Handbook of Behavioral and Cognitive Therapies with Older Adults Book

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