Handbook of Behavioral and Cognitive Therapies With Older Adults

by Gallagher-Thompson, Dolores; Steffen, Ann M., Ph.D.; Thompson, Larry W.

• ISBN13: 9780387720067
• ISBN10: 0387720065
• Edition: 1st
• Format: Hardcover
• Copyright: 2007-12-02
• Publisher: Springer Nature

Summary

The purpose of this book is to disseminate "best practice" models of treatment for the common mental health problems of late life, so that evidence-based practice will become the norm (rather than the exception) when working clinically with older adults. Each chapter will contain reviews of the empirical literature focusing on studies conducted with elders; then they will emphasize how CBT can be applied most effectively to that specific patient population. Case studies will be used to illuminate practice recommendations, and issues of diversity will likewise be highlighted whenever possible. Clinical researchers will also find this book useful because gaps in knowledge will be identified, and suggestions for future treatment oriented research will be made throughout the book. This is a unique volume in that it contains both solid reviews of empirically supported interventions for common mental health problems of older adults, as well as attention to emerging areas, in response to the needs of practitioners.

Author Biography

Dr. Dolores Gallagher Thompson is Professor of Research in the Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine. She has been both a funded clinical researcher and a practicing geropsychologist for over 20 years, focusing her work on intervention research. In the past decade she has devoted more time to understanding the unique problems faced by ethnically and culturally diverse family caregivers, and has developed intervention programs tailored to their needs. In addition, she was one of the founding members of the Academy of Cognitive Therapy and enjoys teaching graduate students "the fundamentals" of CBT- in particular, how to implement this approach with older adults. Dr. Ann Steffen is Associate Professor of Psychology and Director of Clinical Training at the University of Missouri-St. Louis. Her teaching, research and clinical interests all focus on mental health and aging, with a particular focus on the development and evaluation of community-based interventions for dementia family caregivers.Dr. Larry W. Thompson is currently Professor Emeritus from both Stanford University School of Medicine and the Pacific Graduate School of Psychology. He is also an active clinician/ mental health consultant to one of the local counties in northern CA where he has had the opportunity to work with bipolar patients and those with more severe mental disorders. Larry has authored a recent text on the use of CBT with bipolar individuals and is now working on a project to adapt CBT for use with depressed older adults of Asian ancestry - particularly Chinese Americans.

