Category: Aging and Older Adults

Symposium

Engage: A Streamlined Psychotherapy for Late-Life Depression

Friday, November 17
10:15 AM - 11:45 AM
Location: Cobalt 502, Level 5, Cobalt Level

Keywords: Aging / Older Adults | Depression | Service Delivery
Presentation Type: Symposium

Objective: The complexity of psychotherapies has been a barrier to community implementation.  We used the Research Domain Criteria consensus as a guide to develop Engage, a streamlined, neurobiology-based psychotherapy for late-life depression that may match the skill set of practicing clinicians. We present preliminary data comparing Engage to Problem Solving Therapy (PST) in training time to certification; reducing depressive symptoms and disability; and increasing behavioral activation.  We present the design of a fully powered RCT.


Methods: Engage is based on the theory that dysfunction in the positive valence systems fuels depression, and uses “reward exposure” (engagement in meaningful, rewarding activities) as its principal intervention. Engage targets expression of abnormalities reflecting negativity bias, apathy, and emotional dysregulation with simple interventions if they interfere with reward exposure. We provided open treatment with 9 weekly sessions of Engage to 39 older adults with major depression.  We compared course of depression (HAM-D) and disability (WHODAS) with those of a historical comparison group (N=97) treated with 9 weekly sessions of PST.


Results: Community social workers and research therapists required one third as much training time in Engage as in PST. Engage was non-inferior to PST in reducing HAM-D and WHODAS.  Remission rates were 41% for Engage and 35% for PST.  Change in behavioral activation scores predicted improvement of depressive symptoms for Engage subjects.


Conclusion: Findings suggest that Engage has comparable efficacy with PST in reducing depressive symptoms and disability, and support behavioral activation as a target mechanism.


Funding source: NIMH R01 MH102252 

Patrick Raue

Professor
University of Washington

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