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Overcoming Depression
and Low Mood in Older
Adults
Overcoming Depression and Low Mood in Older Adults joins the bestselling Routledge
Overcoming Series, which includes publications that have the seal of approval from the
Association for Behavioral and Cognitive Therapies and are highly commended by the British
Medical Association.
This workbook outlines how to use the Five Areas® model of cognitive behavioural therapy (CBT)
to equip older adults experiencing low mood or depression with key life skills to overcome these
conditions.
Addressing the common challenges faced by older adults during times of low mood and
depression, the book provides educational life skills and resources to increase mental well-being
in the care home, day hospital and social support networks of this population. Chapters cover
topics such as understanding and changing behaviours; behavioural activation and tackling
avoidance; noticing and changing extreme and unhelpful thoughts; rebalancing relationships;
building assertiveness; and problem solving. Substantially featured throughout are worksheet
resources using interactive questions that can be photocopied for use by practitioners with older
and workbook adults or in their routine business as a therapist or health/social care practitioner.
This is a valuable text for any healthcare or mental health professional working with older adults
including psychological therapists, social care workers, residential home staff, psychiatrists
and practice nurses, general practitioners and health visiting staff. The workbook is also an
approachable resource for older adults themselves.
Award-winning author Professor Chris Williams is an Emeritus Professor of Psychiatry at the
University of Glasgow, UK, and an Honorary Fellow and Past President of BABCP – the lead
body for CBT in the UK. He is a well-known writer, teacher and researcher and his work focuses
on making CBT approaches accessible and usable. He is also Director of Five Areas Ltd which
produces a range of written and online CBT based resources for use across the lifespan.
Discover more at www.llttf.com/evidence
Overcoming Series
Series Editor: Chris Williams
The Overcoming series uses the tried and tested Five Areas® model of CBT to equip and empower
readers with the key life skills they need to overcome the challenges these conditions present.
The Five Areas® model communicates life skills and key interventions in a clear, pragmatic, and
accessible style, by examining five important aspects of our lives:
• Life situation, relationships, practical resources and problems
• Altered thinking
• Altered feelings or moods
• Altered physical symptoms or sensations
• Altered behaviour or activity levels
Titles in the series:
Overcoming Teenage Low Mood and Depression
Nicky Dummett & Chris Williams
Overcoming Postnatal Depression
Chris Williams, Roch Cantwell and Karen Robertson
Overcoming Anxiety, Stress and Panic, Third Edition
Chris Williams
Overcoming Depression and Low Mood, Fourth Edition
Chris Williams
Overcoming Teenage Low Mood and Depression, Second Edition
Nicky Dummett & Chris Williams
Overcoming Depression and Low Mood in Older Adults: A Five Areas® CBT Approach
Chris Williams
For further information about this series please visit:
https://www.routledge.com/Overcoming/book-series/CRCOVERCOMIN
Overcoming Depression
and Low Mood in Older
Adults
A Five Areas® CBT Approach
Chris Williams
First published 2024
by Routledge
4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2024 Five Areas Resources Limited
The right of Dr Chris Williams to be identified as the author of this Work has been asserted by
him/her in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved.
Limited licence to use
Permission is given for limited copying of this book by the purchaser where this is for use in the
normal course of the purchaser’s business within the free-access health care industry and within
small private healthcare clinics in relation to client consultations. This permission extends to provid-
ing copies of the relevant part or parts of the book to an individual patient/client where relevant to
a particular consultation.
This permission does not allow photocopying or use by other healthcare professionals and there-
fore each practitioner in a clinical or other service using this book must have his or her own
purchased copy. Nor does this permission extend to any purchaser working for or within a large
commercial organisation, including but not limited to employment assistant programmes, health
maintenance companies and insurance organisations. Such a purchaser or practitioner is not enti-
tled to copy or otherwise use the book to assist members of any organisation unless a commercial
license has been obtained from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks, and
are used only for identification and explanation without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Names: Williams, Chris, 1964- author.
Title: Overcoming depression and low mood in older adults : a five areas
CBT approach / Chris Williams.
Description: Abingdon, Oxon ; New York, NY : Routledge, 2024. |
Series: Overcoming series | Includes index. |
Identifiers: LCCN 2023037715 (print) | LCCN 2023037716 (ebook) |
ISBN 9781032389455 (hbk) | ISBN 9781032389448 (pbk) |
ISBN 9781003347637 (ebk)
Subjects: LCSH: Depression in old age--Treatment. | Cognitive therapy.
