Recognition of posttraumatic stress disorder (PTSD) in older adults is often difficult due to its complicated presentation. Once recognized, trauma symptoms can, in accordance with (inter)national guidelines, be successfully treated with eye movement desensitization and reprocessing (EMDR) therapy. However, limited empirical research has been done on the expression and treatment of PTSD in older adults. This article explains trauma and age in the context of psychotherapy. It discusses the interaction between age and pathology and summarizes the cognitive issues related to age, PTSD, and anxiety. It provides practical suggestions for how these can be addressed in treatment. Age-related challenges related to motivation are identified with practical suggestions for addressing them. The case illustrates the necessary additions and subtractions for older adults, with clear explanations and instructions. This article points the way for future research.
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- Go to article: Cognitive Behavioral Therapy for Older Adults With Anxiety and Cognitive Impairment: Adaptations and Illustrative Case Study
Cognitive Behavioral Therapy for Older Adults With Anxiety and Cognitive Impairment: Adaptations and Illustrative Case Study
Anxiety is a prevalent condition in older adults with neurocognitive disorders such as dementia. Interventions based on cognitive behavioral therapy (CBT) appear to be an emerging area of treatment innovation for treating anxiety in older adults with cognitive impairment. Drawing on the empirical literature on CBT for late-life anxiety and recent trials of CBT for anxiety in persons with mild-to-moderate dementia, this article provides an overview of the customization of CBT to the needs of older adults with anxiety and cognitive impairment. Adaptations for assessment, case conceptualization, socialization, therapeutic alliance, and treatment strategies are discussed. A case study to illustrate implementation of these adaptations is presented. Limitations to the current state of the literature on the efficacy and feasibility of CBT for anxiety in older adults with cognitive impairment are identified, and future directions for treatment research are proposed.
Chronic pain is often resistant to traditional medical management and other types of professional intervention. As such, several investigators have conducted studies of pain self-management programs. These self-management programs, however, were often led by therapists and shared much in common with traditional cognitive behavioral therapy (CBT); the efficacy of which, despite some inconsistencies, is largely supported in the literature. Although, like CBT, many therapist led programs involve a component of self-management in the form of “homework assignments,” it is important to evaluate the effectiveness of pain self-management, which is not therapist led. Within the context of controlled investigation, we evaluated a pain self-management program that involved use of a comprehensive self-help pain management book for older adults. Contrary to expectation, we did not identify any differences in the outcomes observed in the self-help patient group as compared to the control group (i.e., participants who did not receive the pain management book until after the study was completed) despite a great deal of satisfaction with the manualized program that was expressed by the participants. The implications of these findings are discussed.
Primary care providers (PCPs) often assess for complex needs and refer to specialty geriatric clinics focused on the unique needs of older adults. Being familiar with the components of a geriatric assessment is important for providers working in primary care as is familiarity with available community resources. The presence of behavioral health providers in primary care settings often helps bridge this gap, raising the likelihood of patients receiving a thorough geriatric assessment, referral, and follow-up as part of an integrated care plan. Facilitating effective referrals and coordinating services for geriatric patients is one of the primary interventions available to behavioral health specialists (BHSs) in primary care settings. Geriatric assessments require that the BHS remember that patients have autonomy. Geriatric depression is frequently comorbid with anxiety and often complicated further by the presence of comorbid physical illness or cognitive impairment that may limit pharmacological treatments and interfere with recommended behavioral interventions.