DOCSLIB.ORG

How to Adapt Cognitive-Behavioral Therapy for Older Adults

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
How to Adapt Cognitive-Behavioral Therapy for Older Adults Web audio at CurrentPsychiatry.com Dr. Chand: Key points on providing CBT to older patients How to adapt cognitive-behavioral therapy for older adults To improve efficacy, focus on losses, transitions, and changes in cognition ome older patients with depression, anxiety, or insom- nia may be reluctant to turn to pharmacotherapy and Smay prefer psychotherapeutic treatments.1 Evidence has established cognitive-behavioral therapy (CBT) as an effective intervention for several psychiatric disorders and CBT should be considered when treating geriatric patients (Table 1).2 Research evaluating the efficacy of CBT for depression in older adults was first published in the early 1980s. Since then, research and application of CBT with older adults has expanded to include other psychiatric disorders and re- searchers have suggested changes to increase the efficacy of CBT for these patients. This article provides: © JOHN LUND/MARC ROMANELLI/BLEND IMAGES/CORBIS • an overview of CBT’s efficacy for older adults with de- Suma P. Chand, PhD pression, anxiety, and insomnia Associate Professor • modifications to employ when providing CBT to older George T. Grossberg, MD patients. Samuel W. Fordyce Professor Director, Geriatric Psychiatry • • • • The cognitive model of CBT Department of Neurology and Psychiatry In the 1970s, Aaron T. Beck, MD, developed CBT while Saint Louis University School of Medicine working with depressed patients. Beck’s patients reported St. Louis, MO thoughts characterized by inaccuracies and distortions in association with their depressed mood. He found these thoughts could be brought to the patient’s conscious atten- tion and modified to improve the patient’s depression. This finding led to the development of CBT. CBT is based on a cognitive model of the relationship among cognition, emotion, and behavior. Mood and be- havior are viewed as determined by a person’s perception Current Psychiatry 10 March 2013 and interpretation of events, which manifest as a stream of automatically generated thoughts (Figure, Table 1 page 12).3 These automatic thoughts have their origins in an underlying network of Indications for CBT beliefs or schema. Patients with psychiatric Mild to moderate depression. In the case of disorders such as anxiety and depression severe depression, CBT can be combined with typically have frequent automatic thoughts pharmacotherapy that characteristically lack validity because Anxiety disorders, mixed anxiety states they arise from dysfunctional beliefs. The Insomnia—both primary and comorbid with other medical and/or psychiatric conditions therapeutic process consists of helping the patient become aware of his or her internal CBT: cognitive-behavioral therapy stream of thoughts when distressed, and to identify and modify the dysfunctional thoughts. Behavioral techniques are used to As patients get older, cognitive impair- bring about functional changes in behavior, ment with comorbid depression can make regulate emotion, and help the cognitive re- treatment challenging. Limited research structuring process. Modifying the patient’s suggests CBT applied in a modified format underlying dysfunctional beliefs leads to that involves caregivers and uses problem Clinical Point lasting improvements. In this structured solving and behavioral strategies can sig- For depressed older therapy, the therapist and patient work col- nificantly reduce depression in patients laboratively to use an approach that features with dementia.15 adults, RCTs have reality testing and experimentation.4 found CBT is superior Anxiety. Researchers have examined the to treatment as efficacy of variants of CBT in treating older usual, wait-list Indications for CBT in older adults adults with anxiety disorders—commonly, control, and talking Depression. Among psychotherapies generalized anxiety disorder (GAD), panic used in older adults, CBT has received disorder, agoraphobia, subjective anxi- as control the most research for late-life depression.5 ety, or a combination of these illnesses.16,17 Randomized controlled trials (RCTs) have Randomized trials have supported CBT’s found CBT is superior to treatment as efficacy for older patients with GAD and usual in depressed adults age ≥60.6 It also mixed anxiety states; gains made in CBT has been found to be superior to wait-list were maintained over a 1-year follow- control7 and talking as control.6,8 