Treatment for Depression: Problem Adaptation Therapy
Here at Mayo Clinic Arizona, we are working to expand our mental health support in our primary care practice. In that process, we have hired several new social workers who can provide therapeutic support right in the primary care office. I recently had an opportunity to get to know one of our new staff, Janna Broxson. It turns out, she is also passionate about supporting those with memory problems and their loved ones. She has experience with a type of treatment called Problem Adaptation Therapy (PATH), which has been researched in older adults with depression and cognitive impairment. I hadn’t heard of this therapy, so I asked her for a short interview so I could learn more.
Unfortunately, depression is common in our patients with Mild Cognitive Impairment, so I'm always happy to learn more about evidence-based treatments specifically designed for those with MCI. I also found this research article that showed that PATH was more effective in reducing depression and disability than another type of therapy called supportive therapy. Below is an overview of Janna and I's discussion.
Dona Locke: Hi Janna—Thanks so much for taking some time to help me understand more about this treatment for depression in those with cognitive impairment. First of all, tell me a little more about what you do in your day to day practice here at Mayo Clinic Arizona.
Janna Broxson: I am a Licensed Master Social Worker (LMSW) with the Community Internal Medicine primary care area of Mayo Clinic Scottsdale in Arizona. I provide same-day appointments to patients that may need brief behavioral health interventions or referrals to specialty care clinics. I am integrated into the primary care practice to coordinate that care right in our clinic and collaborate with our primary care providers. I can triage patients at the point of care with their primary care physician to help address their mental or behavioral health needs in the moment.
DL: We’re all really excited to see those supports growing at Mayo Clinic—both for our patients and our primary care providers! OK, now tell me more about PATH treatment.
JB: Problem Adaption Therapy (PATH) is an evidence-based non-medication treatment approach that helps patients with mild to moderate cognitive impairment and depression learn adaptive ways to cope with mood and memory issues. It is an individualized therapy that helps the patients learn ways to avoid situations that cause negative changes in mood such as feeling down, depressed, hopeless, helpless, overwhelmed, anxious, guilt and shame.
DL: How long is the treatment?
JB: The formal PATH protocol is a 12-week home-delivered intervention that is personalized to the patient’s specific needs. The first two sessions focus on identifying situations or triggers that cause the patient to experience negative feelings. Once the triggers have been identified then the therapist and patient create a plan to improve mood by identifying specific problem-solving strategies that help with maintaining mood stability. Specifically, the patient will work closely with a PATH trained therapist to identify specific activities that bring a sense of pleasure and meaning, which assists in improving mood.
DL: Makes sense. Is the patient’s partner or caregiver involved in the therapy?
JB: Yes! Just like in HABIT the partner is involved in the therapy to help with ongoing application. In PATH the caregivers are encouraged to participate in the process, which helps the patient to use the skills that he or she have learned. The caregiver also assists the patient by encouraging the patient to engage in activities that bring a sense of pleasure and enjoyment throughout the day. This helps the patient to be less influenced by situations or triggers that tend to cause low mood. PATH also integrates the use of adaptive tools, much like in HABIT, such as checklists, signs, and calendars to assist the patient in avoiding low mood that may come from decreased cognitive function. For example, if a patient is struggling with feelings of loneliness, the caregiver, patient, and therapist might make a sign that reminds the patient that “going to bingo nights with my friends makes me feel better” and “staying home makes me feel more alone and sadder.”
DL: If a patient or partner reading this thinks this treatment might be helpful to them, what’s a good first step for them?
JB: Certainly, if a patient with cognitive impairment is experiencing depression a good first step is to reach out to their primary care physician. That physician can consider a number of options, both medication and non-medication, to treat that depression. Therapy may be part of that plan. Unfortunately, I am not aware of any formal in-home PATH treatment programs here in our area. It is a new treatment and in-home therapies are complicated to launch. However many local Area Agencies on Aging have some in-home consultations for depression. Patients could search for availability in their area via this link. In addition, many therapists can take a problem-solving and adaptive tools approach to treatment in the clinic as well.
DL: Thanks so much Janna! It sounds like PATH is really focused on mood impairment, but acknowledges the complicating factor that cognitive impairment can be to typical psychotherapies for depression. Thanks so much for sharing this new treatment with us!
Have you struggled with depression? If so, what healthy coping strategies have you found helpful? You may also find the Mayo Clinic Connect Depression & Anxiety discussion group helpful.