Abstract
Psychotherapy is one of the evidence-based clinical interventions for the treatment of depression in older adults with dementia. Randomised controlled trials are often the first methodological choice to gain evidence, yet they are not applicable to a wide range of humanistic psychotherapies. Amongst all, the efficacy of the Gestalt therapy (GT) is under-investigated. The purpose of this paper is to present a research protocol, aiming to assess the effects of a GT-based intervention on people with dementia (PWD) and indirect influence on their family carers. The study implements the single-case experimental design with time series analysis that will be carried out in Italy and Mexico. Six people in each country, who received a diagnosis of dementia and present depressive symptoms, will be recruited. Eight or more GT sessions will be provided, whose fidelity will be assessed by the GT fidelity scale. Quantitative outcome measures are foreseen for monitoring participants’ depression, anxiety, quality of life, loneliness, carers’ burden, and the caregiving dyad mutuality at baseline and follow-up. The advantages and limitations of the research design are considered. If GT will effectively result in the treatment of depression in PWD, it could enrich the range of evidence-based interventions provided by healthcare services.
Highlights
Beyond the multiple cognitive impairment, the behavioural and psychological symptoms experienced by people with dementia (PWD), such as depression, personality changes, aggressiveness, delusions, hallucinations, wandering, and sleep disturbances [19,20], are challenging to accept and manage by informal carers
Ment and the improvement will be maintained at follow-up; the level of loneliness, if a factor, can decrease post-treatment and remain so at follow-up; the improvement of Methods symptoms is and related to the Gestalt therapy (GT) treatment; the level of burden of the family carer will reduce whilst the mutuality
To be part of the study, PWD will need to: (a) provide evidence of a formal diagnosis by a medical doctor, i.e., a neurologist, geriatrist, or psychiatrist; (b) have a clinical dementia rating–sum of the boxes (CDR-sum of the boxes” (SOB)) score of 3–4 or 4.5–9 [71]; (c) be able to engage in therapy; (d) display symptoms of mild depression, i.e., geriatric depression scale (GDS) score 10–19 [72] and/or anxiety; (e) maintain the psychopharmacological treatment during the investigation; (f) live in the community
Summary
Dementia affects the person suffering from it, as well as all his/her family and social network. Beyond the multiple cognitive impairment, the behavioural and psychological symptoms experienced by PWD, such as depression, personality changes, aggressiveness, delusions, hallucinations, wandering, and sleep disturbances [19,20], are challenging to accept and manage by informal carers. The latter, often tend to reduce the occasions on which they can be in public, in order to avoid embarrassing situations, leading them to social isolation, defined as the lack of social contact, relationships, and integration [21–23]. GT prioritising the relationship between the person (and his/her social contacts) and environment may be an effective approach for mitigating the disruptive impact of depression on PWD and family carers, as described in the paragraphs below
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