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Resumen
En este trabajo se presenta una revisión de la situación actual de la terapia cognitivo-conductual (TCC) de la depresión en las personas mayores. La TCC se enmarca en una perspectiva biopsicosocial y, usualmente, consiste en una integración de los modelos cognitivo y conductual en una terapia de tiempo limitado, altamente estructurada, de corte psicoeducativo, centrada en los problemas del «aquí y ahora», identificables y mensurables y basada en una fuerte alianza de trabajo. También se repasan los modelos empleados de forma habitual para afrontar clínicamente la depresión, así como su aplicación en la población mayor. Además, se discute la eficacia diferencial de la TCC en la vejez respecto a otras alternativas, como la terapia farmacológica. En este sentido, la evidencia empírica existente, aunque limitada, apunta a que la TCC es igual de eficaz con personas mayores que con personas más jóvenes y, al menos, igual de eficaz en las personas mayores que otro tipo de terapias (p. ej., la de tipo farmacológico). Además, se señalan las ventajas específicas que puede tener el empleo de la TCC para la depresión en la vejez respecto a otro tipo de terapias: filosofía optimista, estilo psicoeducativo y colaborativo, y el respeto y el reconocimiento de la experiencia y el conocimiento acumulados por la persona mayor. Finalmente, se sugieren algunas modificaciones que podrían ser pertinentes en la aplicación de la TCC a la población mayor, para adaptarse a los cambios sensoriales y cognitivos que acompañan frecuentemente al envejecimiento normal.
Palabras clave:
Depresión
Personas mayores
Terapia cognitivo-conductual
Abstract
We present a review of the current state of cognitive-behavioral therapy (CBT) for depression in the elderly. Framed in a bio-psy-cho-social perspective, CBT usually involves an integration of cognitive and behavioral models into a highly-structured, time-limited therapy, with a psycho-educational slant, focused on identifiable, measurable, «here-and-now» problems and based on a strong work alliance. In this study, the different models typically used for the clinical management of depression, and their application in the elderly are reviewed. In addition, the efficacy of CBT in the elderly compared with that of alternative therapies such a pharmacological treatment is discussed. The available empirical evidence, though limited, suggests that the efficacy of CBT for depression is as high in the elderly as it is in younger individuals and that CBT is at least as effective as other types of therapy (e.g., pharmacological) in the elderly. The specific advantages of using CBT versus other types of therapies for depression in the elderly are also described: its optimistic philosophy, psychoeducational and collaborative style, and respect and acknowledgment of the experience and knowledge accumulated by elderly individuals. Finally, we suggest some modifications that may be appropriate when using CBT in older adults, in order to adapt to the sensorial and cognitive changes that usually accompany normal aging.
Key words:
Depression
Elderly
Cognitive-behavioral therapy
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Bibliografía
[1.]
E. Cumming, W. Henry.
Growing old: the process of disengagement.
[2.]
R. Fernández-Ballesteros.
Hacia una vejez competente. Un desafío a la ciencia y a la sociedad.
Psicología evolutiva,
[3.]
S.H. Zarit, B.G. Knight.
Psychotherapy and aging: multiple strategies, positive outcomes.
Effective clinical interventions in al life-stage context. A guide to psychotherapy and aging, pp. 1-13
[4.]
J.J. Gross, L. Carstensen, M. Pasupathi, J. Tsai, C. Goetestam Skorpen.
Hsu AYC. Emotion and Aging: Experience, expression and control.
Psychol Aging, 12 (1997), pp. 590-599
[5.]
L.L. Carstensen.
Gross, JJ, Fung, HH. The Social Context of Emotional Experience.
Annual review of gerontology and geriatrics, pp. 17
[6.]
S.T. Charles, C.A. Reynolds, M. Gatz.
Age-related differences and change in positive and negative affect over 23 years.
J Pers Soc Psychol, 80 (2001), pp. 136-151
[7.]
M.P. Lawton, M.H. Kleban, D. Rajagopal, J. Dean.
