The Effect of Social Support on Quality of Life in Older Adults Receiving Cognitive Behavioral Therapy.

The current study extends the findings of Scogin et al. (2007) by exploring the role of social support in changes in quality of life resulting from home-delivered cognitive behavioral therapy (CBT). One hundred thirty-seven participants, characterized primarily as rural, low resource, and frail, were randomly assigned to either CBT or a minimal support control condition. Hierarchical regression revealed that positive change in satisfaction with social support was associated with improvement in quality of life beyond the effects of the CBT treatment. In addition, pretreatment satisfaction with social support, and change in satisfaction with social support moderated the effect of CBT on quality of life. These results suggest that bolstering social support concomitant to CBT may increase quality of life.

NEW AND EMERGING PROFESSIONALS: Does Race Moderate Social Support and Psychological Distress Among Rural Older Adults?

Greater social support is associated with decreased psychological distress among older adults. Researchers have found racial differences in psychological distress. Might race moderate social support and psychological distress? The authors hypothesized African American collectivistic values could increase the importance of social support. Participants were rural adults aged 60 and older (N = 100). Multiple regression analyses controlled for health, income, education, and sex. Race moderated satisfaction with social support and psychological distress. However, greater satisfaction predicted less psychological distress among Caucasians while it was not associated with African Americans' distress in this sample. Achieving satisfaction with social support may be particularly important for Caucasians receiving therapy. Interventions may also address strategies to improve physical health, emotional support, and quality of social support, which significantly predicted psychological distress for both groups.

Treatment of depressive symptoms in diverse, rural, and vulnerable older adults.

BACKGROUND: We examined the effects of home-delivered cognitive-behavior therapy (CBT) on depressive symptoms among rural, diverse, and vulnerable older adults. Furthermore, we differentiated depression into its two salient aspects: psychological and somatic. METHOD: Data came from a randomized controlled experiment of CBT on 134 individuals residing in rural Alabama. RESULTS: Cognitive-behavior therapy resulted in significantly lower depressive symptom severity scores. When depressive symptoms were categorized as psychological or somatic, CBT was found to significantly improve the former but not the latter. Notably, there was a trend toward somatic symptom improvement. CONCLUSION: Cognitive-behavior therapy can be an effective treatment for depression in a hard-to-reach group of older adults. Home delivery affords advantages but is also an expensive delivery modality. Diverse older adults responded to the CBT intervention.

Evidence to Support the Pike's Peak Model: The UA Geropsychology Education Program.

The University of Alabama's Graduate Geropsychology Education program (GGE) was conceived and implemented in the years prior to the design of the Pike's Peak Model (PPM) of geropsychology training. The GGE program provides a unique opportunity to evaluate the PPM, and this paper outlines the GGE program in the framework of the model. Three primary goals defined the GGE program: recruitment and retention of students in the geropsychology program, a doctoral level interdisciplinary class, and a set of clinical rotations in urban and rural sites. Outcomes were promising, indicating that geropsychology students were able to provide services with positive outcomes to underserved older adults in primary care settings and in a legal clinic, students from several disciplines rated the course very highly, and psychology students indicated that they were likely to continue in the field of geriatric care. Participating students have gone on to careers in geropsychology. Findings from this program support the design of the Pike's Peak Model, and provide support for broader implementation of similar training programs.

Providing mental health services to older people living in rural communities.

Rural dwelling elders who experience mental health problems often have difficulty finding help since rural communities often lack adequate mental health service providers. This paper reports on the initial phase of a 5-year, interdisciplinary clinical research study that is testing the effectiveness of providing a home delivered, therapeutic psychosocial intervention, aimed at improving the emotional wellbeing and the quality of life of medically frail elders who live in rural communities. In the early phases of this study, the clinical research team encountered a number of interesting and often unanticipated challenges as it attempted to recruit study participants and provide services to them. In this article, we examine these challenges and share what we have learned so far about providing mental health services to elderly persons living in rural environments.

Self-administered treatments for depression: a review.

Although there are numerous self-help books for depression, relatively few have been empirically tested. However, those that have been used in clinical trials have fared well, with an average effect size roughly equivalent to the average effect size obtained in psychotherapy studies. Computer-based treatments are being developed and appear promising as an alternative to bibliotherapy for those interested in self-administered treatments. This article provides a summary of the depression bibliotherapy literature and discusses several remaining questions such as effectiveness versus efficacy, practice applications, ethics, and future research.

Self-administered treatment in stepped-care models of depression treatment.

Stepped behavioral health care models have begun to receive increased attention. Self-administered treatments deserve consideration as an element in these models for some disorders and for some consumers. Features suggesting inclusion include low cost, wide availability, and evidence-based status. We present a stepped-care model for depression inclusive of a self-administered treatment component. We also discuss cautions such as depression severity and consumer preference. Evaluation of the efficacy and cost effectiveness of this approach to depression treatment is necessary.

The effectiveness of self-administered treatments: a practice-friendly review of the research.

Self-administered treatments are a cost-effective way to treat a broad spectrum of people. This article focuses on the existing research of self-administered treatments and their effectiveness when integrated with ongoing practice or when implemented alone. Evidence for their effectiveness is mixed; self-help has been proven successful in the treatment of depression, mild alcohol abuse, and anxiety disorders. It has proven less successful for smoking cessation and moderate to severe alcohol abuse. When determining whether self-administered treatment is appropriate, individual characteristics and attitude as well as the nature and severity of the problem should be taken into consideration. In addition, because many self-help treatments have not been evaluated, caution should be exercised when implementing self-administered treatment, and progress should be carefully monitored.