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~ Is It Normal to Feel Bad? ~
Help for Those Over Sixty-Five Dealing with Depression

by
Barbara Riley-Baker, BA, MA, CMC, C.P.G.

 Mrs. D. is a seventy-two-year old woman who lives alone. She has been a widow for eight months. Her husband of fifty years died suddenly as the result of a car accident, (Mr. D was crossing the street and was hit by a drunk driver). Mrs. D. has a daughter who lives in Chicago, her name is Mary. Mary stayed with her mother as long as she could after her father’s funeral, but Mary eventually had to get back to work. Mary urged her mother to move to Chicago, but she refused. Mrs. D. assured her daughter that friends and neighbors would be checking on her and she would be fine. She just needed time to adjust to life without her husband. 

Mrs. D. sees her primary care physician on her scheduled appointments about every six months, unless a problem arises between visits. Mrs. D. has several chronic conditions arthritis, high blood pressure, and osteoporosis. She takes medications for her conditions along with a daily multi-vitamin. Lately, Mrs. D. has been showing signs of confusion, anhedonia (marked disinterest in most activities), difficulty sleeping, and fatigue. Neighbors assure her these changes are all just part of growing old. She fears she may be experiencing signs of Alzheimer’s disease; she says nothing more to anyone about these troubling changes for fear of nursing home placement.

Mary pays her mother a surprise visit on her mother’s birthday and is shocked to see the decline in her mother and her home. Mary calls the primary care physician and schedules an appointment for the next afternoon. Mary too fears the worst, Alzheimer’s.

Dr. Smith is also surprised by Mrs. D.’s flat affect and gives her a complete physical and labs. Scans may also be needed. While in the doctor’s private office, Dr. asks Mrs. D. to tell him how she is feeling, to describe a typical day, and list her concerns. Dr. Smith asks her numerous questions to test her memory and also screens for depression. The doctor concludes depression appears to be the culprit.

Dr. Smith informs Mrs. D. that it is not normal to feel bad; her symptoms appear related to depression, not dementia.  Mrs. D. is greatly relieved. Dr. Smith starts her on an antidepressant, discusses how and when to take the medication, lists possible side effects, and schedules a follow-up appointment in six weeks. Dr. Smith would like Mrs. D. to see a counselor and gives her a list of therapists in the area. She agrees to give counseling a try.

Mary begins to research the therapists on the list and the type or model of therapy they practice. Mary discovers there are dozens of approaches to solving her mother’s depression. Mary has to pick the right practitioner for her mother.

Mary learns that Client-Centered Therapy, put forward by Carl Rogers in 1940, would not be appropriate for her mother at this time. This model focuses on client self-discovery through empathy, congruence, and unconditional positive regard. The outcome of this approach increases self-awareness and self-esteem. Mary concludes this form of therapy would be appropriate for individuals who have specific issues such as relationships. Mary believes her mother’s depression is based on loss, the loss of her husband and soul mate. Mary investigates other possible therapies.

Individual therapy from a Family Systems Perspective also proves not to be the correct approach for Mrs. D.’s depression. This model focuses on how each person in the system influences every other member of the system.  Mary concludes this model would work well for younger families.

Mary wants to find the therapy model that meets her mother’s needs based on where her mother is now, what she is feeling now, not issues Mrs. D. had as a child or in young adulthood. Mary continues her quest.

Mary researches the Ecological Systems Model, by Gibson. This approach is not what Mrs. D. needs either. This model focuses on perception and prevention.  Mrs. D. needs counseling centered on her immediate situation.

Rational Emotive Therapy, founder Albert Ellis, may be what Mary is looking for. This model borrows from the cognitive and the behavior theories. Its premise states psychological problems are the result of irrational thinking and behavior that support irrational thought. Counseling’s goal is to increase the patient’s ability to think and behave more rationally. Could Mrs. D.’s depression be self-generated based on irrational ideas?  Perhaps, but Mrs. D.’s depressed mood is due to real issues, most likely grief and anxiety due to the sudden death of her husband. So many theories, there has to be one for Mrs. D.  Mary continues her search.

