Cognitive–Behavioral Therapy for Late-Life Depression
Cognitive–behavioral therapy (CBT) is an effective and appropriate approach for late-life depression because it is problem focused, examining and treating present-day problems that negatively impact the client's quality of life. Established empirical studies support the use of standard CBT with older clients, and subsequent research has reinforced CBT's effectiveness when tailored to fit the needs of this prominent population.
In this video, Dr. Dolores Gallagher-Thompson works with an older woman with depression, demonstrating the technical assets of CBT while skillfully building an effective therapeutic relationship with the client.
Dolores Gallagher-Thompson's technique uses a three-phase approach to treatment.
Early-stage treatment involves socializing the client into treatment, using psychoeducation to explain the approach and how it differs from his or her initial ideas about mental health care, and goal-setting to give a concrete conceptualization of positive outcomes.
The middle stage uses cognitive and behavioral interventions and leads to skill building to address potential issues such as difficulties with loneliness, becoming more active in one's daily life, and reframing negative views about oneself, one's life up till now, and the future. Often there are significant family issues (e.g., conflict with adult children, or caregiving issues regarding a disabled spouse) that need to be addressed as well.
The late stage involves both relapse prevention and actual termination. Skills are reviewed, and the relationship discussed; this functions as a way for client and therapist to transition out of the relationship gradually. This final stage is important because this relationship is often highly significant to the client, and its loss needs to be acknowledged and processed.
Dolores Gallagher-Thompson, PhD, ABPP, received her doctorate in clinical psychology in 1979 from the University of Southern California (USC) in Los Angeles after completing an APA-approved internship at the UCLA Neuropsychiatric Institute.
Dr. Gallagher-Thompson's additional interest in assessment and treatment of mental health problems of later life led her to courses in this field through the Andrus Gerontology Center at USC. She did postdoctoral training with Aaron Beck at the Center for Cognitive Therapy in Philadelphia and with Peter Lewinsohn at the University of Oregon.
Dr. Gallagher-Thompson was employed as a clinical and research psychologist (specializing in geropsychology) at the VA Palo Alto Health Care System from 1981 through 2002, and she has worked as full-time faculty in the Department of Psychiatry and Behavioral Sciences at Stanford University since that time.
Dr. Gallagher-Thompson's areas of interest are the treatment of late-life depression using cognitive–behavioral therapy (CBT) as well as reducing distress of dementia family caregivers through the use of CBT techniques, with a particular focus on the issues faced by ethnically, racially, and culturally diverse family caregivers.
Dr. Gallagher-Thompson has been a funded researcher for over 25 years, with grants primarily from the National Institute of Mental Health (NIMH), National Institute on Aging, and the Alzheimer's Association national office, and she has worked on more than 150 peer-reviewed publications and four books (both edited and authored) that reflect these research projects and findings. Her most recent grant (from NIMH) is an exploratory study of the kinds of cognitive processing skills (as indexed by fMRI) needed by older adults in order to respond adequately to CBT for depression.
Dr. Gallagher-Thompson maintains a clinical practice in the Geropsychiatry Outpatient Clinic at Stanford University, where she "tests the limits" of what CBT can do for patients who mostly suffer from chronic, intractable depression.
- Arean, P. A., Gum, A., McCulloch, C. E., Gallagher-Thompson, D., & Thompson, L. W. (2005). Treatment of depression in low income older adults. Psychology and Aging, 20, 601–609.
- Cook, J., Katz, I., & Gallagher-Thompson, D. (2005). Psychotherapy across the life cycle: Old age. In G. Gabbard, J. Beck, & J. Holmes (Eds.), Concise Oxford textbook of psychotherapy. Oxford, England: Oxford University Press.
- Coon, D. W., DeVries, H. M., & Gallagher-Thompson, D. (2004). Cognitive behavioral therapy with suicidal older adults. Behavioural and Cognitive Psychotherapy, 32, 481–493.
- Coon, D. W., Keaveny, M., Valverde, I., Dadvar, S., & Gallagher-Thompson, D. (2012). Evidence-based psychological treatments for distress in family caregivers of older adults. In F. Scogin (Ed.), Making evidence-based psychological treatments work with older adults (pp. 225–284).Washington, DC: American Psychological Association.
- Coon, D. W., Rabinowitz, Y. G., Thompson, L. W., & Gallagher-Thompson, D. (2005). Older adults. In N. Kazantzis, F. P. Deane, K. R. Ronan & L. L'Abate (Eds.), Using homework assignments in cognitive behavior therapy (pp. 117–152). New York, NY: Taylor and Francis.
- Coon, D. W., Rider, K., Gallagher-Thompson, D., & Thompson, L. W. (1999). Cognitive–behavioral therapy for the treatment of late-life distress. In M. Duffy (Ed.), Handbook of counseling and psychotherapy with older adults (pp. 487–510). New York, NY: Wiley.
- Coon, D. W., Robinson Shurgot, G., Gillispie, Z., Cardenas, V., & Gallagher-Thompson, D. (2005). Cognitive–behavioral group interventions. In G. Gabbard, J. Beck, & J. Holmes (Eds.), Oxford textbook of psychotherapy (pp. 45–55). New York, NY: Oxford University Press.
- Gallagher-Thompson, D., Dillinger, J., Gray, H., L., Cardenas, V., Singer, L., & Hsu, S. (2006). Women's issues at the end of life. In J. Worell & C. Goodheart (Eds.), Handbook of girls' and women's psychological health (pp. 406–415). New York, NY: Oxford University Press.