Dimensions of affective experience in three age groups.
Psychol Aging, 7 (1992), pp. 171-184
[8.]
F. Blanchard-Fields, H.C. Jahnke, C. Camp.
Age differences in problem-solving style: The role of emotional salience.
Psychol Aging, 10 (1995), pp. 173-180
[9.]
I. Montorio, M. Izal.
La vejez con éxito. Pero, ¿por qué las personas mayores no se deprimen más?.
Intervención Psicosocial, 6 (1997), pp. 53-75
[10.]
J.M. Rybash, W.J. Hoyer, P.A. Roodin.
Adult cognition and aging.
[11.]
G. Labouvie-Vief, J. Hakim-Larson, M. DeVoe, S. Schoeberlein.
Emotions and self-regulation: a life span view.
Hum Dev, 32 (1989), pp. 279-299
[12.]
B.L. Neugarten.
The psychology of aging: an overview.
Catalogue of Selected Documents in Psychology, 6 (1976), pp. 7
[13.]
L. Tornstam.
Gero-trascendence: a meta-theoretical reformulation of the disengagement theory, aging.
Clin Exp Res, 1 (1989), pp. 55-63
[14.]
L.L. Carstensen, D.M. Isaacowitz, S.T. Charles.
Taking time seriously: a theory of socioemotional selectivity.
Am Psychologist, 54 (1999), pp. 165-181
[15.]
M. Izal, I. Montorio.
Manual de gerontología conductual.
[16.]
D.V. Powers, L. Thompson, A. Futterman, D. Gallager-Thompson.
Depression in later life. Epidemiology, assesment, impact, and treatment.
Handbook of depression, pp. 560-580
[17.]
S.H. Qualls.
Mental health and mental disorders in older adults.
Gerontology: an interdisciplinary perspective,
[18.]
IMSERSO..
Las personas mayores en Espana: Informe 2000.
[19.]
Asociación Psiquiátrica Americana..
Manual diagnóstico y estadístico de los trastornos mentales.
4a,
[20.]
D.G. Blazer.
Epidemiology of late-life depression.
Diagnosis and treatment of depression in late life, pp. 9-19
[21.]
S.K. Whitbourne.
The normal aging process.
Psychopathology in later adulthood, pp. 27-59
[22.]
J.W. Williams, J. Barrett, T. Oxman, E. Frank, W. Katon, M. Sullivan, et al.
Treatment of dysthymia and minor depression in primary care. A randomized controlled trial in older adults.
JAMA, 284 (2000), pp. 1519-1526
[23.]
J.L. Wetherell, M. Gatz, B. Johansson, N.L. Pedersen.
History of depression and other psychiatric illness as risk factors for Alzheimer disease in a twin sample.
Alz Dis Assoc Dis, 1 (1999), pp. 47-52
[24.]
D.L. Chambless, W.C. Sanderson, V. Shoham, S. Bennett Johnson, K.S. Pope, P. Crits-Christoph, et al.
An update on empirically validated therapies.
Clin Psychol, 49 (1996), pp. 5-18
[25.]
M.A. López, R.J. Mermelstein.
A cognitive-behavioral program to improve geriatric rehabilitation outcome.
Gerontologist, 35 (1995), pp. 696-700
[26.]
L.L. Carstensen.
The emerging field of behavioral gerontology.
Behav Ther, 19 (1988), pp. 253-281
[27.]
M. Gatz, A. Fiske, L.S. Fox, B. Cacique, J.E. Kasl-Godely, T.J. McCallum, et al.
Empirically validated psychological treatments for older adults.
J Mental Health Aging, 4 (1998), pp. 9-46
[28.]
A.M. Zeiss, A. Steffen.
Behavioral and cognitive-behavioral treatments: an overview of social learning.
Effective clinical interventions in al life-stage context. A guide to psychotherapy and aging, pp. 35-60
[29.]
B.G. Knight, D.D. Satre.
Cognitive Behavioral Psychotherapy with Older Adults.
