Characteristics of Cognitive Behavioral Therapy for Older Adults Living in Residential Care: Protocol for a Systematic Review

Background: The prevalence rates of depressive and anxiety disorders are high in residential aged care settings. Older adults in such settings might be prone to these disorders because of losses associated with transitioning to residential care, uncertainty about the future, as well as a decline in personal autonomy, health, and cognition. Cognitive behavioral therapy (CBT) is efficacious in treating late-life depression and anxiety. However, there remains a dearth of studies examining CBT in residential settings compared with community settings. Typically, older adults living in residential settings have higher care needs than those living in the community. To date, no systematic reviews have been conducted on the content and the delivery characteristics of CBT for older adults living in residential aged care settings. Objective: The objective of this paper is to describe the systematic review protocol on the characteristics of CBT for depression and/or anxiety for older adults living in residential aged care settings. Methods: This protocol was developed in compliance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Studies that fulfill the inclusion criteria will be identified by systematically searching relevant electronic databases, reference lists, and citation indexes. In addition, the PRISMA flowchart will be used to record the selection process. A pilot-tested data collection form will be used to extract and record data from the included studies. Two reviewers will be involved in screening the titles and abstracts of retrieved records, screening the full text of potentially relevant reports, and extracting data. Then, the delivery and content characteristics of different CBT programs of the included studies, where available, will be summarized in a table. Furthermore, the Downs and Black checklist will be used to assess the methodological quality of the included studies. Results: Systematic searches will commence in May 2018, and data extraction is expected to commence in July 2018. Data analyses and writing will happen in October 2018. Conclusions: In this section, the limitations of the systematic review will be outlined. Clinical implications for treating late-life depression and/or anxiety, and implications for residential care facilities will be discussed

patrimonio intelectual

Actas de congresoLas VI Jornadas se realizaron con la exposición de ponencias que se incluyeron en cuatro ejes temáticos, que se desarrollaron de modo sucesivo para facilitar la asistencia, el intercambio y el debate, distribuidos en tres jornadas. Los ejes temáticos abordados fueron: 1. La enseñanza como proyecto de investigación. Recursos de enseñanza-aprendizaje como mejoras de la calidad educativa. 2. La experimentación como proyecto de investigación. Del ensayo a la aplicabilidad territorial, urbana, arquitectónica y de diseño industrial. 3. Tiempo y espacio como proyecto de investigación. Sentido, destino y usos del patrimonio construido y simbólico. 4. Idea constructiva, formulación y ejecución como proyecto de investigación. Búsqueda y elaboración de resultados que conforman los proyectos de la arquitectura y el diseño

Application of the cool teens computerized CBT program with an anxious adolescent in a Community Mental Health Center

Background: Cool Teens is a computerised cognitive behavioural therapy (CCBT) program designed for anxious adolescents that has demonstrated efficacy in a university clinic. Aims: The effectiveness of this program in real world settings has not been evaluated. This study aimed to examine the benefits and acceptability of using CCBT in a community mental health setting. Method: An adolescent girl (aged 16) with anxiety completed CCBT as a first step to therapy in a community mental health setting. She completed the program on her home computer supported by brief therapist phone calls. Further face-to-face sessions were provided post-CCBT and focused on practicing the skills learnt in CCBT. Self-reported adolescent anxiety was measured pre-treatment, post-CCBT, post-face-to-face therapy, and at 3 month follow up. The participant and therapist also provided feedback on the CCBT program and its usefulness at post-treatment. Results: Changes in self-reported anxiety scores over time were observed for CCBT, with further reductions after face-to-face therapy. Both the adolescent and therapist reported positive benefits to using CCBT as the first step in treatment, and identified few barriers. Conclusions: CCBT is a promising first step in treatment that can be utilised in community mentalhealth settings with the likely benefits of increased user satisfaction (due to decreasing in therapy waiting times) and reduced therapist time per client.5 page(s