- Gallagher-Thompson, D., Dupart, T., Liu, W., Gray, H., Eto, T., & Thompson, L. W. (2008). Assessment and treatment issues in bereavement in later life. In K. Laidlaw & B.G. Knight (Eds.), Handbook of emotional disorders in later life: Assessment and treatment (pp. 287–307). Oxford, England: Oxford University Press.
- Gallagher-Thompson, D., McKibbin, C., Koonce-Volwiler, D., Menéndez, A., Stewart, D., & Thompson, L. W. (2000). Psychotherapy with older adults. In C.R. Snyder & R. Ingram (Eds.), Handbook of psychological change: Psychotherapy processes and practices for the 21st century (pp. 614–637). New York, NY: John Wiley & Sons.
- Gallagher-Thompson, D., Steffen, A., & Thompson, L. W. (Eds.). (2007). Handbook of behavioral and cognitive therapies with older adults. New York, NY: Springer.
- Gallagher-Thompson, D., & Thompson, L. W. (2010). Effective treatment for late-life depression: A therapist guide. New York, NY: Oxford University Press.
- Gallagher-Thompson, D., & Thompson, L. W. (2010). Effectively using cognitive/behavioral therapy with the oldest old: Case examples and issues for consideration. In N. A. Pachana, K. Laidlaw, & B. Knight (Eds.), Casebook of clinical geropsychology: International perspectives on practice (pp. 227–241). Oxford, England: Oxford University Press.
- Holland, J. M., & Gallagher-Thompson, D. (2010). Interventions for mental health problems in later life. In D. H. Barlow (Ed.), The Oxford handbook of clinical psychology (pp. 810–836). New York, NY: Oxford University Press.
- Laidlaw, K., Thompson, L. W., Dick-Siskin, L., & Gallagher-Thompson, D. (2003). Cognitive–behaviour therapy with older people. Chichester, England: John Wiley & Sons.
- Laidlaw, K., Thompson, L. W., & Gallagher-Thompson, D. (2004). Comprehensive conceptualization of cognitive behaviour therapy for late life depression. Behavioural & Cognitive Psychotherapy, 32, 389–399.
- Liu, W., & Gallagher-Thompson, D. (2009). Impact of caregiving: Risks, strains, and growth. In S. Qualls & S. Zarit (Eds.), Aging families and caregiving: A clinician's guide to research, practice, and technology (pp. 85–112). New York, NY: Wiley.
- Malik, M. L., Beutler, L. E., Alimohamed, S., Gallagher-Thompson, D., & Thompson, L. (2003). Are all cognitive therapies alike? A comparison of cognitive and non-cognitive therapy process and implications for the application of empirically supported treatments (ESTs). Journal of Consulting and Clinical Psychology, 71(1), 150–158.
- Molinari, V., Karel, M., Jones, S., Zeiss, A., Cooley, S., Wray, L., Brown, E., & Gallagher-Thompson, D. (2003). Recommendations about the knowledge and skills required of psychologists working with older adults. Professional Psychology: Research & Practice, 34, 435–443.
- Powers, D. V., Thompson, L., Futterman, A., & Gallagher-Thompson, D. (2002). Depression in later life: Epidemiology, assessment, impact, and treatment. In I. H. Gotlib & C. L. Hammen (Eds.), Handbook of depression (3rd ed., pp. 560–580). New York, NY: Guilford Press.
- Powers, D. V., Thompson, L. W., & Gallagher-Thompson, D. (2008). The benefits of using psychotherapy skills following treatment for depression: An examination of "afterwork" and a test of the skills hypothesis in older adults. Cognitive and Behavioral Practice, 15(2), 194–202.
- Reiser, R., Reddy, S., Parkins, M., Thompson, L., & Gallagher-Thompson, D. (2011). Psychosocial treatment of bipolar disorder in older adults. In K. H. Sorocco & S. Lauderdale (Eds.), Cognitive behavioral therapy with older adults: Innovations across care settings (pp. 65–94). New York, NY: Springer Publishing Company, LLC.
- Tang, P., & Gallagher-Thompson, D. (2005). Treatment of depressive symptoms in a Chinese female dementia caregiver: A case study using cognitive/behavioral methods. Clinical Gerontologist, 28(3), 81–85.
- Thompson, L. W., Coon, D. W., Gallagher-Thompson, D., Sommer, B., & Koin, D. (2001). Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild to-moderate depression. American Journal of Geriatric Psychiatry, 9(3), 225–240.
- Thompson, L. W., Dick-Siskin, L., Coon, D. W., Powers, D., & Gallagher-Thompson, D. (2010). Effective treatment for late-life depression: A client workbook. New York, NY: Oxford University Press.
- Thompson, L. W., McGee, J. S., & Gallagher-Thompson, D. (2005). Cognitive behavioral therapy. In B. J. Sadock & V. A. Sadock (Eds.), Comprehensive textbook of psychiatry, Vol. II (8th ed., pp. 3758–3763). Philadelphia, PA: Lippincott, Williams & Wilkins.
- Thompson, L. W., Powers, D. V., Coon, D. W., Takagi, K., McKibbin, C., & Gallagher-Thompson, D. (2000). Older adults. In J.R. White & A.S. Freeman (Eds.), Cognitive–behavioral group therapy for specific problems and populations (pp. 235–261). Washington, DC.: American Psychological Association.
- Thompson, L. W., Spira, A. P., Depp, C. A., McGee, J. S., & Gallagher-Thompson, D. (2006). The geriatric caregiver. In M. E. Agronin & G. J. Maletta (Eds.), Principles and practice of geriatric psychiatry (pp. 37–48). Philadelphia, PA: Lippincott Williams & Wilkins.
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