Cogn Behav Psychother, 6 (1999), pp. 188-203
[30.]
L. Teri, J. Curtis, D. Gallagher-Thompson, L. Thompson.
Cognitive-behavioral therapy with depressed older adults.
Diagnosis and treatment of depression in late life: results of the NIH Consensus Development Conference, pp. 279-291
[31.]
L.W. Thompson.
Cognitive-behavioral therapy and treatment for late-life depression.
J Clin Psychiatry, 57 (1996), pp. 29-37
[32.]
A.T. Beck, A.J. Rush, B.F. Shaw, G. Emery.
cognitive therapy of depression.
[33.]
A.T. Beck, G. Emery, R. Greenberg.
Anxiety disorders and phobias: a cognitive perspective.
[34.]
P.M. Lewinsohn.
A behavioral approach to depression.
The psychology of depression: contemporary theory and research,
[35.]
P.M. Lewinsohn, R. Muñoz, M. Youngren, A. Zeiss.
Control your depression.
[36.]
R. Fernández-Ballesteros, M. Izal, I. Montorio, J.L. González, P. Díaz.
Evaluación e intervención psicológica en la vejez.
[37.]
A.T. Beck.
Depression: causes and treatment.
[38.]
A. Ellis.
Reason and emotion in psychotherapy.
[39.]
A.T. Beck, D.A. Clark.
An information processing model of anxiety: automatic and strategic processes.
Behav Res Ther, 35 (1997), pp. 49-58
[40.]
D.A. Clark, A.T. Beck, B.A. Alford.
Scientific foundations of cognitive theory and therapy of depression.
[41.]
A.T. Beck, A. Freeman, F.D. Wright.
Cognitive therapy of personality disorders.
[42.]
N. Epstein, S.E. Schlesinger, W. Dryden.
Cognitive-behavioral therapy with families.
[43.]
A.T. Beck.
Prisioners of hate.
[44.]
P. Chadwick, M. Birchwood.
Challenging the omnipotence of voices: a cognitive approach to auditory hallucinations.
Br J Psychol, 164 (1994), pp. 190-201
[45.]
A.T. Beck.
Cognitive therapy and the emotional disorders.
[46.]
J.S. Beck.
Cognitive therapy: Basics and beyond.
[47.]
M. Young.
Workshop on rational-emotive therapy.
[48.]
R. Oliver, F.A. Bock.
Coping with Alzheimer's.
[49.]
A. Ellis, M. Abrams.
How to cope with a fatal illness.
[50.]
A. Ellis.
Rational emotive behavior therapy and cognitive behavior therapy for elderly people.
J Rational Emotional Cognitive Behav Ther, 17 (1999), pp. 5-18
[51.]
A. Ellis, R. Tafrate.
How to control your anger -Before it controls you. Secaucus, NJ, editor.
[52.]
L.I. Lega, V.E. Caballo, A. Ellis.
Teoría y práctica de la terapia racional emotivo-conductual.
[53.]
C.B. Fester.
A functional analysis of depression.
Am Psychologist, 28 (1973), pp. 857-870
[54.]
V. Andrés, F. Bas.
Tratamiento de la depresión.
Intervención psicológica en la vejez. Aplicaciones en el ámbito clínico y de la salud, pp. 111-150
[55.]
R. Wolfe, J. Morow, B.L. Frederikson.
Mood disorders in older adults.
The practical handbook of clinical gerontology,
[56.]
F. Scogin, L. McElreath.
Efficacy of psychosocial treatments for geriatric depression: a qualitative review.
J Consulting Clinical Psychol, 62 (1994), pp. 69-74
[57.]
L.W. Thompson, D. Gallagher-Thompson, J.S. Breckenridge.
Comparative effectiveness of psychotherapies for depressed elders.
J Consulting Clinical Psychol, 55 (1987), pp. 385-390
[58.]
A. Futterman, L.W. Thompson, D. Gallagher-Thompson, R. Ferris.
Depression in later life: epidemiology, assessment, etiology and treatment.
