Weill Cornell Institute of Geriatric Psychiatry (NS, JNB, JAS, FMG, GSA), Weill Cornell Medicine, White Plains, NY.
Weill Cornell Institute of Geriatric Psychiatry (NS, JNB, JAS, FMG, GSA), Weill Cornell Medicine, White Plains, NY.
Am J Geriatr Psychiatry. 2019 Jun;27(6):571-578. doi: 10.1016/j.jagp.2018.12.033. Epub 2019 Jan 10.
Loneliness and social isolation are associated with depressive symptoms, cognitive and physical disabilities, and increased risk of mortality among older adults. Socially rewarding activities reduce loneliness, and neurobiological evidence suggests that these activities may activate neural reward systems in older adults to a greater extent than other rewarding experiences. The current study was designed to investigate whether engagement in social and interpersonal activities (i.e., exposure to social rewards) predicts subsequent increase in behavioral activation and reduction in depressive symptoms in reward exposure treatment for late-life depression.
Forty-eight older adults without cognitive impairment and with major depression received nine sessions of "Engage" psychotherapy. Behavioral activation and depression severity were assessed by trained raters at baseline and weeks 6 and 9. Patients' weekly behavioral plans were categorized into three groups: 1) solitary activities; 2) social-group activities (attending a social gathering or a social setting such as church or a senior center); and 3) interpersonal-individual activities (engaging in an interpersonal interaction with a specific friend or family member).
Mixed-effects models showed reduction in depression severity and increase in behavioral activation over time. In linear regression models, a higher percentage of interpersonal-individual activities (but not solitary or social-group activities) predicted subsequent increase in behavioral activation and improvement of depression.
These findings highlight the importance of understanding the effects of engagement in specific types of rewarding activities in behavioral activation treatments for late-life depression. Exposure to socially rewarding interpersonal interactions could contribute to the efficacy of psychotherapy for late-life depression.
孤独和社会隔离与老年人的抑郁症状、认知和身体残疾以及死亡率增加有关。社交奖励活动可以减轻孤独感，神经生物学证据表明，与其他奖励体验相比，这些活动可能会更大程度地激活老年人的神经奖励系统。本研究旨在探讨在针对老年抑郁症的奖励暴露治疗中，参与社交和人际活动（即接触社交奖励）是否可以预测随后的行为激活增加和抑郁症状减轻。
48 名无认知障碍且患有重度抑郁症的老年人接受了 9 次“参与”心理治疗。行为激活和抑郁严重程度由经过培训的评估者在基线和第 6 周和第 9 周进行评估。患者每周的行为计划分为三组：1）单独活动；2）社交团体活动（参加社交聚会或社交场所，如教堂或老年人中心）；3）人际个人活动（与特定朋友或家庭成员进行人际互动）。
混合效应模型显示，随着时间的推移，抑郁严重程度降低，行为激活增加。在线性回归模型中，人际个人活动（而不是单独或社交团体活动）的比例越高，预测随后行为激活的增加和抑郁的改善。
这些发现强调了理解参与特定类型奖励活动对老年抑郁症行为激活治疗效果的重要性。接触社交奖励性人际互动可能有助于心理治疗治疗老年抑郁症的疗效。
