Problem-solving therapy beats supportive therapy at reducing disability in old people with depression and executive dysfunction

shutterstock_75538075 old man talking to doctor

Older people who suffer from depression and executive dysfunction experience significant levels of disability and often don’t respond well to conventional drug treatments.

This randomised controlled trial conducted by researchers from Weill Cornell Medical College in New York State, attempted to find out if problem-solving therapy is better than supportive therapy for reducing disability in older adults with depression and executive dysfunction.

The trial took 221 older adults (aged >59 years) with major non-psychotic depression and randomised them to either:

  • 12 weeks of supportive therapy (ST) or
  • 12 weeks of problem-solving therapy (PST), which was delivered individually at once-weekly sessions and followed the unpublished manual, Social Problem Solving Therapy for Depression and Executive Dysfunction, which is based on setting and achieving goals, creating action plans and evaluating the accomplishment of goals. The first five sessions were educational, the subsequent seven based on enhancing skills and the final two on a relapse-prevention plan. Experienced clinical psychologists or licensed social workers received specific training in the delivery of each intervention.

The results favoured problem solving therapy:

  • Both PST and ST led to comparable improvement in disability in the first 6 weeks of treatment
  • A more prominent reduction was noted in PST participants at weeks 9 and 12
  • The difference between PST and ST was greater in patients with greater cognitive impairment and more previous episodes
  • Reduction in disability paralleled reduction in depressive symptoms
  • The therapeutic advantage of PST over ST in reducing depression was, in part, due to greater reduction in disability by PST
  • Although disability increased during the 24 weeks after the end of treatment, the advantage of PST over ST was retained.

The researchers concluded:

These results suggest that PST is more effective than ST in reducing disability in older patients with major depression and executive dysfunction, and its benefits were retained after the end of treatment. The clinical value of this finding is that PST may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy.

Alexopoulos GS, Raue PJ, Kiosses DN, Mackin RS, Kanellopoulos D, McCulloch C, Areán PA. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Arch Gen Psychiatry. 2011 Jan;68(1):33-41. [PubMed abstract].