., et al. Which elderly patients with remitted depression remain well with continued interpersonal psychotherapy after discontinuation of antidepressant medication? Am J Psychiatry. 1997;54:958-962. [DOI] [PubMed] [Google Scholar]
  38. Thompson L. , Coon D., Gallagher-Thompson D., Sommer B., Koin D. Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression. Am J Geriatr Psychiatry. 2001;9:225-240. [PubMed] [Google Scholar]
  39. Shah S., Reichman W. Psychiatric intervention in long-term care. Geropsychological Interventions in Long Term Care. In: Hyer L, Intrieri R, eds. New York, NY: Springer; 2006:85-107. [Google Scholar]
  40. Datto C., Katz I. Specificity of antidepressants in the nursing home setting. The American Association for Geriatric Psychiatry 15th Annual Meeting; Orlando, FL; 2002. [Google Scholar]
  41. Hyer L., Carpenter B., Bischmann D., Wu H. Depression in long term care. Clin Psychol Sci Pract . 2006;12:280-299. [Google Scholar]
  42. Lewinsohn P. , Weinstein M., Alper T. A behavioral approach to the group treatment of depressed persons: a methodological contribution . J Clin Psychol. 1970;26: 525-532. [DOI] [PubMed] [Google Scholar]
  43. Teri L., McKenzie G., LaFazia D. Psychosocial treatment of depression in older adults with dementia . Clin Psychol Sci Pract. 2006;12:303-316. [Google Scholar]
  44. Snow L., Powers D., Liles D. Cognitive-behavioral therapy for long-term care patients with dementia . In: Hyer L, Intrieri R, eds. Geropsychological Interventions in Long Term Care. New York, NY: Springer; ; 2006:265-293. [Google Scholar]
  45. Teri L., Logsdon R., Peskind E., et al. Treatment of agitation in AD: a randomized, placebo-controlled clinical trial. Neurology. 2000;55:1271-1278. [DOI] [PubMed] [Google Scholar]
  46. Teri L., Umoto J. Reducing excess disability in dementia patients: training caregivers to manage patient depression. Clin Gerontol. 1991;31:49-63. [Google Scholar]
  47. Burgio L., Allen-Burge R., Roth D., et al. Come talk with me: improving communication between nursing assistants and nursing home residents during care routines. Gerontologist . 2001;41:449-460. [DOI] [PubMed] [Google Scholar]
  48. Burgio L., Stevens A. Behavioral interventions in the nursing home: motivating staff to apply a therapeutic model of care. In: Schulz R, Maddox G, Lawton M, eds. Annual Review of Gerontology and Geriatrics . New York, NY: Springer Publishing; 1999. [Google Scholar]
  49. Feil N. Current concepts and techniques in validation therapy. In: Duffy M, ed. Handbook of Counseling and Psychotherapy With Older Adults. New York, NY: John Wiley & Sons; 1999:590-613. [Google Scholar]
  50. Camp C., McKitrick L. Memory interventions in Alzheimer's-type dementia populations: methodological and theoretical issues. In: West R, Sinnott J, eds. Everyday Memory and Aging: Current Research and Methodology. New York, NY: Springer-Verlag; 1992:155-172. [Google Scholar]
  51. Coon D., Thompson L., Steffen A., Sorocco K., Gallagher-Thompson D. Anger and depression management: psychoeducational skill training for women caregivers of a relative with dementia. Gerontologist . 2003;43:678-689. [DOI] [PubMed] [Google Scholar]
  52. Moniz-Cook E., Agar S., Gibson G., Win T., Wang M. A preliminary study of the effects of early intervention with people with dementia and their families in a memory clinic . Aging Ment Health. 1998. ;2:199-211. [Google Scholar]
  53. Sifton C. Navigating the Alzheimer's Journey: A Compass for Caregiving. Baltimore, MD: Health Professions Press; ; 2004. [Google Scholar]
  54. Volicer L., Hurley A. Management of behavioral symptoms in progressive degenerative dementias . J Gerontol A Biol Sci Med Sci. 2003;58:M837-M845. [DOI] [PubMed] [Google Scholar]