Classification: LCC RC537.5 .W55 2024 (print) | LCC RC537.5 (ebook) |
DDC 618.97/68527--dc23/eng/20231018
LC record available at https://lccn.loc.gov/2023037715
LC ebook record available at https://lccn.loc.gov/2023037716
ISBN: 978-1-032-38945-5 (hbk)
ISBN: 978-1-032-38944-8 (pbk)
ISBN: 978-1-003-34763-7 (ebk)
DOI: 10.4324/9781003347637
Typeset in Frutiger
by KnowledgeWorks Global Ltd.
Contents
Introduction ix
Foreword by Professor Stephen Curran xi
Acknowledgements xiii
Part 1: Getting started and understanding why you feel
as you do
1 Starting out … and how to keep going if you feel stuck 3
2 Understanding why you feel as you do 15
Part 2: Tackling problems and rebalancing relationships
3 Practical problem solving 33
4 Being assertive 49
5 Building relationships with your family and friends 61
6 Information for families and friends: How can you offer the best support? 75
Part 3: Making changes to what you do
7 Doing things that make you feel better 95
8 Using exercise to improve how you feel 111
9 Helpful things you can do 123
10 Unhelpful things you do 135
Part 4: Noticing and changing unhelpful thinking
11 Noticing unhelpful thinking 151
12 Changing unhelpful thinking 161
Part 5: Improving sleep, tackling alcohol misuse,
understanding and using antidepressant medication
13 Overcoming sleep problems 177
14 Harmful drinking and you 189
15 Understanding and using antidepressant medication 203
viii Contents
Part 6: Planning for the future
16 Planning for the future213
Index 227
Introduction
Overcoming depression and low mood in older adults is written for two main groups of people:
1 Older adults themselves, who are struggling with low mood or low mood and anxiety.
2 Practitioners such as doctors, nurses, mental health or social care-based workers, who are
looking for high-quality resources that they can use with older adults they work with.
About the resources
This book is one of a range of resources created by Five Areas Resources Ltd, and made available
under licence by Five Areas Ltd. It uses the widely recommended CBT approach. This book is one
of a series of books in the Overcoming … Five Areas® series. The companion book Overcoming
depression and low mood: a five areas® approach is aimed at adult readers. This book has been
widely recommended. It has been recognised and highly recommended by the British Medical
Association (BMA) Medical Book awards and has received the Self-help Seal of Approval by the
Association for Behavioural and Cognitive Therapies (ABCT: https://www.abct.org/sh-books/)
Read research about that book and the evidence base supporting its use at: www.llttf.com/
evidence
About the author
Professor Chris Williams is a medical doctor and an Emeritus Professor of Psychosocial Psychiatry
at the University of Glasgow. His first degree was in Psychology in relation to medicine, and
his subsequent work has focused on how to widen how to widen access to evidence-based
psychological therapies. His main research and teaching focus has been on how to create CBT-
based resources that are usable, and effective. He has written over 40 books, and over a million
copies of his titles have been sold worldwide. His award-winning books have been translated
into over 15 languages. He has also twice been President of the lead body for CBT in the UK –
the British Association for Behavioural and Cognitive Psychotherapies (BABCP www.babcp.com).
Professor Williams is also the Director of Five Areas Limited (www.fiveareas.com) which develops
and publishes a range of books, online courses and practitioner class resources for use in
educational and health, charity and social care settings.
How this book can be used
This book is based on the widely used and recommended Overcoming depression and low mood:
a five areas® approach book – for adults. It has been updated by specialist workers with older
adults/seniors in Oregon who commissioned a re-write of the book for older adults to be used
Statewide in the State of Oregon USA. This work was led by North-West Senior and Disability
Services (https://nwsds.org/), a local intergovernmental agency serving seniors and adults with
Overcoming Depression and Low Mood in Older Adults: A Five Areas® CBT Approach © 2024 Five Areas Resources Limited
x Introduction
physical disabilities in five Oregon counties. The book is made available with peer mentor support
as part of the Healthy Opportunities for Personal Empowerment (HOPE) Senior Peer Mentor
Program. Senior Peer Mentors are volunteers (age 45 or older) who are trained and supervised. The
HOPE Senior Peer Mentor Program is free. It is aimed at older adults aged 50 or older who wish to
gain more effective coping skills to help manage their mild to moderate depression and/or anxiety.
The current version of this book has been updated again by Professor Williams and colleagues Mrs
Theresa Kelly, and Mrs Sue Wood, to provide an up-to-date well-being resource for older adults.
The book can be read in order but is usually used by picking out the content that is relevant.
Recommended reading
Read Part 1 of the book:
a Starting out … and how to keep going if you feel stuck
b Understanding why you feel as you do
This will help you identify which other workbooks might be useful for you to work through.
Then select what topics and chapters might be relevant from Parts 2 and 3 of the book.
Additional optional topics are held in Part 4 of the book. Finally, there is a summary/review of
learning in the final Part of the book which addresses Planning for the future.