Table of Contents

Behavioral and Cognitive Treatments for Geriatric Depression: An Evidence-Based Perspective	p. 1
Background/Prevalence	p. 1
Evidence Base	p. 3
Assessment Considerations	p. 3
Treatment/Intervention Approach	p. 4
Behavioral Therapy	p. 5
Cognitive-Behavioral Therapy	p. 6
Cognitive Bibliotherapy	p. 7
Problem-Solving Therapy	p. 8
Combination Treatment	p. 8
Issues of Diversity	p. 10
Case Example	p. 11
Commentary	p. 13
Conclusion	p. 13
References	p. 14
Treating Generalized Anxiety in a Community Setting	p. 18
Generalized Anxiety in Older Adults-Prevalence, Definitions, and Conundrums	p. 18
Understanding Diversity Issues	p. 21
Assessment Strategies	p. 21
Clinician-Administered Measures	p. 21
Self-Report Measures	p. 22
Psychosocial Treatments for Generalized Anxiety	p. 24
The Case of Evie and Her Angst	p. 26
Commentary	p. 28
Conclusion	p. 28
References	p. 29
Treatment of Late-Life Generalized Anxiety Disorder in Primary Care Settings	p. 33
Brief Review of Empirically Supported Treatments of Anxiety in Older Adults	p. 33
Models of Integration of Mental Health Treatment: Primary Care Setting	p. 34
Extending Psychotherapy for Late-Life Gad into Primary Care	p. 36
A Clinical Perspective on Integrating Psychotherapy into the Primary Care Setting	p. 37
Assessment of Anxiety in Primary Care Settings	p. 39
Diversity	p. 40
Case Study	p. 40
Summary and New Directions in the Treatment of Gad	p. 43
References	p. 43
Cognitive-Behavior Therapy for Late-Life Insomnia	p. 48
Assessment Considerations Linked to Treatment Planning	p. 49
Treatment	p. 51
Behavioral Interventions	p. 51
Cognitive Interventions	p. 54
Case Example	p. 55
Combining Pharmacological and CBT Interventions	p. 56
Issues of Diversity	p. 57
SES and Ethnicity/Culture	p. 57
Cognitive Impairment	p. 57
Conclusion	p. 58
References	p. 58
A Relapse Prevention Model for Older Alcohol Abusers	p. 61
Issues of Diversity	p. 62
Screening and Assessment	p. 62
Treatment Approaches	p. 63
The Relapse Prevention Model	p. 63
The CBT/Self-Management Model	p. 65
Determining Discharge Readiness	p. 69
Follow-Up and Aftercare	p. 69
Suggestions for Counselors	p. 70
Case Example: The Widow Who Drank Alone	p. 71
Drinking Pattern	p. 71
Intervention	p. 71
Pharmacological Approaches	p. 72
Summary	p. 73
References	p. 73
Cognitive-Behavioral Pain Management Interventions for Long-Term Care Residents with Physical and Cognitive Disabilities	p. 76
Pain in Long-Term Care	p. 76
Special Considerations Regarding Pain in Older Persons with Dementia	p. 77
Evidence of the Effectiveness of CBT for Older Adults with Chronic Pain	p. 78
Psychological Assessment for Pain Management	p. 79
Psychosocial History	p. 79
Cultural, Personality, and Psychophysiological Styles Affecting Pain Experience and Expression	p. 80
Cognitive Assessment	p. 81
Psychiatric History and Current Medical Symptoms	p. 86
Medical Conditions Associated with Acute and Chronic Pain	p. 86
Pain Assessment	p. 86
Nociceptive/Perceptual Assessments	p. 87
One-Item Pain Rating Scales	p. 87
Minimum Data Set 2.0	p. 87
Behavioral Observational Pain Severity Scales	p. 87
Assessment of ADL and Behavioral Dysfunction Associated with Pain	p. 88
Multidimensional Assessment Batteries	p. 89
GMCBT	p. 89
Case Conceptualization and Psychological Care Plans	p. 89
GMCBT: A Comprehensive Approach to Pain Management	p. 91
Case Study	p. 92
Pharmacological Interventions	p. 96
Diversity Issues	p. 96
References	p. 97
Reducing Psychosocial Distress in Family Caregivers	p. 102
Background	p. 102
Overview of Caregiver Distress: Why Do We Need Interventions for Caregivers?	p. 102
Diversity Issues in Intervention Research	p. 104
Assessment Issues and Recommendations	p. 106
Case Examples	p. 107
Brendan	p. 107
Esther	p. 109
Directions for Future Research	p. 112
References	p. 114
Integrated Psychosocial Rehabilitation and Health Care for Older People with Serious Mental Illness	p. 118
Evidence Base	p. 118
The Hopes Program	p. 120
Assessment	p. 120
Description of the HOPES Program Components	p. 121
Orientation to the HOPES Program	p. 121
Skills Training Classes	p. 122
Curriculum	p. 122
Community Practice Trips	p. 122