Meta- up.18,19 In a meta-analysis of 15 studies us- analyses have shown above-average effect ing cognitive and behavioral methods of sizes for CBT in treating late-life depres- treating anxiety in older patients, Nordhus sion.9,10 A follow-up study found improve- and Pallesen16 reported a significant effect ment was maintained up to 2 years after size of 0.55. In a 2008 meta-analysis that CBT, which suggests CBT’s impact is likely included only RCTs, CBT was superior to to be long lasting.11 wait-list conditions as well as active con- Thompson et al12 compared 102 de- trol conditions in treating anxious older pressed patients age >60 who were treat- patients.20 ed with CBT alone, desipramine alone, However, some research suggests that or a combination of the 2. A combination CBT for GAD may not be as effective for of medication and CBT worked best for older adults as it is for younger adults. In severely depressed patients; CBT alone a study of CBT for GAD in older adults, or a combination of CBT and medication Stanley et al19 reported smaller effect sizes worked best for moderately depressed compared with CBT for younger adults. Discuss this article at patients. Researchers have found relatively few www.facebook.com/ CurrentPsychiatry CBT is an option when treating de- differences between CBT and comparison pressed medically ill older adults. Research conditions—supportive psychotherapy indicates that CBT could reduce depres- or active control conditions—in treating sion in older patients with Parkinson’s dis- GAD in older adults.21 Modified, more ef- ease13 and chronic obstructive pulmonary fective formats of CBT for GAD in older Current Psychiatry disease.14 adults need to be established.22 Mohlman Vol. 12, No. 3 11 Figure The cognitive model of CBT Core belief: I am unlovable CBT for older adults Intermediate belief: If someone is critical of me it means I am not a likeable person Situation: Automatic thoughts: Reactions: Social gathering No one will want to Physiological— Clinical Point talk to me Tension in shoulders Adding memory Behavioral—Quiet, avoid eye contact and learning aids Emotional—Anxious, to CBT for anxious sad older patients may improve the CBT: cognitive-behavioral therapy Source: Adapted from reference 3 response rate et al23 supplemented standard CBT for treatment for late-life insomnia.25 late-life GAD with memory and learn- RCTs have reported significant im- ing aids—weekly reading assignments, provements in late-life insomnia with graphing exercises to chart mood ratings, CBT-I.26,27 Reviews and meta-analyses have reminder phone calls from therapists, and also concluded that cognitive-behavioral homework compliance requirement. This treatments are effective for treating insom- approach improved the response rate from nia in older adults.25,28 Most insomnia cases 40% to 75%.23 in geriatric patients are reported to occur secondary to other medical or psychiatric Insomnia. Studies have found CBT to be an conditions that are judged as causing the effective means of treating insomnia in geri- insomnia.25 In these cases, direct treatment atric patients. Although sleep problems oc- of the insomnia usually is delayed or omit- cur more frequently among older patients, ted.28 Studies evaluating the efficacy of only 15% of chronic insomnia patients re- CBT packages for treating insomnia occur- ceive treatment; psychotherapy rarely is ring in conjunction with other medical or used.24 CBT for insomnia (CBT-I) should be psychiatric illnesses have reported signifi- considered for older adults because man- cant improvement of insomnia.28,29 Because aging insomnia with medications may be insomnia frequently occurs in older pa- problematic and these patients may prefer tients with medical illnesses and psychiat- nonpharmacologic treatment.2 CBT-I typi- ric disorders, CBT-I could be beneficial for cally incorporates cognitive strategies with such patients. established behavioral techniques, including sleep hygiene education, cognitive restruc- turing, relaxation training, stimulus control, Good candidates for CBT and/or sleep restriction. The CBT-I mul- Clinical experience indicates that older ticomponent treatment package meets all adults in relatively good health with no Current Psychiatry 12 March 2013 criteria to be considered an evidence-based significant cognitive decline are good can- didates for CBT. These patients tend to Table 2 comply with their assignments, are inter- ested in applying the learned strategies, Contraindications for CBT and are motivated to read self-help books. High levels of cognitive impairment CBT’s structured, goal-oriented approach Severe depression with psychotic features makes it a short-term treatment, which Severe anxiety with high levels of agitation makes it cost effective. Insomnia patients Severe medical illness may improve after 6 to 8 CBT-I sessions Sensory losses and patients with anxiety or depression CBT: cognitive-behavioral therapy may need to undergo 15 to 20 CBT ses- sions. Patients age ≥65 have basic Medicare coverage that includes mental health care and psychotherapy. transitions. For example, depressed pa- There are no absolute contraindica-
