Implementing Behavioral Activation in Geriatric Depression: A Primer

Behavioral activation (BA) is a psychosocial treatment for depression designed to help patients increase contact with positive and rewarding aspects of daily life. The majority of BA research has focused on general adults and adolescents. While emerging data suggests that behavioral treatment is efficacious for depressed, elderly patients, there is little published guidance on how to adapt behavioral principles to meet the unique needs of an aging patient population. This article is designed as a primer to move from the empirically supported treatment to working as an evidence-based practitioner when treating geriatric patients with depression, providing suggestions for adapting the principles of behavioral activation to a depressed elderly population. We highlight prototypical situations and stressors that can present in older age patients who meet the criteria for late-life depression. We start with general suggestions for case conceptualization in behavioral activation. We then place a specific emphasis on case conceptualization and treatment planning for four prototypical psychosocial stressors: retirement, bereavement, physical pain/medical comorbidities, and caregiver stress. In each section, we emphasize how to anticipate and intervene around difficulties with activity scheduling and activity enjoyment

Valuation in major depression is intact and stable in a non-learning environment

The clinical diagnosis and symptoms of major depressive disorder (MDD) have been closely associated with impairments in reward processing. In particular, various studies have shown blunted neural and behavioral responses to the experience of reward in depression. However, little is known about whether depression affects individuals' valuation of potential rewards during decision-making, independent from reward experience. To address this question, we used a gambling task and a model-based analytic approach to measure two types of individual sensitivity to reward values in participants with MDD: `risk preference,' indicating how objective values are subjectively perceived, and `inverse temperature,' determining the degree to which subjective value differences between options influence participants' choices. On both of these measures of value sensitivity, participants with MDD were comparable to nonpsychiatric controls. In addition, both risk preference and inverse temperature were stable over four laboratory visits and comparable between the groups at each visit. Neither valuation measure varied with severity of clinical symptoms in MDD. These data suggest intact and stable value processing in MDD during risky decision-making