Health Management Meetings	p. 123
Content of the Skills Training Curriculum	p. 123
Skills Training Methods	p. 123
Steps of Social Skills Training	p. 125
Establish the Rationale for the Skill	p. 125
Introducing the New Skill	p. 125
Practicing the Skill	p. 126
Home Practice	p. 129
Planning for the Community Trip	p. 129
Age-Related Adaptations to Skills Training	p. 129
Adaptations to Skills Training to Accommodate Cognitive Impairment	p. 130
Health Management Procedures	p. 130
Integration of Components	p. 131
Case Example	p. 131
Diversity Issues	p. 132
Summary	p. 133
References	p. 133
Cognitive Therapy for Suicidal Older Adults	p. 135
Evidence-Based Treatment for Depression with Suicidal Older Adults	p. 137
Suicide Risk Assessment	p. 138
Cognitive Therapy for Suicidal Older Adults and Case Example	p. 140
Developing a Safety Plan	p. 140
Constructing a Cognitive Case Conceptualization	p. 141
Case Example	p. 141
Targeting Hopelessness and Increasing Problem-Solving Skills	p. 143
Improving Social Resources	p. 144
Improving Adherence to Medical Regimen	p. 144
Increasing the Reasons for Living	p. 145
Termination Issues	p. 145
Diversity Issues	p. 146
Summary	p. 147
References	p. 147
Cognitive Therapy for Older People with Psychosis	p. 151
Adapting Cognitive Therapy for Older People with Psychosis	p. 151
Evidence for the Efficacy of Cognitive Therapy for Older People with Psychosis	p. 152
Use of Medication	p. 153
Use of Cognitive Therapy in Practice	p. 153
Assessment	p. 154
Formulation and Goal Setting	p. 157
Psychoeducation and Normalization	p. 158
Working with Hallucinations	p. 159
Case Formulation and Intervening with Delusions	p. 161
Case Study	p. 163
Second Session	p. 166
Third Session	p. 167
Conclusion	p. 168
References	p. 168
Behavioral Interventions to Improve Management of Overweight, Obesity, and Diabetes in Patients with Schizophrenia	p. 171
Evidence Base	p. 172
Diabetes Management and Rehabilitation Training	p. 173
Theoretical Foundation	p. 173
Basic Structure	p. 173
Assessment	p. 174
Pilot Test of the DART Program	p. 174
Cognitive-Behavioral Elements of the DART Intervention	p. 175
Goal Setting	p. 175
Short-Term Goals	p. 175
Behavioral Monitoring	p. 175
Stimulus Control	p. 176
Problem-Solving	p. 176
Behavioral Shaping Through Use of Incentives	p. 177
Graded-Task Assignments	p. 177
Modifications for Older Adult Patients with Serious Mental Illness	p. 178
Case Example: Ms. B.	p. 179
Overview	p. 179
Assessment	p. 179
Intervention	p. 180
Outcomes	p. 181
Diversity Issues	p. 181
Summary	p. 182
References	p. 183
Dialectical Behavior Therapy for Personality Disorders in Older Adults	p. 187
Evidence Base for Treatment of Older Adults	p. 188
Study 1	p. 188
Study 2	p. 189
Assessment Considerations	p. 189
DBT[superscript D+PD] for Older Adults with Personality Disorders	p. 190
Individual Therapy	p. 191
Group Skills Training	p. 191
Telephone Consultation	p. 192
Team Consultation	p. 193
Case Example	p. 193
Assessment	p. 193
Treatment Interventions	p. 193
Treatment Outcome	p. 195
DBT[superscript D+PD] in Combination with Psychopharmacological Treatment	p. 195
Diversity Issues and Personality Disorders in Older Adults	p. 196
Conclusion	p. 197
References	p. 197
Treating Persons with Dementia in Context	p. 200
Cognitive Decline, Behavioral, and Psychological Symptoms	p. 200
Pharmacological Treatment	p. 201
Behavioral Treatment	p. 201
The Functional Analytic Model	p. 202
Evidence Base for the FA Model	p. 202
Assessment Issues Unique to Dementia	p. 203
Behavior Change Strategies	p. 205
Treatment Goals	p. 205
Case Example	p. 209
Initial Contact	p. 209
Case Conceptualization	p. 210
Descriptive Functional Assessment	p. 210
Initial Coaching Plan	p. 211
The First Two Years	p. 212
The Third Year	p. 212
Second Coaching Plan	p. 213
The Fourth Year	p. 213
Third Coaching Plan	p. 214
References	p. 215
Cognitive Behavioral Case Management for Depressed Low-Income Older Adults	p. 219
Background	p. 219
Evidence Base	p. 221
Assessment Considerations	p. 222
Treatment Model	p. 223
The Structure of CB Case Management	p. 224
Case Example	p. 225
Cultural Considerations	p. 226
Conclusions	p. 228
