Program to Encourage Active, Rewarding Lives (PEARLS)


(For resources, this is the publication date. For programs, this is the date posted.)


University of Washington Health Promotion Research Center (HPRC)

Visit the PEARLS Training page for training options and costs. The PEARLS Program Toolkit is free.

See This Resource

The Program to Encourage Active, Rewarding Lives (PEARLS), an intervention for adults and older adults with a depression or dysthymia diagnosis, aims to reduce symptoms of depression and suicidal ideation and improve quality of life.

Designed to empower clients through behavioral techniques, PEARLS consists of these primary components:

  • Problem-solving treatment: Participants learn to understand the link between unsolved problems and depression and to apply a seven-step approach to solving their problems.
  • Social and physical activation: Participants are encouraged to engage in social and physical activities that most interest them.
  • Pleasant activity scheduling: Participants identify and participate in activities they find pleasurable.

PEARLS is delivered in six to eight 50-minute sessions by a trained health or social service professional (e.g., social worker, nurse, case manager) in the client’s home or other community-based setting. Sessions are initially held weekly and become less frequent over a four- to five-month period. During sessions, clients choose the problems they would like to discuss, and the counselor guides, teaches, and supports the client in developing action plans that are to be implemented between sessions to address these problems.

Originally developed for older adults, PEARLS has been implemented with a variety of populations, including adults and older adults with chronic conditions, veterans and the spouses of veterans, older adults with minor depression or dysthymia who were receiving home-based social services, and individuals with epilepsy and depression who were receiving outpatient services.

Designation as a “Program with Evidence of Effectiveness”

SPRC designated this intervention as a “program with evidence of effectiveness” based on its review and rating by the Clearinghouse for Military Family Readiness and its inclusion in SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP).

(1)  Clearinghouse for Military Family Readiness Review of PEARLS

  • The Clearinghouse rates programs, not individual outcomes. PEARLS was rated as Promising.
  • The evidence summary states: “In the second study, at the 12-month follow-up, suicidal ideations decreased by 24% in the intervention group, while they decreased by 12% in the control group.  An additional study, conducted in individuals with epilepsy, demonstrated lower scores of depression severity, less suicidal ideation, and better emotional well-being 18 months after baseline compared to participants in usual care.”  

Read about the Clearinghouse review and rating process.

(2)  National Registry of Evidence-Based Programs and Practices (NREPP) Review of PEARLS

Please note that the National Registry for Evidence-based Programs and Practices (NREPP) has been discontinued and the full review is no longer available.     

Outcome(s) Reviewed (Evidence Rating)*

  • General Functioning and Well-Being (Promising)
  • Depression and Depressive Symptoms (Promising)
  • Receipt of Health Care (Promising)
  • Physical Health Conditions and Symptoms (Ineffective)

In an earlier NREPP review, PEARLS was listed as effective for reducing suicide ideation, but suicide-related outcomes were not listed after the program was re-reviewed using new criteria in 2015. 

* NREPP changed its review criteria in 2015. This program was reviewed under the post-2015 criteria. To help practitioners find programs that fit their needs, NREPP reviewed the evidence for specific outcomes, not overall programs. Each outcome was assigned an evidence rating of Effective, Promising, or Ineffective. A single program could have multiple outcomes with different ratings.

Reminder: When considering programs, we recommend (a) assessing whether the specific outcomes achieved by the program are a fit for your needs; and (b) examining the strength of evidence for each outcome.

2012 NSSP Objectives Addressed: 

Objective 3.1: Promote effective programs and practices that increase protection from suicide risk.

Objective 8.3: Promote timely access to assessment, intervention, and effective care for individuals with a heightened risk for suicide.