Barriers to treatment for older adults seeking psychological therapy

BACKGROUND: Older adults with mental health disorders underutilize mental health services more than other adults. While there are well known general barriers to help seeking across the population, specific barriers for older adults include difficulties with transportation, beliefs that it is normal to be anxious and depressed in old age, and beliefs by referrers that psychological therapy is less likely to be effective. This study examined barriers related to identifying the need for help, seeking help and participating in therapy in a clinical population of older adults. METHOD: Sixty older adults (aged 60-79 years) with comorbid anxiety and unipolar mood disorders completed barriers to treatment questionnaires before and after psychological group treatment, as well as measures of cognitive ability, anxiety, depression, and quality of life at baseline. RESULTS: The greatest barriers to help seeking related to difficulties identifying the need for help, with 50% of the sample reporting their belief that their symptoms were normal as a major barrier. Other major barriers identified were related to: self-reliance, cost of treatment, and fear of medication replicating previous findings. The main barriers reported for difficulties in continuing therapy included not finding therapy helpful, cost of treatment, and thinking that the therapist did not understand their issues. CONCLUSIONS: The main barriers identified related to issues with identifying the need to seek help. More attention is needed to educate older adults and professionals about the need for, and effectiveness of, psychological therapies for older adults with anxiety and depression to reduce this barrier to help seeking.10 page(s

Randomised controlled trial of group cognitive behavioural therapy for comorbid anxiety and depression in older adults

Anxiety and depression are commonly comorbid in older adults and are associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments. However, little research has examined the effectiveness of psychological programs to treat comorbid anxiety and depression in older adults. Sixty-two community dwelling adults aged over 60 years with comorbid anxiety and depression were randomly allocated to group cognitive behavioural therapy or a waitlist condition and were assessed immediately following and three months after treatment. After controlling for cognitive ability at pre-treatment, cognitive behaviour therapy resulted in significantly greater reductions, than waitlist, on symptoms of anxiety and depression based on a semi-structured diagnostic interview rated by clinicians unaware of treatment condition. Significant time by treatment interactions were also found for self-report measures of anxiety and depression and these gains were maintained at the three month follow up period. In contrast no significant differences were found between groups on measures of worry and well-being. In conclusion, group cognitive behavioural therapy is efficacious in reducing comorbid anxiety and depression in geriatric populations and gains maintain for at least three months.8 page(s

Confirmatory factor analysis of the three-factor structure of the Schizotypal Personality Questionnaire and Chapman schizotypy scales

We examined the factor structure of the Schizotypal Personality Questionnaire (SPQ; Raine, 1991), using confirmatory factor analysis in 3 experiments, with an aim to better understand the construct of schizotypy. In Experiment 1 we tested the fit of 2-, 3-, and 4-factor models on SPQ data from a normal sample. The paranoid 4-factor model fit the data best but not adequately. Based on the strong basis for the Raine 3-factor model we attempted to improve the fit of the 3-factor model by making 3 modifications to the Raine model. These modifications produced a well-fitting model. In Experiment 2 the good fit of this modified 2-factor model to SPQ scores was replicated in an independent normal sample. In Experiment 3, the modified 3-factor model was successfully extended to include the 3 Chapman schizotypy scales. Together these 3 experiments indicate that the 3-factor model of the SPQ, albeit with some slight modifications, is a good model for schizotypy structure that is not restricted to 1 measure of schizotypal personality traits.13 page(s

Comparison of the Penn State Worry Questionnaire (PSWQ) and abbreviated version (PSWQ-A) in a clinical and non-clinical population of older adults

The Penn State Worry Questionnaire (PSWQ) is a widely used measure of worry severity. An 8-item abbreviated version (PSWQ-A) has been developed as a brief screening measure, although there are limited studies assessing the psychometric properties of this measure in a large geriatric population. The aim of this study was to assess the utility of the PSWQ-A compared to the full PSWQ, to identify pathological worry in an older adult sample (N= 108) of clinically anxious and depressed older adults, compared to a non-clinical sample (N= 53). The PSWQ and PSWQ-A were found to have similarly adequate reliability and validity. The factor structure of the PSWQ-A was replicated, but not for the PSWQ. Both measures accurately distinguished between clinical and non-clinical status with similar sensitivity and specificity. These findings indicate the PSWQ-A is a useful measure for screening or epidemiological studies assessing worry in geriatric populations.7 page(s