Particularités des thérapies cognitivo-comportementales et des interventions de psychologie positive dans la prise en charge de la dépression chez les personnes âgées
Résumé
Summary
The increase in psychological and psychiatric consultations by the older adult population, in particular for depressive disorders closely linked with suicide risk [2], calls for effective psychotherapeutic support adapted to the characteristics of this population. Given the lack of research on the effectiveness of psychotherapy for older adults [5], recent studies recognize its success, particularly in the case of cognitive behavioral therapy (CBT) [4]. However, some limitations of CBT with regard to this population require adaptations to their specific needs. Several authors have focused on the adaptation of CBT to the older adult [8], [9], [10], [11]. A complete summary of Evans in 2007 [8] lists the cognitive, sensory and physical disorders which may interfere with therapy and demand particular attention from therapists. The specificity of certain issues, recurring factors or cognitions lead the therapist to adapt the content of the sessions: among other things, issues relating to loss and transition according to Thompson [10], the negative portrayal of old age or anxiety about health [8]. An integrative view appears beneficial in the elderly population. It allows the identification of cognitive schemas, specific to depression in the elderly [17], and typical dysfunctional cognitions, such as the trivialization of depressive symptoms and the inability to change due to aging. An improvement of cognitive restructuring of these cognitions has been proven [18], [19], [20]. At present, adaptations of CBT remain focused on problem areas of the patient, yet work on individual resources would appear to be relevant as a means of optimizing CBT with the older adult.
The benefits of positive psychology interventions with the older adult
Psychotherapeutic work focusing on positive emotions appears effective [21], [22] and positive psychology interventions (PPIs) are proving to be very promising. Recently, integrated into so-called third wave CBT therapies, these empirically validated approaches focus on positive resources, values and experiences. Their benefits have been shown, particularly in the older adult [24], and demonstrate an improvement in well-being and a decrease in depressive symptoms. However, the few studies in older adults use a limited variety of PPI techniques and are very focused on the past. This should encourage research on existing PPIs to assess and to identify those that are effective, valid and easy to use with the elderly population. Positive psychotherapy (PPT), created by Martin Seligman, is a promising development in this direction. It aims to eliminate psychopathological symptoms and promote happiness and well-being by building positive emotions, reinforcing strength of character and giving meaning to life. Under this approach, emotions and positive forces are as authentic and real as psychopathological symptoms and disorders, and therefore must be fully appreciated. It is complimentary to approaches focusing on the eradication of symptoms. Through more attractive and easy to follow exercises and strategies, it emphasizes the importance of seeking and enhancing positive emotions and strength of character, an important factor in the treatment of the psychopathology [34]. Although not directly concerning the elderly population at present, studies on the effectiveness of PPT show that it is particularly efficient in reducing depressive symptoms and significantly increasing the level of well-being, while reducing the risk of relapse without the need for maintenance sessions.
Conclusion
Whilst CBT seems effective in the treatment of depression in the older adult, exercises, which are sometimes constraining or even inaccessible, have been adapted to take into account their specificities; it still remains focused on dysfunctions. Yet, work focusing on the resources of the older adult would appear to be useful and efficient. This could be accomplished by PPIs, and in particular PPT, which appear to compliment CBT. The benefits of PPIs and their validity with the elderly population are, therefore, promising areas of research.
La population âgée représente aujourd’hui une part de plus en plus considérable des consultations pour troubles dépressifs, d’où l’importance de proposer une prise en charge efficace et optimale. Alors que la thérapie cognitivo-comportementale s’est montrée efficace chez ces patients, elle comporte des limites, d’où la nécessité d’adaptations spécifiques au sujet âgé déprimé. De plus, à l’heure où la psychologie positive et son travail sur les ressources de l’individu s’installent dans les nouvelles techniques thérapeutiques reconnues, des études soulignent leur potentiel important auprès de la population âgée. Ce constat nous interroge sur le rôle des interventions de psychologie positive et de leurs techniques simples et accessibles, qui pourraient apporter des perspectives complémentaires aux thérapies cognitivo-comportementales classiques.