Load more

Recommended publications
  • Cognitive Behavioral Therapy for Perfectionism Over Time (DVD)
    Cognitive-Behavioral Therapy for Perfectionism Presented by Martin M. Antony, PhD, ABPP Department of Psychology, Ryerson University Website: www.martinantony.com E-mail: [email protected] Handouts and slides from this presentation may not be reproduced without permission of the presenter April 9, 2015 ©2015 Martin M. Antony, PhD Professor and Chair, Department of Psychology, Ryerson University, Toronto Director of Research, Anxiety Treatment and Research Center, St. Joseph’s Healthcare, Hamilton 1 Anxiety and Depression Association of America Outline Cognitive-Behavioral Therapy for § Overview of perfectionism Perfectionism § Causes of perfectionism § Assessment of perfectionism April 9, 2015 § Introduction to cognitive-behavioral therapy Martin M. Antony, PhD, ABPP § Changing perfectionistic thinking Professor and Chair, Department of Psychology, § Changing perfectionistic behavior Ryerson University, Toronto § Mindfulness and acceptance-based Director of Research, Anxiety Treatment and approaches Research Centre, St. Joseph’s Healthcare, Hamilton § Emerging research on treating perfectionism www.martinantony.com § Recommended books and DVDs Definition of Perfectionism Perfectionism is a disposition to regard anything short of perfection OVERVIEW OF as unacceptable PERFECTIONISM Merriam Webster Dictionary Definition of Clinical Perfectionism Historical Perspectives “The overdependence of self- § “Tyranny of the shoulds” (Horney, 1950) evaluation on the determined pursuit § “Musterbation” (Ellis & Harper, 1961) (and achievement) of self-imposed, § Normal vs. neurotic perfectionism personally demanding standards of (Hamacheck, 1978) performance in at least one salient domain, despite the occurrence of adverse consequences.” Shafran, Cooper, & Fairburn, 2002 2 Examples of Perfectionists Perfectionism in the Context of OCPD § A woman struggles to be a perfect parent, a perfect wife, and a perfect employee, often to the detriment of her own emotional and physical health.
    [Show full text]
  • Emotion-Scanning Therapy : an Integrative Use of Biofeedback and Cognitive Therapy in Pain Management
    University of Massachusetts Amherst ScholarWorks@UMass Amherst Doctoral Dissertations 1896 - February 2014 1-1-1986 Emotion-scanning therapy : an integrative use of biofeedback and cognitive therapy in pain management. Nancy J. Erskine University of Massachusetts Amherst Follow this and additional works at: https://scholarworks.umass.edu/dissertations_1 Recommended Citation Erskine, Nancy J., "Emotion-scanning therapy : an integrative use of biofeedback and cognitive therapy in pain management." (1986). Doctoral Dissertations 1896 - February 2014. 1401. https://scholarworks.umass.edu/dissertations_1/1401 This Open Access Dissertation is brought to you for free and open access by ScholarWorks@UMass Amherst. It has been accepted for inclusion in Doctoral Dissertations 1896 - February 2014 by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. EMOTION-SCANNING THERAPY- AN INTEGRATIVE USE OF BIOFEEDBACK AND COGNITIVE THERAPY IN PAIN MANAGEMENT A Dissertation Presented By NANCY JANE ERSKINE Submitted to the Graduate School of the University of Massachusetts in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY February, 1986 Department of Psychology EMOTION-SCANNING THERAPY- AN INTEGRATIVE USE OF BIOFEEDBACK AND COGNITIVE THERAPY IN PAIN I^IANAGEMENT A Dissertation Presented By NANCY JANE ERSKINE Approved as to style and content by: Seymour Epstein, Chairperson of Committee Morton Harmatz, Member Ronnie Janbf f^Bulman , Member D. Nico Spinfelli, Member Seymour Berger, Deparjtment Head Department of Psychol/ogy 11 Nancy Jane Erskine All Rights Reserved . ACKNOWLEDGEMENTS In embarking upon the pursuit of a graduate degree it IS important to have access to people who represent the forerunners in one's field of study.
