Group guided low intensity self-help for community dwelling older adults experiencing low mood : a dissertation presented in partial fulfillment of the requirements for the degree of Doctor of Clinical Psychology, Massey University, Albany, New Zealand
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Date
2017
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Massey University
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Abstract
Depression is amongst the most common health issues affecting older adults,
however, access to evidence-based psychological treatments remains low amongst this age
group. This is due, in part, to numerous barriers that surround current mental health
treatment and delivery, which has contributed to discrepancies between treatment needs,
availability, and uptake. To address such barriers, low intensity Cognitive Behavioural
Therapies (LI-CBT) and in particular guided self-help interventions have emerged as
promising, brief, cost-effective, and evidence-based alternatives to traditional high intensity
therapies.
Recently, interventions have begun to utilise the advantages of guided LI-CBT selfhelp
within a group or class setting, thus providing both a cost-effective and time-efficient
form of treatment delivery. Of these group guided approaches, Living Life to the Full
(LLTTF) is the only intervention that primarily targets depression and has undergone
randomised effectiveness testing. While early evidence lends support for the efficacy of
LLTTF, further research is needed to extend the findings to different populations and age
groups, particularly older adults.
The current study examined the effect of the group guided version of LLTTF on
community dwelling older adults’ ratings of depression, anxiety, and quality of life.
Additionally, the relationship between older adults’ engagement with LLTTF and
improvements in their reported ratings on all primary outcome measures was evaluated.
Twenty-four older adult participants with symptoms of depression were recruited from a
New Zealand community setting. Participants completed the intervention over eight
sessions and data was collected at baseline, during each session, and at 1- and 6-week
follow-up. Data was analysed using Multilevel Modelling, implementing a multilevel (2
level), repeated measure (11 waves), single group design.
Results indicated significant improvements in participants’ symptoms of depression,
anxiety, and quality of life over time. There was no evidence of an interaction between
participants’ engagement and depression or anxiety ratings. Unexpectedly, engagement did
however interact with quality of life, demonstrating that higher levels of out-of-class
engagement with self-help content was related to significantly lower improvements in
quality of life. Finally, supplementary analyses indicated greater reductions in anxiety
symptoms amongst participants who lived with others compared to those who lived alone.
These results endorse LLTTF as a viable and effective low intensity treatment
option for depression in older adults, with additional benefits for symptoms of anxiety and
quality of life. When delivered to older adults, LLTTF could increase treatment access and
choice, contribute to the reduction of secondary mental health service load, minimise
treatment barriers, and importantly support older adults’ to manage symptoms of
depression and anxiety while remaining in communities of their choosing.
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Keywords
Depression in old age, Treatment, Cognitive therapy, Psychotherapy for older people, Research Subject Categories::SOCIAL SCIENCES::Social sciences::Psychology::Applied psychology