Academic journal article New Zealand Journal of Psychology

Behavioural Activation Self-Help to Improve Depression in People Living with Dementia: The PROMOTE Treatment Protocol

Academic journal article New Zealand Journal of Psychology

Behavioural Activation Self-Help to Improve Depression in People Living with Dementia: The PROMOTE Treatment Protocol

Article excerpt

Background

By the year 2026, New Zealand is set to experience an 18% increase in the number of people living with dementia to over 78,000 (Alzheimer's New Zealand, 2012). This contributes to in excess of 35 million people with dementia on a worldwide scale, with this figure set to triple by 2050 (Prince et al., 2013). Given such increases in prevalence, supporting people to live well with dementia has been identified as a global healthcare priority (World Health Organisation; WHO, 2012) and seminal to the New Zealand Framework for Dementia Care (Ministry of Health, 2013). Given the current absence of a cure for dementia (Winblad et al., 2016), the provision of appropriate physical and emotional support is essential (Samsi & Manthrope, 2014)

Estimates concerning the number of people with dementia experiencing depression vary between 30% (Enache, Winbald, & Aarsland, 2011; CastillaPuentes & Habeych, 2010) to 50% (Modrego, 2010). These estimates, alongside anticipated increases in dementia prevalence, highlight a significant need to focus on improving the long-term quality of life and wellbeing of people living with dementia (Gates, Valenzuela, Sachdev, & Singh, 2014). This is particularly justified given people with comorbid dementia and depression experience poor quality of life (Hoe, Hancock, Livingston, & Orrell, 2006), increased verbal agitation and behavioural symptoms of dementia (Van der Mussele et al., 2013), functional impairment (Thyrian et al., 2016), cognitive decline (Rapp et al., 2011) and increased risk of institutionalisation (Gaugler, Yu, Krichbaum, & Wyman, 2009). However, given the symptom overlap between depression and dementia in memory and concentration difficulties and loss of interest in activities, depressive symptoms are often misdiagnosed as signs of further cognitive decline (Pattanayak & Sagar, 2011).

Furthermore, although evidence based psychological therapies have been identified (Orgeta, Qazi, Spector, & Orrell, 2014), depression in dementia often goes untreated (Curran & Loi, 2012; Thyrian et al., 2016; van der Roest et al., 2009) even when detected. The limited availability of evidence based psychological treatments arising from high economic costs of delivery and shortage of qualified therapists (Kazdin & Blase, 2011; Lovell, Richards & Bower, 2003) has been cited as contributing to the worldwide treatment gap (Shidhaye, Lund, & Chisholm, 2015). In attempts to overcome the treatment gap, innovative strategies to improve access to evidence based psychological therapies are being adopted worldwide (Rebello, Marques, Gureje, & Pike, 2014). Within the Improving Access to Psychological Therapies (IAPT) programme implemented across England (Clark, 2011), this has resulted in the delivery of psychological therapies within a stepped care model of service delivery (Bower & Gilbody, 2005). The IAPT programme represents a paradigm shift away from the conventional delivery of face-to-face 'high intensity' CBT by experienced and specialist mental health professionals towards the delivery of 'low intensity' CBT (Bennett-Levy, Richards, & Farrand, 2010). Indeed, 'low intensity' CBT is an approach being adopted globally (Gyani, Shafran, Layard, & Clark, 2013; Pilgram & Carey, 2012; Rebello et al., 2014; Vis et al., 2015), including New Zealand (Merry et al., 2012; Shepherd et al., 2015). Furthermore, similar programmes to IAPT have been adopted in Australia within the NewAccess initiative (Cromarty, Drummond, Francis, Watson, & Battersby, 2016).

With a low intensity approach, CBT techniques are delivered in a self-help format through written material or health technologies such as online programmes or smartphone applications (Donker et al., 2013; Ridgway & Williams, 2011) as opposed to delivery by a therapist (Farrand & Woodford, 2013). Whilst CBT self-help can be completely self-administered, to improve the effectiveness of low intensity CBT, guidance from a health professional in the use of self-help materials often represents a core characteristic of service delivery (Andersson & Cuijpers, 2009; Gellatly et al. …

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