Telephone-based behavioral activation with mental imagery for depression: A pilot randomized clinical trial in isolated older adults during the Covid-19 pandemic

Johnny Pellas, Fritz Renner, Julie L Ji, Mattias Damberg, Johnny Pellas, Fritz Renner, Julie L Ji, Mattias Damberg

Abstract

Objectives: To shield vulnerable persons, particularly the elderly, during the Covid-19 pandemic governments around the world have advised to use social distancing and self-isolation. Social isolation might put older adults at an increased risk for mental health problems such as depression. There is a need for brief, easy-accessible psychological treatments for depressive symptoms that can be delivered remotely. The aim of this study was to investigate the feasibility, acceptability, and preliminary efficacy of telephone-delivered Behavioral Activation with Mental Imagery (BA-MI) for the treatment of depressive symptoms in individuals 65 years and older living in isolation during the Covid-19 pandemic.

Methods: In this open-label pilot randomized clinical trial, N = 41 individuals aged 65 years or older with clinically significant symptoms of depression were randomly assigned to either a BA-MI treatment condition, or an Attention-Assessment control condition delivered over the telephone over a 4-week period.

Results: Depressive symptoms decreased more in the treatment condition compared to the control condition. At post-treatment, 2 out of 16 participants in the treatment condition met diagnostic criteria for depression compared to 9 out of 13 in the control condition. Most participants in the treatment condition were satisfied with the treatment and few adverse effects were observed.

Conclusions: This pilot study suggests that behavioral activation with mental imagery delivered over the telephone is feasible, acceptable, and potentially efficacious for the treatment of depressive symptoms in older individuals living in isolation. Replication in larger samples is needed.

Keywords: activity scheduling; behavioral activation; depression; mental imagery; older adults; social isolation.

Conflict of interest statement

The authors declare no conflicts of interest.

© 2021 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Participant flow through the trial
FIGURE 2
FIGURE 2
Mean depression severity over the different time points. Error bars are 95% confidence intervals. MADRS‐S, Montgomery‐Åsberg Depression Rating Self‐rating Scale

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