NOVEL INTERVENTIONS FOR THE COMMUNITY CARE OF LATE-LIFE DEPRESSION: A REPORT BY THE WEILL CORNELL ALACRITY CENTER

Abstract

The research team will present effectiveness data of three developmental projects offering ALACRITY treatments to primary care patients living with depression and chronic pain, depressed mistreatment victims, and depressed attendees of senior centers. Dr. Alexopoulos will present neurobiological findings that contributed to the neurobiological model of mid- and late-life depression and discuss the rationale for developing this model and highlight how they can be used to streamline behavioral interventions. He will also discuss how the introduction of behavioral economics principles delivered by mobile technology can be used to increase adherence to treatment and to treatment assignments. Dr. Marino will present findings of the REDS study, which is implemented in senior center clients. REDS uses a community care model to improve recognition of depression, referral, and treatment adherence. The REDS intervention is Engage-M, a stepped-therapy, streamlined based on the theory that a dysfunction of the reward network is central to the pathogenesis of depression and uses “reward exposure” as its principal intervention. If patients fail to engage in “reward exposure”, therapists address barriers to reward exposure originating from other network dysfunctions (e.g. negativity bias, apathy, or emotional dysregulation) so that “reward exposure” can proceed unimpeded. Dr. Kiosses will present the theory and new data on “Relief”, a 9-session intervention for depression and chronic pain in primary care practices. These patients are mainly treated in primary care practices and often receive opioids and benzodiazepines. Relief assumes that chronic pain and depression are characterized by an attentional bias assigning greater salience to interoceptive stimuli and to negative emotions along with difficulty shifting attention to a goal-oriented/reward-driven state, leading to inadequate engagement of the reward networks. Accordingly, Relief aims to shift patient attention away from pain and negative emotions and to increase their focus on pleasurable activities. Dr. Sirey will present feasibility and effectiveness data of EM/PROTECT, a psychosocial intervention for depressed older mistreatment (EM) victims. EM/PROTECT is based on a model, which postulates that chronic stress promotes dysfunction of the cognitive control (CCN) and reward networks, impairing the victims’ ability to flexibly respond to the environment and limits their rewarding activities. PROTECT therapists work with victims to develop action plans to reduce stress, and to increase rewarding experiences. The intervention is designed to work in synergy with EM mistreatment resolution services that provide safety planning, support services, and links to legal services.