References	p. 228
Post-Stroke Depression and CBT with Older People	p. 233
Understanding the Context of CBT for Post-Stroke Depression	p. 233
Stroke	p. 234
Post-Stroke Depression	p. 234
Assessment of Depression Following a Stroke	p. 236
The Efficacy of CBT as a Treatment for Post-Stroke Depression	p. 237
The Application of CBT for Post-Stroke Depression	p. 239
Characteristics of CBT for PSD	p. 239
The Application of CBT for PSD	p. 239
Assessment and Therapy	p. 242
Case Examples of CBT for PSD	p. 243
First Case Mr. C.	p. 243
An Example Illustrating the Use of SOC in CBT for Post-Stroke Depression	p. 244
Summary	p. 245
References	p. 246
Cognitive Behavioral Therapy for Older Adults with Bipolar Disorder	p. 249
Clinical Presentation in Older Adults	p. 250
Assessment	p. 251
Depression	p. 251
Mania	p. 251
Treatment Approach	p. 252
Pharmacotherapy	p. 252
Psychosocial Treatment	p. 252
The Role of Social Rhythm Stability in Reducing Episodes	p. 253
A Conceptual Model for Psychosocial Treatment of Older Adults	p. 253
Socializing Older Adults to Cognitive Behavioral Therapy	p. 254
Adapting Cognitive Therapy to Older Adults with Physical and Cognitive Limitations	p. 254
Treating Bipolar Depression	p. 255
Behavioral Strategies for Treating Bipolar Depression in Older Adults	p. 255
Treating Mania in Older Adults	p. 256
Case Example - Coping with Hypomania: "I'm a Super Woman"	p. 257
Case Example: Mrs. M.	p. 258
History	p. 258
Current Family and Social Context	p. 258
Specific Age-Related Issues	p. 259
Summary	p. 260
References	p. 260
Meaning Reconstruction in Later Life: Toward a Cognitive-Constructivist Approach to Grief Therapy	p. 264
Background: Pathways Through Bereavement	p. 265
Assessment	p. 267
Conceptual Issues	p. 270
Treatment	p. 271
Case Illustration	p. 273
Conclusion	p. 274
References	p. 275
PTSD (Post-Traumatic Stress Disorder) in Later Life	p. 278
Empirically Supported Treatment and Principles	p. 278
Acute and Chronic Trauma at Late Life	p. 280
Aging Issues of Trauma: Vulnerability and Stress Inoculation Hypotheses	p. 281
Assessment	p. 282
Treatment Model	p. 283
Case Example	p. 286
Assessment	p. 287
Treatment	p. 288
Conclusion	p. 289
References	p. 289
Training of Geriatric Mental Health Providers in CBT Interventions for Older Adults	p. 295
Core Competencies in Working with Older Adults	p. 295
Importance of CBT Competencies in Formal Training Programs as Well as Continuing Education	p. 297
Therapist Skills Training Models	p. 299
Supervision of Skills Training in Geropsychology	p. 301
Conclusions	p. 303
References	p. 303
Appendix	p. 305
Training Courses	p. 305
North America	p. 305
International	p. 306
Professional Societies (Aging Focus)	p. 306
Professional Societies (CBT Focus)	p. 307
Manuals and Publications of Note	p. 308
The Role of Positive Aging in Addressing the Mental Health Needs of Older Adults	p. 309
SOC and Reserve Capacity	p. 311
CBT and Positive Aging Characteristics	p. 313
Dealing with Age-Related Decline	p. 313
Making Affirmative Lifestyle Choices	p. 314
Invoking Novel Problem Solving Strategies	p. 314
Focusing on the "Positives"	p. 315
Meaning-Centered Strategies and Coping Capacity	p. 315
Gratitude	p. 316
Altruism	p. 316
Forgiveness	p. 317
Case Presentation	p. 318
References	p. 321
How Medicare Shapes Behavioral Health Practice with Older Adults in the US: Issues and Recommendations for Practitioners	p. 323
Why Bother to become a Medicare Provider?	p. 325
Essential Sources of Information	p. 326
A Cautionary Tale for Medicare Providers	p. 326
The Resource-Based Relative Value Scale, Basis of Reimbursement	p. 327
Advocacy Efforts Make a Difference	p. 328
Medical Necessity	p. 328
Documentation Should Reflect Observable Symptoms and/Or Problem Behaviors	p. 329
Audits Impact Clinical Practice	p. 329
The Use of Modifiers in Correct Billing	p. 330
Expansion and Change of Clinical Procedural Codes	p. 330
Documentation of Clinical Service	p. 330
Develop a Medicare Compliance Plan for Your Practice	p. 332
Pay-For-Performance: A Future Trend in Medicare Reimbursement?	p. 333
References	p. 333
Index	p. 335
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