Does age matter? Initial treatment goals of older adults with major depression in outpatient cognitive behavioural therapy.

BACKGROUND: Personal treatment goals (PTG) are important means to tailor psychotherapy to the needs of the patient, leading to increased engagement and greater improvement in relevant outcomes. According to lifespan developmental research, motivational goals in old age differ from goals of younger people, with management of losses rather than growth becoming more prevalent. However, this study is the first to systematically investigate age-specific differences in PTGs. METHOD: We used routine data from patients with major depression assessed at the beginning of outpatient cognitive behavioural therapy. Initial high-priority PTGs were assessed using the Bern Inventory of Treatment Goals (BIT-C). Older patients (≥60 years, n = 52) were matched to younger patients (<60 years, n = 52) with regard to severity of depression, number of comorbidities, gender and level of education. RESULTS: Using a mixed method approach, high-priority PTGs of both age groups were focused most strongly on reducing depressive symptoms and, subsequently, anxiety. At the same time, older patients focused more strongly on PTGs related to well-being and functioning, while younger patients' emphasis was on personal growth. Furthermore, better coping with the ageing process and physical losses emerged as important PTGs for some older patients. CONCLUSION: Initial PTG themes are specific to diagnosis, but also seem to differ in regard to age. Thus, it is important to develop age-sensitive measures that allow appropriate and efficient tailoring of psychotherapy to meet older patients' needs and preferences.

Long-term effects of telephone-based cognitive-behavioral intervention for family caregivers of people with dementia: Findings at 3-year follow-up.

INTRODUCTION: Long-term outcomes are of particular importance in evaluating interventions for family caregivers of people with dementia (PwD). So far, evidence for long-term effects (>6 months postintervention) is limited to four interventions. OBJECTIVE: We examined the long-term effects of Tele.TAnDem, a telephone-based cognitive-behavioral therapy (CBT) intervention, on a variety of outcomes at 3-year follow-up, the longest follow-up of any intervention study for caregivers of PwD (without continuous support). METHODS: Caregivers of PwD were randomly assigned to receive Tele.TAnDem consisting of 12 sessions over 6 months (intervention group [IG]) or usual care (control group [CG]). At 3-year follow-up (i.e., 2.5 years postintervention), 29 caregivers in the IG and 22 caregivers in the CG were still caring at home for a PwD. RESULTS: Caregivers in the IG reported significantly lower caregiver burden and higher quality of life regarding social relationships. CONCLUSIONS: Tele.TAnDem is successful in buffering detrimental effects of caregiving on caregiver burden and social relationships in the long term. The small- to medium-sized effects lie in the range of effect sizes reported in the few previous investigations. The findings add to the scant evidence that interventions yielding long-term outcomes have to date mostly been multicomponent interventions based on CBT principles with structured techniques and at least seven sessions over more than 2 months. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Movement and Emotional Facial Expressions during the Adult Attachment Interview: Interaction Effects of Attachment and Anxiety Disorder.

INTRODUCTION: Adult attachment is commonly associated with emotion regulation. Less is known about the nonverbal embodiment of adult attachment. OBJECTIVE: We hypothesized that dismissing attachment is related to less movement and fewer facial expressions of emotions, whereas preoccupied attachment is associated with more negative emotional facial expressions. Moreover, the interaction of attachment and the presence of an anxiety disorder (AD) was explored. METHODS: The sample included 95 individuals, 21 with AD without comorbidity, 21 with AD and comorbid major depression (AD-CD), and 53 healthy controls. We analyzed nonverbal behavior during a part of the Adult Attachment Interview (AAI) asking about the family and parental figures. The movements of the interviewees were captured via Motion Energy Analysis. Facial expressions were coded according to the Facial Action Coding System using the OpenFace software. We compared individuals with secure, dismissing, and preoccupied states of mind (assessed with the AAI) with regard to the frequency and complexity of movements and the frequency of the facial expressions such as happy, sad, and contemptuous. RESULTS: As expected, dismissingly attached individuals moved less often and with lower complexity than securely attached. For emotional facial expressions, a main effect of the disorder group and interaction effects of attachment by disorder were found. In the AD-CD group, dismissingly attached patients showed comparatively fewer happy facial expressions than securely attached individuals. CONCLUSIONS: Reduced movement specifically seems to be related to dismissing attachment when interviewees talk about significant parental figures. Facial expressions of emotions related to attachment occurred when maladaptive emotion regulation strategies were intensified by a psychological disorder.