  55. Doubleday E. , King P., Papageorgiou C. Relationship between fluid intelligence and ability to benefit from cognitive-behavioural therapy in older adults: a preliminary investigation. Br J Clin Psychol. 2002;41:423-428. [DOI] [PubMed] [Google Scholar]
  56. Gallagher D. , Thompson L. Effectiveness of psychotherapy for both endogenous and nonendogenous depression in older adult outpatients . J Gerontol. 1983;38:707-712. [DOI] [PubMed] [Google Scholar]
  57. Leung S., Orrell M. A brief cognitive behavioural therapy group for the elderly: who benefits ? Int J Geriatr Psychiatry. 1993;8:593-598. [Google Scholar]
  58. Thompson L. , Gallagher D., Czirr R. Personality disorder and outcome in the treatment of late-life depression. J Geriatr Psychiatry. 1988;21:133-146. [PubMed] [Google Scholar]
  59. Teri L., Lewinsohn P. Modification of the pleasant and unpleasant events schedules for use with the elderly. J Consult Clin Psychol. 1982;50:444-445. [DOI] [PubMed] [Google Scholar]
  60. Kennedy G. Geriatric Mental Health Care: A Treatment Guide for Health Professionals . New York, NY: The Guilford Press; ; 2000. [Google Scholar]
  61. Friedman M. , Cardemil E., Gollan J., Uebelacker L., Miller I. The GIFT program for major depression. Cogn Behav Pract. 2003. ;10:157-168. [Google Scholar]
  62. Dubbert P. Physical activity and exercise: recent advances and current challenges . J Consult Clin Psychol. 2002;70:526-536. [PubMed] [Google Scholar]
  63. Brown R., Lewinsohn P. A psychoeducational approach to the treatment of depression: comparison of group, individual, and minimal contact procedures. J Consult Clin Psychol. 1984;52:774-783. [DOI] [PubMed] [Google Scholar]
  64. Jacobson N. , Dobson K., Truax P., et al. A component analysis of cognitive-behavioral treatment for depression. J Consult Clin Psychol. 1996;64:295-304. [DOI] [PubMed] [Google Scholar]
  65. Nezu A., Peri M. Social problem-solving therapy for unipolar depression: an initial dismantling investigation. J Consult Clin Psychol. 1989. ;57:408-413. [PubMed] [Google Scholar]
  66. Nezu A. Efficacy of a social problem-solving therapy approach for unipolar depression . J Consult Clin Psychol. 1986;54:196-202. [DOI] [PubMed] [Google Scholar]
  67. Vitaliano P. , Young H., Russo J., Romano J., Magana-Amato A. Does expressed emotion in spouses predict subsequent problems among care recipients with Alzheimer's disease? J Gerontol. 1993;48:202-209. [DOI] [PubMed] [Google Scholar]
  68. Beck A., Rush A., Shaw B., Emery G. Cognitive Therapy of Depression. New York, NY: The Guilford Press; 1979. [Google Scholar]
  69. France D., Dugo J. Pretherapy orientation as preparation for open psychotherapy groups. Psychother Theory, Res Pract Train. 1985;22:256-261. [Google Scholar]
  70. Zlotnick C. , Shea M., Rosen K., et al. An affect-management group for women with posttraumatic stress disorder and histories of childhood sexual abuse . J Trauma Stress. 1997;10:425-436. [DOI] [PubMed] [Google Scholar]
  71. Coyne J. Depression and the response of others. J Abnorm Psychol . 1976;85:186-193. [DOI] [PubMed] [Google Scholar]
  72. Keitner G., Miller I. Family functioning and major depression: an overview. Am J Psychiatry. 1990;147: 1128-1137. [DOI] [PubMed] [Google Scholar]
  73. Lesher E., Berryhill J. Validation of the geriatric depression scale-short form among inpatients . J Clin Psychol. 1994;50:256-260. [DOI] [PubMed] [Google Scholar]
  74. Neugarten B. Personality in Middle and Later Life. New York, NY: Atherton Press; 1964. . [Google Scholar]
  75. Folstein M. , Folstein S., McHugh P. ``Mini-mental state.'' A practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res. 1975;12: 189-198. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Alzheimer's Disease and Other Dementias are provided here courtesy of SAGE Publications

RESOURCES