Practitioner 2011 – 255 (1745): 10-12

Life review therapy can help older patients with depression

22 Nov 2011Registered users

Life review therapy is an effective intervention for adults aged 55 and older with depressive symptoms, a Dutch pragmatic randomised controlled trial has found. Dr Philip Bland comments ont he study: 'NICE recommends a low-intensity psychosocial intervention for patients with persistent subthreshold symptoms (>2-3 months). Life review therapy would seem to be an attractive option for older patients, but the positive findings of the present study should be treated with caution. First, the participants in this study were recruited by advertisement and may therefore have been more highly motivated and more likely to respond to therapy than patients presenting in a primary care setting. Second, comparison with usual care does not control for non-specific benefits of group participation, so we do not know what proportion, if any, of the response to treatment was due to the specific intervention. Finally, there is a problem of publication bias among trials of psychotherapy for adult depression. GPs are primarily diagnosticians, not therapists. The diagnosis of depression is complex and should incorporate an assessment of cognition as well as the number and severity of symptoms and the degree of functional impairment. Depressed patients have negative, unhelpful thoughts about themselves, their current experiences and the future: Beck’s cognitive triad. I suggest that for older patients we should add a fourth category i.e. negative evaluation of their past life. I find that the use of genograms is an effective way of placing the presenting problem within a historical and family context, and encouraging patients to tell stories about their lives. '

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