Psychotherapeutic and psychopharmacological approaches
Little research exists on preventive strategies to enhance resilience to stress in older adults. There are a few examples of the cognitive-behavioral therapy approach to resilience and well-being in younger adults. The resiliency training program is a 5-day progressive program that provides experiences for participants to enhance personal resilience.27 Select aspects of resilience that improve as a result of the intervention include self-esteem, locus of control, purpose in life, and interpersonal relations.
Fava and colleagues28-31 used well-being therapy (a short-term psychotherapeutic strategy) to improve symptoms of anxiety and depression in younger adults. Well-being therapy is based on a multidimensional model that encompasses environmental mastery, personal growth, purpose in life, autonomy, self-acceptance, and positive relations with others.7,26,32 It has been used as a relapse-preventive strategy in mood disorders and in treatment-resistant patients.28-30,33 Complementary and alternative interventions can also help treat or prevent stress-related disorders. Mind-body interventions, such as tai chi and meditation, have also been noted to modulate the immune response.34-37 These interventions can normalize immune and endocrine response to stress and depression. Relaxation and stress reduction can change the immune system by decreasing negative emotions. These interventions may influence immunity by providing people with more social contact or helping them develop better coping strategies.38,39
Physical exercise may be an effective intervention for limiting the impact of stress on immunity in chronically stressed older populations.40 Stress management interventions attempt to alleviate the immune system dysregulation that accompanies psychological stress.
Observations from an ongoing study of yoga meditation by family caregivers of patients with dementia have shown that meditation for 25 to 30 minutes can be strikingly beneficial (H. Lavretsky, unpublished data, 2010). Study participants report relief from depression and insomnia and improved coping ability.
Case vignette
A 65-year-old African American woman who was caring for her mother with Alzheimer disease and her sister with stroke-related dementia had significant depressive symptoms and distress and scored 12 on the Hamilton Depression Rating Scale (HDRS). Her symptoms began to diminish after she began to meditate daily; after 2 weeks her HDRS score decreased to 1. She reported an increased ability to cope and assess her stressful situation more objectively without the level of anger and resentment that was present before she started meditating. She also learned to allocate time to herself and take part in pleasurable activities. She no longer felt trapped or a victim of the circumstances.
For this stressed caregiver, daily meditation and the recognition of her psychological needs increased her resilience and ability to cope with her life stressors. This woman felt empowered by the idea of wellness, resilience, and self-reliance.
A recently published review of the effect of mindfulness meditation on cellular aging suggests that mindful meditation techniques shift cognitive appraisals from threat to challenge, decrease ruminative thought, reduce stress arousal, and directly increase positive arousal states that affect telomerase activity and telomere length, thereby improving longevity.41 Further studies are needed because currently there is only preliminary evidence that the use of mind-body techniques such as meditation can be useful in preventing diseases of aging.