    [Show full text]
  • Chapter 14: Therapy
    Chapter 14: Therapy PSY 100 Rick Grieve, Ph.D. Western Kentucky University Therapy TreatmentTreatment forfor abnormalabnormal behaviorbehavior logicallylogically derivesderives fromfrom whatwhat oneone believesbelieves thethe causecause ofof thethe abnormalabnormal behaviorbehavior toto be.be. Psychotherapy Psychotherapy and its goals goals of psychotherapy achieving a cure for psychological problems provide support and caring for those who seek help Psychotherapy PsychotherapyPsychotherapy ConversationConversation FocusedFocused DiffuseDiffuse ClientClient--CenteredCentered EquallyEqually--CenteredCentered TimeTime LimitedLimited NotNot TherapistTherapist DirectedDirected TakeTake TurnsTurns DirectingDirecting Only Clients Self- Both People Self- Disclose Disclose PowerPower DifferentialDifferential EqualEqual PowerPower Psychotherapy Where is psychotherapy done? Therapist's office Community mental health center Hospitals Schools in the home prisons Who goes to therapy? Psychodynamic Therapy Goal: Catharsis Techniques Methods used to get at the unconscious free association dream analysis Psychodynamic Therapy ManifestManifest contentcontent TheThe conscious,conscious, rememberedremembered aspectsaspects ofof aa dreamdream LatentLatent contentcontent TheThe unconscious,unconscious, unremembered,unremembered, symbolicsymbolic aspectsaspects ofof aa dreamdream Psychodynamic Therapy Interpretation of reactions interpretation of slips of the tongue brief psychodynamic therapy Behavior Therapies Classical conditioning
    [Show full text]
  • Exposure and Cognitive Interventions for Anxiety 1
    Exposure and Cognitive Interventions for Anxiety 1 Running head: EXPOSURE AND COGNITIVE INTERVENTIONS FOR ANXIETY Exposure Therapy and Cognitive Interventions for the Anxiety Disorders: Overview and Newer Third Generation Perspectives John P. Forsyth, Velma Barrios, and Dean T. Acheson University at Albany, State University of New York Forsyth, J. P., Barrios, V., & Acheson, D. (2007). Exposure therapy and cognitive interventions for the anxiety disorders: Overview and newer third-generation perspectives. In D. C. S. Richard & D. Lauterbach (Eds.), Handbook of the exposure therapies (pp. 61-108). New York: Academic Press. Exposure and Cognitive Interventions for Anxiety 2 Author Biosketches John P. Forsyth, Ph.D. John P. Forsyth, Ph.D. earned his Ph.D. degree in clinical psychology from West Virginia University in 1997, after serving as Chief Resident in the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center. He is an Associate Professor and Director of the Anxiety Disorders Research Program in the Department of Psychology at the University at Albany, SUNY. His basic and applied research focuses on variables and processes that contribute to the etiology, maintenance, and treatment of anxiety-related disorders. He has written widely on acceptance and experiential avoidance, and the role of emotion regulatory processes in the etiology and treatment of anxiety disorders. Dr. Forsyth was the recipient of the 2000 B. F. Skinner New Research Award by Division 25 of the American Psychological Association and the 1999 Outstanding Dissertation Award by the Society for a Science of Clinical Psychology. He has authored over 50 scientific journal articles, numerous book chapters, and several teaching supplements for courses in abnormal psychology.
    [Show full text]
  • Encyclopedia of Psychotherapy-Logotherapy.Pdf
    Logotherapy Paul T. P. Wong Trinity Western University, British Columbia, Canada I. Introduction Known as the “Third Viennese School of Psychother- II. The Spiritual Dimension apy,” logotherapy was developed in the 1930s because of III. The Meaning of Meaning Frankl’s dissatisfaction with both Freud and Adler. IV. Basic Tenets Frankl accepts Sigmund Freud’s concept of uncon- V. Existential Frustration and Noogenic Neurosis sciousness but considers the will to meaning as more VI. Logotherapeutic Techniques and Applications VII. Recent Developments fundamental than the will to pleasure. Existential Further Reading analysis is designed to bring to consciousness the “hid- den” meaning or spiritual dimension of the client. Frankl received training in individual psychology GLOSSARY from Adler. He differs from Adler because he focuses on the will to meaning, while Adler emphasizes social dereflection A logotherapeutic technique to redirect clients’ attention away from their problems to more positive as- interest and the will to power. However, some of the pects of their lives. It is built on the human capacity for basic concepts of logotherapy, such as freedom and re- self-distancing and self-transcendence. sponsibility, bear the imprint of Adler’s influence. existential analysis Developed by Viktor Frankl, it refers to A major difference between logotherapy and psycho- therapeutic techniques that bring the hidden meaning of analysis is that both Freud and Adler focus on the past, existence into consciousness. while logotherapy focuses rather on the future—on the logotherapy Developed by Viktor Frankl, it refers to a spiri- meanings to be fulfilled. tually, existentially oriented therapy that seeks to achieve Although logotherapy and existential analysis tend healing and health through meaning.
