Comparing Engage with PST in Late-Life Major Depression: A Preliminary Report
Open accessAbstract
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. This proof of concept study tested the hypotheses that Engage is bioequivalent to Problem Solving Therapy (PST) in reducing depressive symptoms, inducing remission, and ameliorating disability.Methods Engage assumes that abnormal function of the positive valence systems fuels depression and uses "reward exposure" (engagement in meaningful, rewarding activities) as its principal intervention. Negativity bias, apathy, and emotional dysregulation are expressions of abnormalities in the negative valence, arousal and regulatory, and cognitive control systems, respectively. Engage targets each of them with simple interventions only if they interfere with reward exposure. We treated openly, with 9 weekly sessions of Engage, 39 older adults with unipolar major depression. We compared their course of depression (HAM-D), remission rate (HAM-D<10), 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 for Engage at 6 and 9 weeks were 18.2% and 41.1%, respectively. The corresponding figures for PST were 13.7% and 35.0%, respectively.Conclusion These initial observations suggest that Engage has comparable efficacy with PST in reducing depressive symptoms and disability and warrants a randomized controlled trial.
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Initial studies suggest that ENGAGE is non-inferior to problem solving therapy.
“Initial studies suggest that ENGAGE can be taught to community based therapists, is non-inferior to problem solving therapy171, and engages its behavioral targets172,173.”
From Mechanisms and treatment of late-life depression (2019) · cites this paper as [171]
Initial studies suggest that ENGAGE can be taught to community based therapists.
“Initial studies suggest that ENGAGE can be taught to community based therapists, is non-inferior to problem solving therapy171, and engages its behavioral targets172,173.”
From Mechanisms and treatment of late-life depression (2019) · cites this paper as [171]
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- Authors
- Alexopoulos, G. S., Raue, P. J., Kiosses, D. N., Seirup, J. K., Banerjee, S., & Arean, P. A.
- Affiliations
- Cornell University (US)
- Corresponding author
- Alexopoulos, George S.
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 23
- Issue
- 5
- Pages
- 506-513
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC4277491
- OpenAlex
- W2058408506
- Cited by
- 51
- References
- 36
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 3 · 2022: 7 · 2021: 3 · 2020: 7 · 2019: 5 · 2018: 4 · 2017: 8 · 2016: 5 · 2015: 3
- FWCI
- 6.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Sanchez Foundation
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- problem-solving therapy, geriatric depression, older adults, positive valence systems, negativity bias, apathy, emotional dysregulation, depressive symptom reduction, remission, disability, community implementation, therapist training
- MeSH terms
- Late Onset Disorders, Affective Symptoms, Aged, Aged, 80 and over, Antidepressive Agents, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Intelligence Tests, Patient Participation, Problem Solving, Psychiatric Status Rating Scales, Remission Induction, Reward, Cognitive Behavioral Therapy, Mental Competency, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders, Apathy
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