Major depressive disorder (MOD) is a prevalent and serious psychiatric condition among older adults that has been associated with many individual and interpersonal problems in later life. Psychotherapy and pharmacotherapy have been used with success in this population, yet non-response, partial response, and relapse rates continue to be significant and there remains a need for improved interventions for this population. Marital therapy has shown promise as a treatment for depression and coexisting marital distress in younger populations, and may provide a beneficial addition to treatment for coupled older adults with depression. The purpose of this R34 application is to develop and test a depression-specific couple therapy treatment manual for depressed older adults (60+) with relationship distress. The new intervention will be adapted from Integrative Behavioral Couple Therapy (IBCT), an empirically supported treatment that incorporates both acceptance and change strategies. Several modifications to IBCT have been proposed to develop a treatment for older depressed adults, including the addition of motivational interviewing strategies to address ambivalence about treatment, psychoeducation classes to provide information and support, expanded assessment of relationship histories, routine use of behavioral exchange as a behavioral activation strategy, and focus on depression-related relationship patterns and problems. The first stage of this research (Stage 1a) will focus on the manual development process, and will include consultation with a panel of experts in geriatric depression (Drs. Steffens and Arean) and couple interventions (Drs. Christensen and Baucom). Modifications will be made to the manual in accordance with information gathered from 8-10 pilot cases, study therapists, team discussion, videotaped sessions, and feedback provided by the expert panel. In the second stage (Stage 1b), efforts will focus on conducting a pilot randomized clinical trial (RCT) to test the new treatment manual. The RCT will include two treatment arms: (1) Combination Treatment (Couple Therapy for Late-Life Depression plus Medication) and (2) Medication Only. The primary aims of the RCT are to examine the acceptability and feasibility of the new manual, revise therapist training procedures, and estimate the degree of change and variability of response to Combination Treatment relative to Medication Only on the primary outcomes of depression and relationship quality at post and 6-months follow- up. ? ? ? ?
