Introduction
Alzheimer’s disease (AD) usually occurs in the old age and poses significant challenges in front of the older individuals and leads to depression and negative mindset. This research study aims to examine the benefits of cognitive behavioral therapy in reducing the depression of older adults suffering from AD. With the growing age, it becomes all the more challenging for the older adults to manage their life and maintain their outlook positive towards life. The person suffering from Alzheimer’s disease has problem with memory, behavior, cognition which impact every dimension of the individual’s life. The disease leads to depression, that too severe as its progressive condition makes the individual difficult to interact socially and poses considerable challenges in functioning at social level. This leads to a solitary condition for the patient, further worsening the depression. This research study would identify the impact of cognitive behavior therapy on such individuals and would determine if CBT is successful in decreasing the level of depression of these people.
Literature Review
The empirical researches on the effectiveness of CBT as the treatment of depressive diseases and the possibility of prevention of re-lapse with the help of CBT have been demonstrated by Karwoski et al. (2006) . It has also been discussed by Karwoski et al (2006) that the social learning theory and the cognitive theory which are the backbone of CBT increases the emotional well-being of a person by building the strength of the person.
Short form of Geriatric Depression Scale is used in the study to identify the level of depression in the participants. Richeson et al. (2007) demonstrated that short form GDS is reliable and effective way of measuring depression and has been identified to be “92 % sensitivity and 89 % specificity when evaluated against diagnostic criteria. (Richeson, Boyne & Brady, 2007, p. 729).
Problem Statement
Depression in the older people is derived from the negative thoughts. These negative thoughts and beliefs lead to the creation of a negative lens through which appraisal of the world is distorted, resulting in automatic erroneous thinking and negative schemas. These negative schemes interact with negative life events to produce depression. The treatment focuses on modifying unhelpful thoughts to change affect and behavior by teaching the participants to identify their negative thinking patterns, and subsequently to challenge these negative cognitions to foster more adaptive ways of perceiving situations and themselves.
Research Questions
The study would be done to ascertain the benefits of application of CBT to the older adults diagnosed with early stage of AD. This research study would focus on the following research question:
Does the use of CBT reduce the level of depression in the older adults with early stage of AD? The hypothesis is considered to be that cognitive behavior therapy is effective in reducing the depression of older people in comparison to the older people who were not a part of the therapy.
Sample
The sample of this research study comprises of a group of 15 older adults who have been diagnosed with depression and early stage of Alzheimer’s disease. Convenience sampling technique is used to select the participants of this research study. The participants of the research study have been made aware about the purpose of the study and the results which are anticipated.
Measurements & Variables
The participant’s age, gender, primary language, ethnicity, employment status, marital status, level of education is the control variables. This data will be collected by means of the questionnaire filled by the participants in the beginning of the therapy. The control variables will be used to implement cultural competency in the interventions of CBT and the scales which will be used in the study. Depression is the dependent variable and is measured by using Geriatric Depression Scale.
This scale will be used to identify the depressive symptoms in the adults of age more than 65. The short form of GDS is used for this study and it has 15 questions which ask for the participants to choose yes and no as the option. The score is measured from 0-10 and the 0-4 represents normal, 5-8 means mild depression, moderate depression is represented by 9-11 and 12-15 means severe depression. GDS short form for the research studies have been demonstrated to be reliable.
Analysis
During the CBT sessions, three techniques have been found to be essential in the effective implementation of group CBT for older adults, namely, mood monitoring, pleasurable activities and learning to monitor and refute dysfunctional and unhelpful thoughts. The order and presentation of these techniques have been adjusted with the requirement of the group. Mood monitoring helps the participants to gain insight into their situations and to recognize when they are not doing well, when they have improved, and what events are associated with their mood change. Without successful mood monitoring, group members may have a difficult time discovering what tools work for them as well as what situations are most challenging for them. Moreover, behavioral interventions are often prescribed during the early stages of treatment because cognitive exercises may be more difficult for participants to understand initially.
Through mood monitoring, group members learn that events can affect their mood positively or negatively, which they can increase pleasant events in their lives and thus they can control their mood. The daily mood rating form is the commonly used self monitoring mood assessment form. The form has three columns in it with the first column of date, second which asks the participant to rate its mood from 1 to 9, that is from very depressed to very happy, and reasons for feeling in the certain way. This completed form is used to facilitate discussion in group therapy sessions and as a building block to teach the role of pleasurable activities in improving daily mood. The concrete realization of this association by monitoring mood on a daily basis can often provide the rationale and incentive for attempting to increase pleasurable events or activities.
Increasing pleasant activities is another activity that serves to quickly improve mood of the group member who has successfully increased the number of pleasant events occurring each day, and to demonstrate other group members who have been less accepting of this technique that negative emotions can be positively impacted by increasing one’s pleasant activities. The success of this activity is contingent upon selecting activities that are pleasurable.
Learning to monitor the negative thoughts depends on the success of mood monitoring and identifying the pleasant activities. When the group member identifies the mood enhancers, the will to maintain the pleasant mood strengthen and depression reduces significantly. Dysfunctional thoughts seem accurate and realistic to the individual who produces them, but are essentially counterproductive, dysfunctional, and unhelpful and upon careful examination represents the individual’s underlying irrational beliefs. These thoughts are automatic and come without much effort on the part of the individual. Such dysfunctional thoughts support the core belief that lead to problems such as depression and anxiety.
Learning to monitor refute dysfunctional thoughts is a cognitive technique used to teach the relationship between negative thoughts and feelings based on the premise that negative emotions are derived from the negative thoughts about a particular situation, and the depressed individual have distorted negative thoughts about specific situations, themselves and the future. The major negative thoughts identified in the older adults were Name calling, unable to do things, feeling helpless or dependent on others, sudden forgetfulness. These thoughts initiated the negative feelings which lead to bad mood and depression in the participants. Moreover the participants also expressed that trying to change the situation was of no use. However, with the cognitive behavioral therapy, they realized the ways to have positive feelings and thoughts and could change their condition.
Findings
Early stage Alzheimer older people demonstrated low level of depression ranging from mild to moderate after the cognitive behavior therapy. The same when treated with cognitive behavior therapy reduces the chances of depression getting worse and teaches the technique to the older adults to maintain positive mindset.
Conclusion
Cognitive Behavioral Therapy is an effective technique to reduce the depression of the older adults suffering from the early stage of Alzheimer’s disease. Due to old age and the increasing disease condition, older people usually gets into depression and are unable to get help to deal with the same. This research study, however confirms the earlier studies that cognitive behavior therapy is successful in decreasing the depression in older people.
Bibliography
Karwoski, L., Garratt, G., & Ilardi, S. (2006). On the integration of cognitive-behavioral therapy for depression and positive psychology. Journal of Cognitive Psychotherapy, 20(2) , 159-170.
Richeson, N., Boyne, S., & Brady, E. (2007). Education for older adults with early-stage dementia: Health promotion for the mind, body, and spirit. Educational Gerontology 33(9) , 723-736.
