Ryan A Mace1, David A Gansler2, Michael K Suvak3, Carla M Gabris4, Patricia A Areán5, Patrick J Raue6, George S Alexopoulos7. 1. Department of Psychology, Suffolk University, 73 Tremont Street, Boston, MA 02114, USA. Electronic address: rmace@suffolk.edu. 2. Department of Psychology, Suffolk University, 73 Tremont Street, Boston, MA 02114, USA. Electronic address: dgansler@suffolk.edu. 3. Department of Psychology, Suffolk University, 73 Tremont Street, Boston, MA 02114, USA. Electronic address: msuvak@suffolk.edu. 4. Department of Psychology, Suffolk University, 73 Tremont Street, Boston, MA 02114, USA; Northwell Health Solutions, Great Neck, NY, USA. Electronic address: carla2939@gmail.com. 5. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. Electronic address: parean@uw.edu. 6. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. Electronic address: praue@uw.edu. 7. Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA. Electronic address: gsalexop@med.cornell.edu.
Abstract
BACKGROUND: The effects of therapeutic relationship (TR) in elder mental health are understudied. A greater understanding of TR in geriatric psychotherapy is particularly needed for treating late-life depression with executive dysfunction, which predicts poor response to antidepressant medication and presents unique clinical challenges. METHODS:Participants were older patients (N = 220) with major depression and executive dysfunction who received 12 weeks ofproblem-solving therapy or supportive therapy in a randomized control trial. Multilevel growth curve modeling and latent change scores were used to analyze TR dimensions of Understanding and Accepting at the patient level (individual patient ratings, N = 194) and therapist level (ratings of each therapist averaged across participants, N = 10). RESULTS:TR predicted reduction of depression in both treatment groups, while treatment×TR interactions were not significant. Patients treated by therapists with higher average Understanding (patient and therapist level) and Accepting (therapist level) ratings had greater decreases in depression. The patient level×therapist level interaction for Understanding approached statistical significance (p=.065), suggesting a synergistic effect on treatment outcome. Together, Understanding and Accepting predicted 21% of variance in depression level changes. LIMITATIONS: TR was not assessed throughout the course of treatment (only after the first therapy session and at post-treatment) and did not include ratings from an objective evaluator. CONCLUSIONS: Assessment of patient's experience of the TR and of therapist ability to foster Understanding and Accepting can play a significant role in the delivery of geriatric psychosocial interventions.
RCT Entities:
BACKGROUND: The effects of therapeutic relationship (TR) in elder mental health are understudied. A greater understanding of TR in geriatric psychotherapy is particularly needed for treating late-life depression with executive dysfunction, which predicts poor response to antidepressant medication and presents unique clinical challenges. METHODS:Participants were older patients (N = 220) with major depression and executive dysfunction who received 12 weeks of problem-solving therapy or supportive therapy in a randomized control trial. Multilevel growth curve modeling and latent change scores were used to analyze TR dimensions of Understanding and Accepting at the patient level (individual patient ratings, N = 194) and therapist level (ratings of each therapist averaged across participants, N = 10). RESULTS: TR predicted reduction of depression in both treatment groups, while treatment×TR interactions were not significant. Patients treated by therapists with higher average Understanding (patient and therapist level) and Accepting (therapist level) ratings had greater decreases in depression. The patient level×therapist level interaction for Understanding approached statistical significance (p=.065), suggesting a synergistic effect on treatment outcome. Together, Understanding and Accepting predicted 21% of variance in depression level changes. LIMITATIONS: TR was not assessed throughout the course of treatment (only after the first therapy session and at post-treatment) and did not include ratings from an objective evaluator. CONCLUSIONS: Assessment of patient's experience of the TR and of therapist ability to foster Understanding and Accepting can play a significant role in the delivery of geriatric psychosocial interventions.
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