Handbook of depression, pp. 494-525
[59.]
G. Niederehe.
Psychosocial therapies with depressed older adults.
Diagnosis and treatment of depression in late life: result of the HIH Consensus Development Conference, pp. 293-315
[60.]
A.J. Rush, W.E. Golden, G.W. Hall, C.M. Herrera, A. Houston, R.G. Kathol.
Depression in primary care. Vol 2. Treatment of major depression.
Clinical practice. guideline N.° 5. Rockville: Agency for Health Care Policy and Research, US Department of Health and Human Services. AHCPR Pub. No 93-0551, (1993),
[61.]
D. Gallagher-Thompson, P. Hanley-Peterson, L.W. Thompson.
Maintenance of gains versus relapse following brief psychotherapy for depression.
J Counseling Clin Psychol, 58 (1990), pp. 371-374
[62.]
L.E. Beutler, J.N. Clarkin.
Systematic treatment selection.
[63.]
D. Gallagher-Thompson, A.M. Steffen.
Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers.
J Consult Clin Psychol, 62 (1994), pp. 543-549
[64.]
M.L. Smith, G.V. Glass, T.J. Miller.
The benefits of psychotherapy.
[65.]
N. Solano, D. Gallagher-Thompson.
Intervenciones cognitivo-conductuales para la depresión en personas mayores. La eficacia de la terapia cognitivo-conductual para el tratamiento de la depresión en personas mayores.
Rev Esp Geriatr Gerontol, 36 (2001), pp. 189-194
[66.]
Y. Dai, S. Zhang, J. Yamamoto, M. Ao, T.R. Belin, F. Cheung, et al.
Cognitive behavioral therapy of minor depressive symptoms in elderly Chinese Americans: a pilot study.
Community Mental Health J, 35 (1999), pp. 537-542
[67.]
D.A. Walker, M. Clarke.
Cognitive behavioural psychotherapy: a comparison between younger and older adults in two inner city mental health teams.
Aging Ment Health, 5 (2001), pp. 197-199
[68.]
D. Gallagher-Thompson, L.W. Thompson.
Applying cognitive-behavioral therapy to the psychological problems of later life.
Effective clinical interventions in al life-stage context. A guide to psychotherapy and aging, pp. 61-82
[69.]
I. Montorio, M. Izal.
La eficacia de la gerontología conductual.
Rev Esp Geriatr Gerontol, 36 (2001), pp. 183-186
[70.]
B.G. Knight.
Psychotherapy with older adults.
[71.]
P.G. Levendusky, M.R. Hufford.
The application of cognitive-behavior therapy to the treatment of depression and related disorders in the elderly.
J Geriatr Psychiatry, 30 (1997), pp. 227-238
[72.]
S. Ilardi, W. Craighead.
The role of nonspecific factors in cognitive-behavior therapy for depression.
Clin Psychol Sci Practice, 1 (1994), pp. 138-156
[73.]
M. Floyd, F. Scogin.
Cognitive-behavior therapy for older adults: how does it work?.
Psychotherapy, 35 (1998), pp. 459-463
[74.]
L. Gaston, C.R. Marmar, D. Gallagher, L.W. Thompson.
Alliance prediction of outcome beyond intreatment symptomatic change as psychotherapy processes.
Psychotherapy Res, 1 (1991), pp. 104-113
[75.]
P.B. Baltes, U.M. Staudinger, A. Maercker, J. Smith.
People nominated as wise: a comparative study of wisdom-related knowledge.
Psychol Aging, 10 (1995), pp. 155-166
[76.]
C. Salzman.
Issues and controversias regarding benzodiazepine use.
NIDA Res Monogr, 3 (1998), pp. 68-88
[77.]
I.M. Anderson.
Selectiva serotonine reputake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability.
J. Affective Disorder, 58 (2000), pp. 19-36
[78.]
S. Gerson, T. Belli, A. Kaufman, J. Mintz, L. Jardick.
Farmacological and psychological treatment for depressive older patients: a meta-analysis and overview of recent findings.
