Wisdom enhancement and life skills to augment CBT outcomes for depression in later life: a series of N-of-1 trials

Background: It has been suggested that cognitive behavioural therapy for older adults be augmented with age-appropriate methods to enhance outcomes for depression treatment. Aims: This study investigated whether a CBT wisdom enhancement timeline technique for older adults reduced depression, as well as increase self-compassion and self-assessed wisdom. Method: An N-of-1 series trial with non-concurrent multiple-baseline AB design was conducted. Older adults experiencing depression, recruited from mental health service waiting lists, were randomly assigned to baseline conditions. Participants received five individual sessions of the examined intervention, offering a structured way of utilising one's life experiences to evolve the psychological resource of wisdom within a cognitive behavioural framework, in order to improve mood. Participants completed idiographic daily measures and self-report standardised measures of depression, anxiety, self-compassion and wisdom during baseline and intervention phases, and at 1 month follow-up. Results: Six participants competed the study and were subject to standardised and single-case data analyses. Four participants were deemed responders with reliable changes in depression post-intervention with idiographic changes coinciding with intervention onset. Two participants saw clinically significant changes in depression scores at follow-up. One responder saw significant changes in measures of self-compassion and self-assessed wisdom. Conclusions: The examined technique shows promise as an effective technique for reducing depression in older adults. There is insufficient evidence to implicate wisdom and/or self-compassion as significant mechanisms of change. Clinical and theoretical implications are discussed.