Comparing Engage to PST for Late Life Depression (Engage)
Stepped, Reward-exposure Based Therapy vs. PST in Late Life Depression
Descripción general del estudio
Estado
Condiciones
Intervención / Tratamiento
Descripción detallada
Policy reports document that evidence-based psychotherapies are rarely employed and sustained in the community. Several causes of this science to service gap have been identified. One cause, specific to behavioral interventions, is the complexity of interventions and the competencies community clinicians must acquire and sustain over time in order to deliver them. A realistic solution is to streamline behavioral interventions and tailor them to the settings and therapist skill level available in the community. In response to this need, we have developed Engage, which: 1) is streamlined on the basis of concepts and findings on the neurobiology of depression; 2) consists of psychotherapeutic and ecosystem management components of known efficacy; 3) has distilled and simplified these components so as they can be accessible to most depressed older patients and taught to larger numbers of clinicians than available therapies, e.g., Problem Solving Therapy (PST); and 4) is personalized through a structured stepped approach focusing on "reward exposure". Problem Solving Therapy is an evidenced-based intervention shown to be effective in treating late-life depression.
Three hundred (150 per site) patient participants will be randomly assigned to receive 9 sessions of either Engage or PST. Forty-two clinician participants will be randomly assigned to receive training and certification in either Engage or PST. Once certified, clinicians will be assigned a patient participant and administer their assigned intervention.
Tipo de estudio
Inscripción (Actual)
Fase
- No aplica
Contactos y Ubicaciones
Ubicaciones de estudio
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New York
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White Plains, New York, Estados Unidos, 10605
- Weill Medical College of Cornell University
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Washington
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Seattle, Washington, Estados Unidos, 98195
- University of Washington Department of Psychiatry and Behavioral Sciences
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
Inclusion Criteria (Patient participants):
- Age ≥ 60 years
- unipolar, non-psychotic major depression (by SCID, DSM-IV)
- MADRS ≥ 20
- MMSE ≥ 24
- off antidepressants or have been on a stable dose of an antidepressant for 12 weeks and do not intend to change the dose in the next 10 weeks
- English speaking
- capacity to provide written consent
Exclusion Criteria (Patient participants):
- Presence of psychiatric diagnoses other than unipolar, non-psychotic major depression or generalized anxiety disorder
- Newly started use of psychotropic drugs (<12wks) or cholinesterase inhibitors other than mild doses of benzodiazepines
- Current active suicidal intent/plan
- Current substance abuse
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación de un solo grupo
- Enmascaramiento: Ninguno (etiqueta abierta)
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
|---|---|
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Comparador activo: Problem Solving Therapy
Problem solving therapy is an evidence based psychotherapy for depression, with 30 years of research supporting its efficacy.
PST focuses on the patients themselves and helps them develop skills in identifying, prioritizing, and solving problems, and thereby creates a sense of empowerment.
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PST is a behavioral intervention for depression that is delivered by trained therapists over a 9 week period.
It consists of a process to help patients understand and then solve the problems in their lives they feel is contributing to their depression.
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Experimental: Engage
Engage utilizes reward exposure consisting of the reintroduction of activities that patients once found rewarding and enjoyed, but have abandoned after they developed depression.
Engage uses basic problem solving through which patients learn how to form "action plans" for pursuing rewarding activities of their choice.
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Engage is a weekly behavioral intervention that is delivered over a 9 week period of time by trained therapists.
The focus of Engage is to help patient reconnect with activities that they have lost interest in pursuing due to depression.
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
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Depression
Periodo de tiempo: Measured at pretreatment and weeks 2,4,6,8,9,26 and 36
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Depression will be assessed using the Hamilton Depression Rating Scale, a multiple item questionnaire used to provide an indication of depression, and as a guide to evaluate recovery.
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Measured at pretreatment and weeks 2,4,6,8,9,26 and 36
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Colaboradores e Investigadores
Patrocinador
Colaboradores
Investigadores
- Investigador principal: George Alexopoulos, M.D., Weill Medical College of Cornell University
- Investigador principal: Patricia Arean, PhD, UW
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Estimar)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- STUDY00001739
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Descripción del plan IPD
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