title: Comparing engage with PST in late-life major depression: a preliminary report.
abstract: OBJECTIVE
  The complexity of psychotherapies has been a barrier to community implementation. We used the Research Domain Criteria consensus as a guide to develop Engage, a streamlined, neurobiology-based psychotherapy for late-life depression that may match the skill set of practicing clinicians. This proof of concept study tested the hypotheses that Engage is bioequivalent to Problem Solving Therapy (PST) in reducing depressive symptoms, inducing remission, and ameliorating disability.
  
  
  METHODS
  Engage assumes that abnormal function of the positive valence systems fuels depression and uses "reward exposure" (engagement in meaningful, rewarding activities) as its principal intervention. Negativity bias, apathy, and emotional dysregulation are expressions of abnormalities in the negative valence, arousal and regulatory, and cognitive control systems, respectively. Engage targets each of them with simple interventions only if they interfere with reward exposure. We treated openly, with 9 weekly sessions of Engage, 39 older adults with unipolar major depression. We compared their course of depression (HAM-D), remission rate (HAM-D<10), and disability (WHODAS) with those of a historical comparison group (N = 97) treated with 9 weekly sessions of PST.
  
  
  RESULTS
  Community social workers and research therapists required one third as much training time in Engage as in PST. Engage was non-inferior to PST in reducing HAM-D and WHODAS. Remission rates for Engage at 6 and 9 weeks were 18.2% and 41.1%, respectively. The corresponding figures for PST were 13.7% and 35.0%, respectively.
  
  
  CONCLUSIONS
  These initial observations suggest that Engage has comparable efficacy with PST in reducing depressive symptoms and disability and warrants a randomized controlled trial.
authors.affiliation: Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY. Electronic address: gsalexop@med.cornell.edu.
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
authors.affiliation: Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Raue
authors.affiliation: Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY.
authors.forename: Dimitris N
authors.initials: DN
authors.lastname: Kiosses
authors.affiliation: Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY.
authors.forename: Joanna K
authors.initials: JK
authors.lastname: Seirup
authors.affiliation: Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY.
authors.forename: Samprit
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Arean
mesh_terms: D000342:Affective Symptoms / Q000209:etiology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D057565:Apathy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007361:Intelligence Tests; D000067562:Late Onset Disorders; D016743:Mental Competency; D010358:Patient Participation / Q000379:methods / Q000523:psychology; D011340:Problem Solving; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction / Q000379:methods; D012201:Reward; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: Late-life depression; RDoC consensus; neurobiology-based; psychotherapy
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