Summary of efficacy data

Cognitive therapy has proven efficacy as a treatment for depression in older people (Dick et al., 1996; Gatz et al., 1998; Karel & Hinrichsen, 2000; Knight & Satre, 1999; Koder et al., 1996; Laidlaw, 2001). In a broad review of the empirical evidence for the psychological treatment of depression in older adults, Gatz et al. (1998) concluded that CBT meets strict American Psychological Association criteria as a probably efficacious treatment. According to Gatz et al. (1998: 13), CBT did not meet criteria as a 'well-established' treatment because 'superiority to psychological placebo has not been demonstrated with sufficiently large samples, and superiority to another treatment has not been found with sufficient consistency'. The conservative conclusion drawn by Gatz et al. (1998) may well be warranted at this stage, as too few studies have been conducted to evaluate properly cognitive therapy's efficacy. For an in-depth evaluation of the efficacy of CBT, see Laidlaw (2001).

CBT has been the most systematically studied psychological treatment for depression in older adults (Karel & Hinrichsen, 2000). The methodological differences across studies investigating the outcome of psychological treatments for late-life depression make cross-comparison difficult. Some studies do not include control conditions (Fry, 1984; Leung & Orrell, 1993; Steuer et al., 1984). It is rare for any study to report data on long-term follow-up of up to 2 years (Gallagher-Thompson et al., 1990). Some studies have evaluated group cognitive therapy (Arean et al., 1993; Beutler et al., 1987; Kemp et al., 1991/2; Leung & Orrell, 1993; Rokke et al., 2000; Steuer et al., 1984), whereas others have evaluated individual cognitive therapy (Dick & Gallagher-Thompson, 1995; Gallagher & Thompson, 1982; 1983; Gallagher-Thompson et al., 1990; Gallagher-Thompson & Steffen, 1994; Kaplan & Gallagher-Thompson, 1995; Thompson et al., 1987, 2001). In terms of attrition rates, there are wide variations across studies (see Laidlaw, 2001, for a more thorough discussion). Surprisingly few studies report upon comorbidity of physical illness, with the studies that do comment upon this reporting very high rates of physical illnesses (Rokke et al., 2000; Steuer et al., 1984). A major criticism of the research conducted so far is that the majority of studies have very small sample sizes.

Overall, the evidence supports the applicability of CBT as an effective treatment alternative to antidepressant medication for late-life depression (see especially Thompson et al., 2001). Although one cannot specify whether any particular type of therapy is most effective for late-life depression, cognitive therapy is an effective treatment for depression in older people.

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