    [Show full text]
  • Cognitive Hypnotherapy for Psychological Management of Depression in Palliative Care
    Review Article Cognitive hypnotherapy for psychological management of depression in palliative care Assen Alladin Department of Psychiatry, University of Calgary Medical School, Calgary, Canada Correspondence to: Assen Alladin, PhD. R.Psych. Department of Psychiatry, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB T2N 2T9, Canada. Email: [email protected]. Abstract: The prevalence of psychiatric disorders in palliative care is well documented, yet they often remain undetected and untreated, adding further to the burden of suffering on patients who are already facing severe physical and psychosocial problems. This article will focus on depression as it represents one of the most common psychiatric disorders treated by psychiatrists and psychotherapists in palliative care. Although depression in palliative care can be treated successfully with antidepressant medication and psychotherapy, a significant number of depressives do not respond to either medication or existing psychotherapies. This is not surprising considering depression is a complex disorder. Moreover, the presentation of depression in palliative care is compounded by the severity of the underlying medical conditions. It is thus important for clinicians to continue to develop more effective treatments for depression in palliative care. This article describes cognitive hypnotherapy (CH), an evidence-based multimodal treatment for depression which can be applied to a wide range of depressed patients in palliative care. CH, however, does not represent a finished product;
    [Show full text]
  • Depression in the Older Adults
    Depression in the Older Adults Summary Major depressive disorder (MDD) is the leading cause of disability according to the World Health Organization. Common clinical conditions and previous research has shown that the worldwide prevalence is approximately 15% in community-dwelling individuals. Significant depressive symptoms are present in nearly 15% of older adults living in the community, especially in those older adults who have chronic illness and pain. Depression in later life is associated with greater risk of suicide, ischemic heart disease, heart failure, osteoporosis and poor cognitive and social functioning. Physiologically it is associated with changes such as hypercortisolemia, visceral adiposity, and higher risk of hypertension and diabetes mellitus. Key Points Depression in the older adult • amplifies disability/pain • lessens quality of life and increases mortality • results in increasing office and emergency department visits • results in more prescription and OTC medication use • leads to increased alcohol and drug use • increases length of hospital stay Eighty percent (80%) of mental health treatment for depressed older adults is delivered in the primary care setting. It is estimated that 10-15 percent of older adults with intact cognitive functioning have depression. Health care providers should screen all geriatric patients for depression. Greater than 50% of nursing home residents are depressed. Dementia syndrome of depression is defined as a cognitive impairment present in an elderly patient with major depression
    [Show full text]
  • About Psychoanalysis
    ABOUT PSYCHOANALYSIS What is psychoanalysis? What is psychoanalytic treatment for? Freud’s major discoveries and innovations • The Unconscious • Early childhood experiences • Psychosexual development • The Oedipus complex • Repression • Dreams are wish-fulfilments • Transference • Free association • The Ego, the Id and the Super-Ego Major discoveries and additions to psychoanalytic theory since Freud: the different strands and schools within psychoanalysis today • Classical and contemporary Freudians • Sándor Ferenczi • Ego-Psychology • Classical and contemporary Kleinians • The Bionian branch of the Kleinian School • Winnicott’s branch of the Object-Relations Theory • French psychoanalysis • Self-Psychology • Relational Psychoanalysis The core psychoanalytic method and setting • Method • Setting Various Psychoanalytic Treatment Methods (adult, children, groups, etc) • Psychoanalysis • Psychoanalytic or psychodynamic psychotherapy • Children and adolescents • Psychoanalytic psychodrama • Psychoanalytic Couples- and Family-Psychotherapy • Psychoanalytic Groups Psychoanalytic training Applied psychoanalysis The IPA, its organisation and ethical guidelines Where to encounter psychoanalysis? What is psychoanalysis? Psychoanalysis is both a theory of the human mind and a therapeutic practice. It was founded by Sigmund Freud between 1885 and 1939 and continues to be developed by psychoanalysts all over the world. Psychoanalysis has four major areas of application: 1) as a theory of how the mind works 2) as a treatment method for psychic problems 3) as a method of research, and 4) as a way of viewing cultural and social phenomena like literature, art, movies, performances, politics and groups. What is psychoanalytic treatment for? Psychoanalysis and psychoanalytic psychotherapy are for those who feel caught in recurrent psychic problems that impede their potential to experience happiness with their partners, families, and friends as well as success and fulfilment in their work and the normal tasks of everyday life.