Harvard Review of Psychiatry, 7 (1999), pp. 1-28
[79.]
C.A. Naranjo, N. Herrmann, N. Mittmann, K.E. Bremner.
Recent advances in geriatric psychopharmacology.
Drugs Aging, 7 (1995), pp. 184-202
[80.]
C.F. Reynolds, L.S. Schneider, B.D. Lebowitz.
Treatment of depression in elderly patients: guidelines for primary care.
Reynolds Charles F III, editors. Diagnosis and treatment of depression in late life: results of the NIH Consensus Development Conference, pp. 463-490
[81.]
B.E. Wexler, D.V. Cicchetti.
The outpatient treatment of depression: implications of outcome research for clinical practice.
J Nerv Ment Disease, 180 (1992), pp. 277-286
[82.]
C.F. Reynolds 3rd, E. Frank, J.M. Perel, S.D. Imber, C. Cornes, R.K. Morycz.
Combined pharmacotherapy and psychotherapy in the acute and continuation treatment of elderly patients with recurrent major depression: a preliminary report.
Am J Psychiatry, 149 (1992), pp. 1687-1692
[83.]
P.A. Newhouse.
Use of serotonin selective reuptake inhibitors in geriatric depression.
J Clin Psychiatry, 57 (1996), pp. 12-22
[84.]
L.W. Thompson, D.W. Coon, D. Gallagher-Thompson, B.R. Sommer, D. Koin.
Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression.
Am J Geriatr Psychiatry, 9 (2001), pp. 225-240
[85.]
F. Schieber, J.A. Sugar, J.M. McDowd, W.R. Cunningham, K.L. Haman, H. Thomae.
Behavioral sciences and aging.
Handbook of mental health and aging, 2nd, pp. 251-375
[86.]
J.R. Dubno, D.D. Dirks, D.E. Morgan.
Effects of age and mild hearing loss on speech recognition in noise.
J Acoustical Soc Am, 76 (1984), pp. 87-96
[87.]
I. Montorio, M. Izal.
Intervención psicológica en la vejez: aplicaciones en el ámbito clínico y de la salud.
[88.]
T.A. Salthouse.
The processing-speed theory of adult age differences in cognition.
Psychological Rev, 103 (1996), pp. 403-428
[89.]
P.B. Baltes, U. Lindenberger.
Emergence of a powerful connection between sensory and cognitive functions across the life span: a new window to the study of cognitive aging?.
Psychol Aging, 12 (1997), pp. 12-21
[90.]
J.L. Horn, H. Masunaga.
New directions for research into aging and intelligence: the development of expertise.
Models of cognitive aging, pp. 125-159
[91.]
L.L. Light, M.W. Prull, D.J. La Voie, M.R. Healy.
Dual process theories of memory in old age.
Models of cognitive aging, pp. 238-300
[92.]
K.C. Kirasic, G.L. Allen, S.H. Dobson, K.S. Binder.
Aging, cognitive resources, and declarative learning.
Psychol Aging, 11 (1996), pp. 658-670
[93.]
A.J. Parkin, R.I. Java.
Determinants of age-related memory loss.
Models of cognitive aging, pp. 188-203
[94.]
L.L. Light.
Interactions between memory and language in old age.
Handbook of the psychology of aging, pp. 275-290
[95.]
G. Emery.
Cognitive therapy with the elderly.
New Directions in cognitive therapy, pp. 84-98
[96.]
I. Montorio, R. Nuevo, A. Losada, M. Márquez.
Prevalencia de trastornos de ansiedad en una muestra de personas mayores residentes en la comunidad.
Mapfre Medicina, 12 (2001), pp. 19-26
[97.]
R.N. Butler.
The life review: an interpretation of reminiscence in the aged.
Psychiatry, 119 (1963), pp. 721-728
[98.]
Montorio I, Márquez M, Losada A, Izal M. Barreras para el acceso a los servicios de intervención psicosocial por parte de las personas mayores [en prensa]. Intervención Psicosocial.
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