A new study in JAMA offers impressive evidence that two treatment modalities – Behavioral Activation Psychotherapy (BA) and Antidepressant Medication Management (MEDS)– can significantly ease the severity of depression in patients, post-heart failure.
Heart failure can be devastating, physically, and patients often experience awful mental health, as well. A full 50% of patients with heart failure will experience clinical depression.
Explanation unnecessary.
Enter a new study that looked at how effective BA and MEDS can be for such patients.
Read this broader review from Giuliana Grossi, but here’s the gist:
Patients given BA therapy experienced a 50% reduction in depression symptoms at the 3, 6, and 12 month marks.
Meanwhile, they also had improved physical quality of life and fewer emergency department visits and hospitalizations.
In other words, BA can work wonders for those enduring the double-trauma of heart failure and depression.
Meanwhile, the MEDS alone group showed strong efficacy, as well (also around 50%) at reducing depressive symptoms, but offered fewer benefits in quality of life and hospital visits.
In other words, the data seems to suggest what you might expect — that BA is a more comprehensive modality with more comprehensive results.
So what is Behavioral Activation Psychotherapy?
The University of Michigan has a great guide, but to shorten things up: It’s a version of CBT that leans in heavily on how behaviors and feelings influence each other. The goal is to shorten, or downright avoid the negative downward spirals (how we all know about those, huh?) by encouraging activities that promote an “upward spiral of motivation and energy through pleasure and mastery” of an enjoyable and meaningful activity.
In other words, sure, turn around the thinking, but that’s not all there is. Start doing.
In BA alone, “action precedes emotion.”
It doesn’t mean you won’t have a negative spiral, you might just experience fewer spirals, and of course, that’s when cognitive rethinking comes into play.
So sure, it’s good to try to hijack the downward spiral, but it’s even better to take positive action before the spiral begins.
On the days you feel good, reinforce that feeling. And it will reap dividends.
Something like that. I’m not a trained therapist, by any stretch of the imagination, so read the guide (which includes a workbook) and look for a therapist (below) if you’re interested, but it seems pretty helpful.
And certainly, the new study suggests it’s awfully helpful, both physically and mentally, for patients suffering from both heart failure and depression.
Indeed, there’s another brand new study from the UK, published in The Lancet Healthy Longevity, that shows behavioral activation therapy through weekly telephone calls can meaningfully improve depression and quality of life for senior citizens (average age: 76 years old).
Now quick note:
I think a lot of Christian senior citizens might feel particular pressure to bottle up their depression or anxiety etc.
First, the younger generation of Christians was raised on the idea that mental health is a real thing, and indeed, a physical condition.
There’s far less shame if you’re a young Christian in revealing your depression or anxiety etc., because those terms are bandied about so often among young people.
But the older generation faces a couple problems on this score. They didn’t grow up in an environment where you talked about these issues. And there seems to be (I’d guess) a natural inclination to assume the role of the wiser person, who’s finally found the secret to life.
“Seek wisdom from the ancients” is as ancient an axiom, across culture and time, as there is.
And while, yes, senior citizens are full of wisdom, wisdom is quite separate from despair.
In fact, a great kind of wisdom comes from understanding despair.
When young people first face it, they’re often overwhelmed. Life isn’t supposed to be like this. What do I do? In addition to the dread, there’s an existential panic of being confronted with something for the first time.
But an older, wiser person might be able to reassure a younger person that, no, they’re not experiencing anything unusual and that, yes, there’s something called anxiety and that looking for help isn’t weakness (like we assume, as young folk), but instead strength.
So wisdom and depression can, and often, co-exist.
Now, for older Christians, I’d suspect the problem is even more acute.
They have to manage the misunderstanding that, along with wisdom and age, comes serenity.
Additionally, they have to manage the further burden of “Christian serenity.” I don’t put “Christian serenity” in quotes to mock it or say it doesn’t exist. It absolutely does. Absolutely. I only say that you can have a peace with Christ that you feel and intellectually know, along with a war that will continue to wage inside, until we reach heaven.
As a minor prophet put it: “There is no discharge in that war,” and to be a wise, older Christian is to recognize that (see my recent interview with Dr. Terry Powell, who smashes stigmas to shreds by openly speaking of his own depression and anxiety).
American society is always forgetting the older, the lonely.
We often view their lives through the same economic criteria that the American productivity model often manufactures. And that is crass and bottom-lined, and bottom in every sense of the term.
We should learn from eastern societies, where the older generation is not forgotten but instead truly venerated.
And the church needs to remember this, as well.
Older congregants might not bring kids or a huge paycheck to fill the coffers, but their needs are as great (maybe greater) and their worth of infinite value until their final breaths.
There is a wisdom in living, perhaps, a few years or days from your passing.
The closer you are to heaven, the more perspective you bring. Many saints of old urged those of every age to think actively of their final day, for it brings urgency to the current one.
So, when we take care of the elderly, they also take care of us. We see our lives through theirs and what a gift.
And remember — they can struggle too, and not just physically, the way we crassly assume.
Their mental wounds can, in fact, be deeper because they carry more nights of grief with them, and those nights add up.
Solomon, the wisest who ever was, ended on the right note (Ecclesiastes) and it wasn’t a particularly sanguine one.
There was melancholy and sadness, but ultimately, his final and most supreme wisdom.
When my wife and I had our first child, I remember taking him places and older folks saying, “Enjoy every minute,” and we chuckle because we hear it so much.
But we hear it so much because it’s so true. And instead of a chuckle, we should stop and say a blessing. For the one who just reminded us what we so often forget. Time is short. God is near.
Find a psychiatrist here.
Find a therapist here.
If you’re having thoughts of harming yourself or others, please call the National Suicide Lifeline at 1-800-273-8255.
[Painting: Old Man with a Cane, Babailov]
