Comparing the streamlined psychotherapy “Engage” with problem-solving therapy in late-life major depression. A randomized clinical trial

Alexopoulos, George S.; Raue, Patrick J.; Banerjee, Samprit; Marino, Patricia; Renn, Brenna N.; Solomonov, Nili; Adeagbo, Adenike; Sirey, Jo Anne; Hull, Thomas D.; Kiosses, Dimitris N.; Mauer, Elizabeth; Areán, Patricia A.

doi:10.1038/s41380-020-0832-3

Cited by 56Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesTreatment of Major Depression

Comparing the streamlined psychotherapy “Engage” with problem-solving therapy in late-life major depression. A randomized clinical trial

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Alexopoulos, George S., Raue, Patrick J., Banerjee, Samprit, Marino, Patricia, Renn, Brenna N., Solomonov, Nili, Adeagbo, Adenike, Sirey, Jo Anne +4 more·2021·Molecular Psychiatry

DOI 10.1038/s41380-020-0832-3PMC PMC7775269

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Abstract

Effective psychotherapies for late-life depression are underutilized, mainly because of their complexity. "Engage" is a novel, streamlined psychotherapy that relies on neurobiology to identify core behavioral pathology of late-life depression and targets it with simple interventions, co-designed with community therapists so that they can be delivered in community settings. Consecutively recruited adults (≥60 years) with major depression (n = 249) were randomly assigned to 9 weekly sessions of "Engage" or to the evidence-based Problem-Solving Therapy (PST) offered by 35 trained community social workers and assessed by blind raters. "Engage" therapists required an average of 30% less training time to achieve fidelity to treatment than PST therapists and had one-third of the PST therapists' skill drift. Both treatments led to reduction of HAM-D scores over 9 weeks. The mixed effects model-estimated HAM-D ratings were not significantly different between the two treatments at any assessment point of the trial. The one-sided 95% CI for treatment-end difference was (-∞, 0.07) HAM-D points, indicating a non-inferiority margin of 1.3 HAM-D points or greater; this margin is lower than the pre-determined 2.2-point margin. The two treatment arms had similar response (HR = 1.08, 95% CI (0.76, 1.52), p = 0.67) and remission rates (HR = 0.89, 95% CI (0.57, 1.39), p = 0.61). We conclude that "Engage" is non-inferior to PST. If disseminated, "Engage" will increase the number of therapists who can reliably treat late-life depression and make effective psychotherapy available to large numbers of depressed older adults.

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Engage required 30% less training time compared to problem-solving therapy.
“A recent randomized controlled trial showed that Engage is as effective as problem-solving therapy in treating late-life major depression, while having the advantage of being less complex; Engage required 30% less training time compared to problem-solving therapy [10].”
From Behavioral Activation and Depression Symptomatology: Longitudinal Assessment of Linguistic Indicators in Text-Based Therapy Sessions (2021) · cites this paper as [10]
Engage is as effective as problem-solving therapy in treating late-life major depression, while having the advantage of being less complex.
“A recent randomized controlled trial showed that Engage is as effective as problem-solving therapy in treating late-life major depression, while having the advantage of being less complex; Engage required 30% less training time compared to problem-solving therapy [10].”
From Behavioral Activation and Depression Symptomatology: Longitudinal Assessment of Linguistic Indicators in Text-Based Therapy Sessions (2021) · cites this paper as [10]

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Authors: Alexopoulos, G. S., Raue, P. J., Banerjee, S., Marino, P., Renn, B. N., Solomonov, N., Adeagbo, A., Sirey, J. A., Hull, T. D., Kiosses, D. N., Mauer, E., & Areán, P. A.
Affiliations: Cornell University (US)
University of Washington (US)
Columbia University (US)
Corresponding author: Alexopoulos, George S.
ORCID: Alexopoulos, George S.
Raue, Patrick J.
Banerjee, Samprit
Marino, Patricia
Renn, Brenna N.
Solomonov, Nili
Sirey, Jo Anne
Hull, Thomas D.
Kiosses, Dimitris N.
Mauer, Elizabeth
Areán, Patricia A.
Venue: Molecular Psychiatry
Publisher: Springer Science and Business Media LLC
Published: 2020-07-01
Volume: 26
Issue: 9
Pages: 5180-5189
ISSN: 1359-4184 (ISSN-L)
1476-5578
DOI: 10.1038/s41380-020-0832-3
PMC: PMC7775269
OpenAlex: W3040198515
Cited by: 56
References: 54
Citations by year: 2026: 6 · 2025: 11 · 2024: 7 · 2023: 8 · 2022: 9 · 2021: 15
FWCI: 3.20
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
Locations: Molecular Psychiatry (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: U.S. Department of Health & Human Services | NIH | National Institute of Mental Health (R01 MH102252, T32 MH019132, P50 MH113838, R01 MH102304, P50 MH115837)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords: geriatric depression, major depressive disorder, problem-solving therapy, non-inferiority, community therapists, therapist training, intervention fidelity, older adults, neurobiology of depression
MeSH terms: Aged, Depression, Major Depressive Disorder, Humans, Psychiatric Status Rating Scales, Psychotherapy, Treatment Outcome

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Comparing the streamlined psychotherapy “Engage” with problem-solving therapy in late-life major depression. A randomized clinical trial

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