THE EFFECT OF COGNITIVE-BEHAVIORAL THERAPY, THERAPIST COMPETENCY, AND GROUP PROCESS ON DEPRESSION AMONG THE ELDERLY.

Abstract

The major purpose of this study was to examine the relative effectiveness of cognitive-behavioral group psychotherapy in the treatment of unipolar depressed elderly outpatients as compared to a nontherapy control group experiencing minimal supportive treatment. In addition, it was designed to explore the possible effect of therapist competency and quality of group process on treatment benefit. A total of 56 older adults, age 65 or older, were randomly assigned to receive either an active anti-anxiety medication or a matched placebo drug. Medication was provided to subjects during a weekly, twenty minute clinical management session with a psychiatrist blinded to treatment. The cognitive-behavioral group treatment was conducted with four groups led by male-female co-therapist teams trained in this modality. The Hamilton Depression Scale and the Beck Depression Inventory were used as depression measures prior, during, at treatment end, and during follow-up. Samples of videotaped sessions were rated for therapist competency utilizing the Cognitive Therapy Scale and for group process utilizing the Hill Interaction Matrix-G. Analysis of variance with the combined cognitive-behavioral therapy group as compared to the nontherapy control group demonstrated significance (p < .05) over time for the cognitive-behavioral group on the Beck Depression Inventory but not the Hamilton Depression Scale. The lack of significance on this scale may be the result of its high somatic components which may cause it to be overreactive as an estimate of depression given the natural physiologic aging process of the elderly age group. A validational assessment examining selective attrition between the cognitive-behavioral group treatment and the nontherapy control group indicated that the control group experienced a statistically significant higher attrition rate which appeared to be the result of dissatisfaction due to poor clinical response. No determination of the effect of therapist team competency on depression can be reached due to the lack of variability displayed among groups. All therapist teams functioned at equivalent competency levels within the satisfactory to good range on the Cognitive Therapy Scale. No conclusions regarding the level of group process and its effect on depression can be reached, also due to lack of significant variability between groups. Recommendations are made to improve the present design of the study and to extend the scope of future research. (Abstract shortened with permission of author.)