Life-review therapy with computer supplements for depression in the elderly: A randomized controlled trial

a Department of Psychopathology and Clinical Intervention , University of Zurich , Zurich , Switzerland.
Aging and Mental Health (Impact Factor: 1.75). 07/2012; 16(8):964-74. DOI: 10.1080/13607863.2012.702726
Source: PubMed


Life-review therapy has been recognized as an effective therapeutic approach for depression in older adults. Additionally, the use of new media is becoming increasingly common in psychological interventions. The aim of this study was to investigate a life-review therapy in a face-to-face setting with additional computer use. This study explored whether a six-week life-review therapy with computer supplements from the e-mental health Butler system constitutes an effective approach to treat depression in older adults aged 65 and over. A total of 36 participants with elevated levels of depressive symptoms were randomized to a treatment group or a waiting-list control group and completed the post-assessment. Fourteen individuals in the intervention group completed the follow-up assessment. Analyses revealed significant changes from pre- to post-treatment or follow-up for depression, well-being, self-esteem, and obsessive reminiscence, but not for integrative reminiscence and life satisfaction. Depressive symptoms decreased significantly over time until the three-month follow-up in the intervention group compared to the control group (pre to post: d = 1.13; pre to follow-up: d = 1.27; and group × time effect pre to post: d = 0.72). Furthermore, the therapy led to an increase in well-being and a decrease in obsessive reminiscence among the participants in the intervention group from pre-treatment to follow-up (well-being: d = 0.70; obsessive reminiscence: d = 0.93). Analyses further revealed a significant but small group × time effect regarding self-esteem (d = 0.19). By and large, the results indicate that the life-review therapy in this combined setting could be recommended for depressive older adults.

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Available from: Cristina Botella, Jan 01, 2014
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    • "Furthermore, well-being increased and obsessive reminiscence decreased, the latter indicating that intrusive memory processes constitute an effective treatment goal (Preschl et al., 2012). "
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    ABSTRACT: Life-review interventions (LRI) are psychotherapeutic techniques originally derived from gerontology, which can be distinguished from other biographical and reminiscing techniques. They have been systematically implemented and investigated not only in elderly clients with depression, cognitive decline, in oncology units and in hospices but also in adolescents with various mental problems. LRI are mainly based on the elaboration of the autobiographical memory as well as on personal identity consolidation. This bears the potential for the systematic introduction, use, and evaluation of LRI within the field of psychotraumatology. This article gives a general overview and outlines a structured LRI by means of a case example of a World War II-traumatised patient. Other applications and implementations of LRI in psychotraumatology and other related areas are presented. So far, only uncontrolled or controlled LRI case studies have been investigated with traumatized samples. The importance of further randomized controlled studies is emphasized.
    European Journal of Psychotraumatology 05/2013; 4. DOI:10.3402/ejpt.v4i0.19720 · 2.40 Impact Factor
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    ABSTRACT: In the past decade, a large body of research has demonstrated that internet-based interventions can have beneficial effects on depression. However, only a few clinical trials have compared internet-based depression therapy with an equivalent face-to-face treatment. The primary aim of this study was to compare treatment outcomes of an internet-based intervention with a face-to-face intervention for depression in a randomized non-inferiority trial. A total of 62 participants suffering from depression were randomly assigned to the therapist-supported internet-based intervention group (n=32) and to the face-to-face intervention (n=30). The 8 week interventions were based on cognitive-behavioral therapy principles. Patients in both groups received the same treatment modules in the same chronological order and time-frame. Primary outcome measure was the Beck Depression Inventory-II (BDI-II); secondary outcome variables were suicidal ideation, anxiety, hopelessness and automatic thoughts. The intention-to-treat analysis yielded no significant between-group difference (online vs. face-to-face group) for any of the pre- to post-treatment measurements. At post-treatment both treatment conditions revealed significant symptom changes compared to before the intervention. Within group effect sizes for depression in the online group (d=1.27) and the face-to-face group (d=1.37) can be considered large. At 3-month follow-up, results in the online group remained stable. In contrast to this, participants in the face-to-face group showed significantly worsened depressive symptoms three months after termination of treatment (t=-2.05, df=19, p<.05). Due to the small sample size, it will be important to evaluate these outcomes in adequately-powered trials. This study shows that an internet-based intervention for depression is equally beneficial to regular face-to-face therapy. However, more long term efficacy, indicated by continued symptom reduction three months after treatment, could be only be found for the online group.
    Journal of Affective Disorders 07/2013; 152(1). DOI:10.1016/j.jad.2013.06.032 · 3.38 Impact Factor
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    ABSTRACT: The effectiveness of psychotherapeutic interventions for elderly persons questioned number of researchers and practitioners, both in the context of treatment of mental disorders and preparation and acceptance of death. Since the seminal work of Butler in 1963 on the role of the reminiscence on successful aging, life review therapy becomes a very popular tool in the modern psychogerontology. The growing interest in the reminiscence is due to the universality of the mental activity of reminiscing. Indeed, as a natural phenomenon for all individual, reminiscence involves recollecting and remembering events personally experienced in the past. Reminiscence activities are often used spontaneously to share memories. The functions of the reminiscence are now well known and well documented. However, life review, besides the fact that it also refers to the evocation of personal past events, involves the analysis of these personal memorabilia. It is rather a dynamic process of looking back at one's life and reinterpretation of one's existence. It allows older people to assign value and meaning to one's life. Thus life review needs the presence of a therapist. Although, research on the uses of the life review among the elderly reveals its important potential for the promotion of the psychological adjustment (e.g., subjective well being, mood, ego integrity), additional studies are needed to determine the effectiveness of this psychotherapeutic function and its universality. The objective of this research was to evaluate the efficacy of the life review on depression and psychological well-being in the elderly by conducting a randomized controlled trial. Thus, 13 voluntary participants were randomly assigned to the life review group (n = 15) and the control group (n = 15, mean age = 83.47, S.D. = 7.57). However, only 11 participants completed the whole life review program (n = 11, mean age = 79.27, S.D. = 13.67). The inclusion criterion was participants with a score equal or above 24 in the Mini-Mental State (MMSE). The two groups were similar with regard to the age, educational level and mini-mental state scores. The life review program consisted of sixteen 90-minute sessions. All the five senses were stimulated by different materials to facilitate the emergence of autobiographical memories. Also, we used La Fontaine's Fables to stimulate remembrance. All life cycle stages were covered. Measurement instruments used in pre-program and post-program included the Geriatric Depression Scale (it is a 15-item scale), the Rosenberg Self-esteem Scale (it is a 10-item scale), The Death Anxiety Scale (it is a 5-item scale), the Ego Integrity Scale (it is a 10-item scale), the Satisfaction with Life Scale (it is a 5-item scale) and the Affect Balance Scale (it is a 10-item scale). Repeated measures analysis of variance (along with power analyses) revealed significant difference between the two groups in the change in scores for depression indicating that those in the intervention group had profited from the life review activities. On the other hand, no differences were found in the changes in scores for life satisfaction, self-esteem, death anxiety, ego integrity, and affect balance. These findings are in line with previous randomized, controlled studies evaluating the effectiveness of life review therapy. However, the modest sample size in the present study may have played a role in limiting the significance of some of the statistical comparisons performed. Thus, further research is needed to assess its long-term effects.
    Journal de Thérapie Comportementale et Cognitive 03/2014; 24(1). DOI:10.1016/j.jtcc.2014.01.001
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