University of Washington Health Promotion Research Center

Three older women lifting dumbbells

A Prevention Research Center Tool Showing Evidence of Effectiveness


PEARLS (Program to Encourage Active, Rewarding Lives) is a treatment program designed to reduce symptoms of depression and improve quality of life among older adults1 and among all-age adults with epilepsy.2,3 More than 50 sites in 18 states use PEARLS, with more organizations enrolling each year. The program consists of six to eight in-home counseling sessions that focus on the following goals:

  • Solving problems.
  • Becoming socially and physically active.
  • Scheduling enjoyable activities.

PEARLS helps individuals to lead more active and rewarding lives. The PEARLS tool kit includes instructions for conducting the program and holding sessions with clients, as well as forms and materials to create the organizational structure for PEARLS. A 2-day in-person training session in Seattle, Washington, prepares staff to implement the program.


A University of Washington study determined that PEARLS participants had a 50% or higher reduction in symptoms of depression, and 36% showed complete remission. The participants’ quality of life, both physical and emotional, also improved, resulting in fewer hospitalizations.1 Later studies showed that the program is also effective for adults of all ages with epilepsy.2,3


PEARLS Toolkit
Download the printable PDF version [PDF – 588 KB] of the web page

  1. Ciechanowski P, Wagner E, Schmaling K, et al. Community-integrated home-based depression treatment in older adults: a randomized controlled trial. JAMA. 2004;291(13):1569–1577.
  2. Ciechanowski P, Chaytor N, Miller J, et al. PEARLS depression treatment for individuals with epilepsy: a randomized controlled trial. Epilepsy Behav. 2010;19(3):225–231. doi:10.1016/j.yebeh.2010.06.003.
  3. Chaytor N, Ciechanowski P, Miller JW, et al. Long-term outcomes from the PEARLS randomized trial for the treatment of depression in patients with epilepsy. Epilepsy Behav. 2011;20(3):545–549. doi:1016/j.yebeh.2011.01.017.