    [Show full text]
  • Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment
    medicina Review Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment Ivan Arnold 1, Julia Dehning 2,*, Anna Grunze 3 and Armand Hausmann 4 1 Helios Klinik Berlin-Buch, 13125 Berlin, Germany; [email protected] 2 Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, 6020 Innsbruck, Austria 3 Psychiatrisches Zentrum Nordbaden, 69168 Wiesloch, Germany; [email protected] 4 Private Practice, Wilhelm-Greil-Straße 5, 6020 Innsbruck, Austria; [email protected] * Correspondence: [email protected]; Tel.: +43-512-504-83802 Abstract: Data regarding older age bipolar disorder (OABD) are sparse. Two major groups are classified as patients with first occurrence of mania in old age, the so called “late onset” patients (LOBD), and the elder patients with a long-standing clinical history, the so called “early onset” patients (EOBD). The aim of the present literature review is to provide more information on specific issues concerning OABD, such as epidemiology, aetiology and treatments outcomes. We conducted a Medline literature search from 1970–2021 using the MeSH terms “bipolar disorder” and “aged” or “geriatric” or “elderly”. The additional literature was retrieved by examining cross references and by a hand search in textbooks. With sparse data on the treatment of OABD, current guidelines concluded that first-line treatment of OABD should be similar to that for working-age bipolar disorder, with specific attention to side effects, somatic comorbidities and specific risks of OABD. With constant monitoring and awareness of the possible toxic drug interactions, lithium is a safe drug for OABD patients, both in mania and maintenance. Lamotrigine and lurasidone could be considered in bipolar Citation: Arnold, I.; Dehning, J.; depression.
    [Show full text]
  • The Effects of Psychotherapy: a Professional Update
    Issues in Religion and Psychotherapy Volume 7 Number 2 Article 5 4-1-1981 The Effects of Psychotherapy: A Professional Update Michael J. Lambert Follow this and additional works at: https://scholarsarchive.byu.edu/irp Recommended Citation Lambert, Michael J. (1981) "The Effects of Psychotherapy: A Professional Update," Issues in Religion and Psychotherapy: Vol. 7 : No. 2 , Article 5. Available at: https://scholarsarchive.byu.edu/irp/vol7/iss2/5 This Article or Essay is brought to you for free and open access by the Journals at BYU ScholarsArchive. It has been accepted for inclusion in Issues in Religion and Psychotherapy by an authorized editor of BYU ScholarsArchive. For more information, please contact [email protected], [email protected]. THE EFFECTS OF PSYCHOTHERAPY: A- PROFESSIONAL UPDATE Michael J. Lambert, Ph.D.· Presented at the AMCAP convention October 3, 1980 The following review attempts to summarize 2. It is not the result of "placebo effects" -- although research on the effects of psychotherapy and its some "placebo" and genuine treatments generate implications for the practice of psychotherapy. This "hope"and other emotions that increase successful review deals mainly with research on adult non­ coping and symptomatic improvement. psychotic outpatients. It is based on the assumption 3. It is not due to "spontaneous remission." The that controlled investigations will lead to replicable, effects of therapy clearly surpass no treatment or trustworthy, and significant findings. It is also spontaneous remission baselines. The assumed that it will result in findings that are specific­ "unsystematic" curative factors within society and -in the sense of identifying the actual causal the individual do not result in as rapid components in psychotherapy.
