Información del artículo
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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