Mary’s quest uncovers the Cognitive Therapy. Martin Seligman refers to this approach as “learned optimism.” Cognitive training can turn negative thoughts and behaviors into positive ones benefiting one’s mental as well as physical health. According to Hans Eysenck’s review of personality and health studies, there is a strong correlation between personalities and disease. Feelings of hopelessness and depression have been associated with cancer and heart disease. Eysenck and Ronald Grossarth-Maticek conducted an experiment in preventive medicine. The results were amazing. The study consisted of 100 heart disease and cancer prone people. The participants were divided into two groups of 50 people; 50 who received therapy and 50 who did not. The two psychologists used cognitive therapy to teach 50 volunteers coping skills to reduce stress, positive ways to express their emotions, and become more self-reliant. After 13 years 45 out of the 50 who received therapy were still alive. Only 19 out of the 50 in the non-therapy group were still alive.

Aaron Beck’s Cognitive Therapy of Depression proposes sad mood and lack of motivation to be the result of cognitive distortions the patient holds about himself, the world, and their future. Three basic beliefs interfere with reasonable information processing in the depressed patient:

1. I am inadequate, deserted and abandoned, and worthless.

2. The world is an unfair and harsh place. There’s nothing in it for me.

3. There is no hope for the future. My current troubles will never go away.

The therapist’s goal is to assist the patient in altering these beliefs in order to improve the patient’s emotions and motivations. Mary was definitely getting closer. Cognitive therapy deals with thoughts. Abnormal thoughts lead to abnormal behaviors.

Behavior therapy focuses on behavior, emphasizing current conditions that maintain a behavior. All healthy or abnormal behavior is learned. This approach is based on Ivan Pavlov’s classical conditioning, learning refers to associations formed between events and actions, B.F. Skinner’s operant conditioning, the likelihood of repeating a behavior depends on the consequences of the behavior, and Albert Bandura’s social learning theory, learning occurs by watching other people. Behavior therapy is problem centered not person centered. “The origins of a problem are not as important as the conditions that keep it going.”

Mary knew her mother needed a psychologist who practiced cognitive and behavioral therapies. Mary also thought a woman therapist would have a better repartee with her mother. Mary began calling the therapists on Dr. Smith’s list. Mary inquired which therapy model or models the clinician practice, whether or not the therapist was a female, what literature each office had pertaining to the therapist’s training and experience, the therapy process, goals, usual number of visits, costs, etc.

Mary’s third call seemed to be a perfect match for her mother’s needs. The office sent the requested information as well as the intake forms for Mrs. D. to complete prior to the initial visit. The packet arrived three days prior to the appointment. Mary reviewed the literature with her mother and helped complete the paper work. Mrs. D. seemed more comfortable with concept of therapy.  She was already starting to feel a bit better due to the prescribed antidepressant. In counseling, the therapist helped Mrs. D. deal with her tragic loss and grieve for husband. She also stated attending group bereavement counseling. The counselor gave Mrs. D. tools to use for the anxiety created by uncertainty about her future alone. Through homework assignments and therapy sessions Mrs. D. learned that she could carry on without her husband and that time would help ease her pain. She regained her self-confidence and returned to the activities she previously enjoyed. The combination of medication and counseling was able to give Mrs. D. her life back. She knew if the negative thoughts ever returned she could call her therapist to schedule a refresher-session.

Many seniors suffer from untreated depression. Depression as previously stated makes one prone to heart disease and cancer. Depression needs to be addressed; it is not a normal part of aging. It is not normal to feel bad. Seniors benefit as well as younger patients from medication and counseling. Primary care physicians need to look for depressive symptoms in their elderly patients and treat with drugs and counseling. Cognitive and behavioral therapy seems to be appropriate for all seniors dealing with depression and its negative consequences.

REFERENCES:

Cash, Adam. Psychology for Dummies. Hoboken, NJ: Wiley Publishing, 2002. 

Hunt, Morton. The Story of Psychology. New York, NY: Anchor Books, 1994. 

Kaslow, Florence W. “Individual Therapy Form A Family Systems Perspective.”  American Psychological Association   pages 1-4, 

Oct. 10, 2005 www.apa.org/  

Lipstein, Owen, Marnao, Hara Estroff. “Loss loss loss.” Psychology Today July1992: pages1-12, Oct.10,2005.  http://cms.psychologytoday.com/articles/index. 

Persons,Jacqueline B. “Cognitive-Behavior Therapy.” American Psychological Association Pages 1-4, Oct. 10, 2005. www.apa.org 

Raskin, Nathaniel J.  “Client-Centered Therapy” pages 1-4, Oct. 10, 2005  www.apa.org

Seligman, Martin. “Avoiding Catastrophic Thinking.” May/June 1994, Oct. 10, 2005.  http://cms.psychologytoday.com/articles/index