Increasing pleasant events in the nursing home Collaborative behavioral treatment for depression

Depression is prevalent in nursing homes, but there are many barriers to effective treatment in these settings. This case study describes a successful behavioral treatment of a nursing home resident with recurrent major depression. The 10-session, manualized program involved negotiating a weekly plan to systematically increase pleasant activities, administered collaboratively with nursing home staff. At baseline, the client was socially withdrawn, participated in no regular activities, did not leave her room except for therapies, and was tearful and apathetic. Treatment outcomes included markedly improved positive affect and increased activity level at posttreatment, and absence of depressive symptoms or diagnosis at both posttreatment and after a 12-week follow-up. The case illustrates barriers to successful treatment in nursing homes such as ongoing medical stressors, poor staff follow-through, and difficulty maintaining gains, but it also supports the potential of a theoretically based, behavioral approach to treating depression in long-term care.