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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