Psychobiological mechanisms underlying the health-beneficial effects of music in people living with dementia: A systematic review of the literature.

BACKGROUND: Music has been used as agent in medicine for decades. The applications of music in health span from music therapy to music listening interventions to mere music listening. Music may reduce stress and improve health in people living with dementia (PwD), but the exact underpinnings of these effects are unclear. It is proposed that beneficial effects of music are mediated by a reduction in psychobiological stress. Therefore, the present review aims to shed light on the potential psychobiological mechanisms underlying the health-beneficial effects of music in PwD. METHODS: We searched for studies investigating health-beneficial effects of music in PwD by means of psychobiological stress measures using the PubMed, PsycINFO and Web of Science databases and by hand-searching. RESULTS: The inclusion criteria were met by 12 studies. Seven of the included studies investigated effects of music therapy on the autonomic nervous system (ANS), the hypothalamic-pituitary-adrenal (HPA) axis or the immune system in patients with mild to moderate dementia. Results showed decreased ANS activity as measured by heart rate variability but no effect on alpha-amylase. Effects on blood pressure were mixed. Concerning the secretion of cortisol, one study found decreased HPA axis activity whereas two studies found no significant effects. No effects were found on salivary immunoglobin A. Three studies investigated the effects of music listening interventions in patients with severe dementia by means of predominantly ANS parameters with evidence indicating increased parasympathetic activation after music listening. Two studies investigated the effects of mere music listening on skin conductance using experimental designs. One study found increases in arousal due to music listening, whereas the other study found no effect. DISCUSSION AND CONCLUSION: These very preliminary results indicate effects of music on central stress pathways in PwD, but also highlight the need for further research focussing on a comprehensive assessment of autonomic, endocrine and immunological parameters in response to music. Furthermore, future studies should directly compare music therapy to music listening interventions and mere music listening in samples of PwD of varying disease severity and varying care settings.

[Quality of sleep in caregiving relatives of people with dementia: investigation of the prevalence and possible predictors]. / Wie gut schlafen pflegende Angehörige von Menschen mit Demenz? Eine Untersuchung der Prävalenz und möglicher Prädiktoren.

BACKGROUND: Caregiving relatives of people with dementia (PwD) are exposed to exhausting tasks all day long. The results of a current study suggest that personality traits, sociodemographic and caregiving variables could be associated with poor sleep quality of caregivers of PwD. Nevertheless, the detailed impact of these variables on sleep quality of caregivers is still unknown. METHOD: This study is based on secondary data from the Tele.TAnDem project. First, descriptive data of 322 caregivers were analyzed regarding prevalence rates of poor sleep quality and high rates of daytime sleepiness in comparison to non-caregivers. Second, hierarchical regression analyses were conducted to calculate the predictive effect of interpersonal and caregiving related variables on subjective sleep quality and daytime sleepiness. RESULTS: With respect to the prevalence, descriptive data indicate a poorer subjective sleep quality and higher rates of daytime sleepiness of caregivers of PwD compared to non-caregivers. Regression analyses revealed significant effects for gender, disturbed day-night rhythm, burden of caregiving, stress coping strategies and depressive symptoms regarding subjective sleep quality. The number of disturbed behavior patterns, the burden of caregiving and depressive symptoms were significantly associated with higher rates of daytime sleepiness. CONCLUSION: Caregiving of PwD affects subjective sleep quality as well as daytime sleepiness of caregiving relatives. Both dimensions of sleep quality were associated with several personal and caregiving related variables. Chronic poor sleep quality is a high-risk factor for psychological and physical health problems and should be considered in further research and development of interventions for caregiving relatives of PwD.