    [Show full text]
  • Cognitive Behaviour Therapy (CBT) and Stroke Rehabilitation
    Cognitive Behaviour Therapy (CBT) and Stroke Rehabilitation Amy Quilty OT Reg. (Ont.), Occupational Therapist Cognitive Behavioural Therapy (CBT) Certificate Program, University of Toronto Quinte Health Care: [email protected] Learning Objectives • To understand that CBT: • has common ground with neuroscience • principles are consistent with stroke best practices • treats barriers to stroke recovery • is an opportunity to optimize stroke recovery Question? Why do humans dominate Earth? The power of THOUGHT • Adaptive • Functional behaviours • Health and well-being • Maladaptive • Dysfunctional behaviours • Emotional difficulties Emotional difficulties post-stroke • “PSD is a common sequelae of stroke. The occurrence of PSD has been reported as high as 30–60% of patients who have experienced a stroke within the first year after onset” Canadian Stroke Best Practice Recommendations: Mood, Cognition and Fatigue Following Stroke practice guidelines, update 2015 http://onlinelibrary.wiley.com/doi/10.1111/ijs.12557/full • Australian rates: (Kneeborne, 2015) • Depression ~31% • Anxiety ~18% - 25% • Post Traumatic Stress ~10% - 30% • Emotional difficulties post-stroke have a negative impact on rehabilitation outcomes. Emotional difficulties post-stroke: PSD • Post stroke depression (PSD) is associated with: • Increased utilization of hospital services • Reduced participation in rehabilitation • Maladaptive thoughts • Increased physical impairment • Increased mortality Negative thoughts & depression • Negative thought associated with depression has been linked to greater mortality at 12-24 months post-stroke Nursing Best Practice Guideline from RNAO Stroke Assessment Across the Continuum of Care June : http://rnao.ca/sites/rnao- ca/files/Stroke_with_merged_supplement_sticker_2012.pdf Cognitive Behavioral Therapy (CBT) https://www.youtube.com/watch?v=0ViaCs0k2jM Cognitive Behavioral Therapy - CBT A Framework to Support CBT for Emotional Disorder After Stroke* *Figure 2, Framework for CBT after stroke.
    [Show full text]
  • Review of Psychodynamic and Interpersonal
    Psychodynamic Psychotherapy, Interpersonal Psychotherapy, Motivational Interviewing, & Cognitive Behavioral Therapy Ottawa Review Course January, 2017 Paula Ravitz MD, FRCPC Associate Professor of Psychiatry, University of Toronto Mt. Sinai Hospital, Morgan Firestone Psychotherapy Chair Disclosures & Acknowledgements • No industry relations • An IPT expert • WW Norton, “Psychotherapy Essentials to Go” (‘13,’15) • CanMAT panel, Psychological Treatments for MDD With thanks to CanMAT, Carolynne Cooper, Mark Fefergrad, Sophie Grigoriadis, Simon Hatcher, Jon Hunter, Rex Kay, Sid Kennedy, Molyn Leszcz, Robert Maunder, Edward McAnanama, Clare Pain, Sagar Parikh, Peggy Richter, Wayne Skinner, and Priya Watson OBJECTIVES Describe the evidence for efficacy, indications, goals, and key concepts of – Psychodynamic Psychotherapy – Cognitive Behavior Therapy – Motivational Interviewing – Interpersonal Psychotherapy List 6 “common” psychotherapy factors that are known to enhance outcomes. Psychotherapies are, “an integral component of psychiatric care,” and highlighted “the unique contributions psychiatrists can make when they are able to integrate psychological and biological approaches within a treatment plan.” Chaimowitz, CPA Position Paper: The Role of Psychotherapy in Psychiatry 2004 Psychiatrists’ knowledge and skills in evidence- supported psychotherapies improve our capacities as stewards of the mental health system, medical experts, consultants, leaders of clinical service teams, shared care collaborators, and trainers of future generations of mental health professionals…to provide the best care for the most complex patients. Psychotherapy in psychiatric care across settings from ER → in-patient med/surg (CL), psych wards → outpatient psych and primary care. Used alone, sequenced with, or combined w/ Rx, psychotherapies are recommended for most psychiatric DOs. Psychotherapy Outcomes Changes the mind & brain; Cost-effective Outcomes of psychotherapy – Symptom reduction (i.e.
    [Show full text]