Implementing Behavioral Activation in Geriatric Depression: A Primer

Behavioral activation (BA) is a psychosocial treatment for depression designed to help patients increase contact with positive and rewarding aspects of daily life. The majority of BA research has focused on general adults and adolescents. While emerging data suggests that behavioral treatment is efficacious for depressed, elderly patients, there is little published guidance on how to adapt behavioral principles to meet the unique needs of an aging patient population. This article is designed as a primer to move from the empirically supported treatment to working as an evidence-based practitioner when treating geriatric patients with depression, providing suggestions for adapting the principles of behavioral activation to a depressed elderly population. We highlight prototypical situations and stressors that can present in older age patients who meet the criteria for late-life depression. We start with general suggestions for case conceptualization in behavioral activation. We then place a specific emphasis on case conceptualization and treatment planning for four prototypical psychosocial stressors: retirement, bereavement, physical pain/medical comorbidities, and caregiver stress. In each section, we emphasize how to anticipate and intervene around difficulties with activity scheduling and activity enjoyment.