The reader can work through as few or as many workbooks as they find useful. Typically, many
readers will read the opening two chapters, then 3–5 additional topics.
You can use the workbooks as self-directed learning by yourself.
Or use it with support from a supporter or practitioner. Here, we recommend that the relationship
is one of tutor/trainer/coach, helping readers choose what topics they wish to work on, clarifying
understanding by asking questions, and applying and discussing what you are learning.
Practitioner Training: We offer Practitioner training for health and social are workers, as well
as businesses/self-employed practitioners via www.llttf.com/training
LIMITED LICENSE TO USE
Permission is given for limited copying of this book by the purchaser where this is for use
in the normal course of the purchaser’s business within the free-access healthcare industry
and within small private healthcare clinics in relation to client consultations. This permission
extends to providing copies of the relevant part or parts of the book to an individual
patient/client where relevant to a particular consultation.
This permission does not allow copying or use by other healthcare professionals and
therefore each practitioner in a clinical or other service using this book must have his or
her own purchased copy. Nor does this permission extend to any purchaser working for or
within a large commercial organisation, including but not limited to employment assistant
programmes, health maintenance companies and insurance organisations. Such a purchaser
or practitioner is not entitled to copy or otherwise use the book to assist members of any
organisation unless a commercial license has been obtained from the publishers.
Overcoming Depression and Low Mood in Older Adults: A Five Areas® CBT Approach © 2024 Five Areas Resources Limited
Foreword
Depression in older adults has been poorly recognised and often either overlooked – or
misidentified as part of getting old. That is misleading because depression is common in older
adults – with 1:10 affected.
Depression and low mood in older people are often also associated with poor physical health
such as hearing loss, poor sight, chronic pain, thyroid disease, cancer and/or disability. Older
adulthood is also a time of changes and often of losses. Losses of job role with retirement can
be also key. Sometimes people can become distanced and socially isolated from friends and
family as they grow older, - perhaps because they find it more difficult to get out and about or
travel on their own. Losses become more frequent as we age and get older. This can not only be
the loss of family members, partners or friends but can also be due to the loss of health, pets or
even losing their home due to life changes.
It is now widely recognised that older adults should have access to a range of evidence-based
interventions for depression and low mood. Part of the challenge for services to offer support for
older adults is a significant mismatch between the large demand for treatment, and the lack of
resources to achieve this. Part of the solution is the low-intensity revolution with the recognition
that access to CBT-based treatments and supports can be offered using books, websites and
classes – as well as the traditional route of seeing an accredited, expert CBT practitioner.
Professor Williams and colleagues have been at the forefront of advocating and developing
effective tools to achieve this. The resources are very widely used across the UK and
internationally, and provide staff and individuals direct access to expert-written life skills
resources that can allow older adults to learn effective strategies they can use to make changes
that can quite literally be life-changing. Overcoming depression and low mood in older adults
provides a wide suite of resources that address all the most common areas of need of older
adults and their carers.
I warmly welcome and highly recommend this excellent set of resources.
Professor Stephen Curran, BSc (Hons), MB ChB, MMedSc, MRCPsych, PhD, trained in
Leeds and was a Lecturer in old age psychiatry at the University of Leeds until he took up his
current post as a Consultant in old age psychiatry in Wakefield, UK. He has published many
peer view publications and nearly 20 books on depression, dementia and psychopharmacology
in older people and more recently on medical management for doctors. He is a co-author of
Practical Psychiatry of Old Age (5th Edition).
Overcoming Depression and Low Mood in Older Adults: A Five Areas® CBT Approach © 2024 Five Areas Resources Limited
Taylor & Francis
Taylor & Francis Group
http://taylorandfrancis.com
Acknowledgements
Photo image licenses from iStockphoto.com. The cartoon illustrations were produced by Keith
Chan, [email protected]. Thank you to Mrs Theresa Kelly and Mrs Sue Wood at Five
Areas Ltd for their helpful advice and comments on earlier drafts of this book. Also, to those
practitioners and Peer mentors at North West Senior and Disability Services in Oregon, USA who
inputted into the initial modifications of these resources to suit an older adult readership.
The term Five Areas® is a registered trademark of Five Areas Resources Ltd. Although we hope
you find this book helpful, it’s not intended to be a direct substitute for consultative advice with
a healthcare professional nor do we give any assurance about its effectiveness in a particular
case. Accordingly, neither we nor the author shall be held liable for any loss or damages arising
from its use.
Overcoming Depression and Low Mood in Older Adults: A Five Areas® CBT Approach © 2024 Five Areas Resources Limited
Taylor & Francis
Taylor & Francis Group
http://taylorandfrancis.com
PART 1
Getting
started and
understanding
why you feel as
you do
Taylor & Francis
Taylor & Francis Group
http://taylorandfrancis.com
