PEARLS Program Fights Depression

by Carl Kaiser, PEARLS Counselor

PEARLS:  "Program to Encourage Active Rewarding Lives for Seniors."

Through PEARLS counseling, clients learn to recognize their unique symptoms of depression. They also focus on conceptualizing depression as unsolved problems problems that they can do something about.

As an outgrowth of a research study that was conducted by the University of Washington Health Promotion Research Center, the City of Seattle Aging and Disability Services is now implementing an in-home counseling program for clients who are seeking active ways to manage their depression. Clinically significant depression affects 15 to 20 percent of elderly individuals in the United States. Many of these people experience frequently undiagnosed, less severe depression, which is more commonly called subsyndromal (or minor) depression. 

Minor depression which shares to a lesser degree the symptoms of major depression often does not come to the attention of medical professionals or social workers. People experiencing minor depression may...

...have feelings of unhappiness and discouragement

...experience less fulfilling lives

...be less likely to follow their healthcare providers'    treatment guidelines

...not engage in healthy practices to manage chronic    medical conditions.

The UW study found that clients receiving the PEARLS counseling as an intervention experienced a significant reduction in symptoms of depression and some experienced a complete remission. 

Meet Jean Crosby

Mrs. Crosby is a mother of five children. She worked as a homemaker as well as outside of the home. While raising her family, she was involved in her church and she continues to attend services and a Bible study group. Mrs. Crosby began participating in the PEARLS in-home counseling program because she felt discouraged over her medical problems. She said, "I can do so much less than I could before. I used to be a very active person." She felt down and sad, and often found little pleasure or interest in doing things. 

These kinds of feelings are symptoms of depression. Although Mrs. Crosby did not experience these feelings to a serious degree, they certainly reduced her level of enjoyment of life, and decreased her ability to care for herself by attending to health care details to managing her medical problems.

But then, through a series of individual counseling sessions, Mrs. Crosby began to see how her depression which seemed overwhelming could be broken down into distinct problems, and put into writing. The next step was to tell the difference between problems that were out of her control and those that she could do something about. Once a problem was defined, Mrs. Crosby was able to formulate a variety of possible solutions to solve it. Even with problems that were out of her control, she often was able to identify an aspect of the problem she could do something about. 

For example: Mrs. Crosby experienced fatigue whenever she went out to an appointment or errand. After considering the possible solutions, she decided to build her strength by walking each day, even if she had no outing planned.

Sometimes finding the solution takes a little "detective work." For example, Mrs. Crosby noted, "I don't have the internal joy I once had."  Examining these feelings, she next realized that one important loss was that she was no longer able to read scripture, for her own edification, as well as to prepare for a Bible study group she had enjoyed. The solution: Mrs. Crosby formulated an action plan to go out, price and purchase low-cost reading glasses. 

Having methodically gone through the PEARLS problem solving process, Mrs. Crosby has learned to conceptualize her depression as a distinct set of problems. She now has a six-step model to use as a formula to solve problems that confront her. And each success in solving problems increases her confidence, empowering her to take greater charge of her life. Her symptoms of depression have diminished and she is much more able to manage her depression. Mrs. Crosby has interrupted a "downward cycle" and turned it into progress.  

For more information....

See the related articles in this issue, "Depression in Older Adults" and "Depression is Treatable," for more about diagnosing and treating depression.

The Aging and Disability Services website has information about the PEARLS Program, including eligibility criteria and links to studies.      

The PEARLS Project website includes information about the project, and background materials about depression in older adults. More information about "problem solving therapy" will also be available at a later date.