Breakout L – October 14, 2011 (MC: Cara Lewis)
Presenter: Lee Hyer, PhD
Author: Lee Hyer, Georgia Neurosurgical Institute and Mercer School of Medicine
Abstract: For older adults, Division 12 APA task force on depression at later life endorses six psychological treatments as evidence-based therapies (EBT); BT, CBT, PST, IPT, cognitive bibliotherapy, and (group) reminiscence). Unfortunately, outcome studies explain only 40-50% of outcome variance. When dealing with older adults then, we are often targeting applications of translational research. As a result, ESTs for older adults are a combination of what works for younger adults, what is known about older adults, and what is age-specific in care algorithms (trained case managers, case management, executive function training, etc.). The translational component involves focusing on the age-specific variables, validated components, patient-specific issues, as well as treatment skills.
We review all extant EBTs for older adults and offer a newer model of psychological care based on modal problems, involving anxiety, depression, somatic/medical problems, cognition, and adjustment. Treating depressive symptoms in isolation of cognitive and physical limitations risks slower or less-effective reduction in depressive symptoms. Based on EBT for older adults and our newer model we argue for modular interventions for these modal problems at late life. Assuring that social reality is in place (home, medical issues, social care, etc.), that dosage is appropriate and compliance is optimal, that cognition (executive function and memory especially) is being addressed, and that monitoring is occurring, we suggest a “watch and wait??? model in primary care and argue for the psychotherapist as transdiagnostician, as neuroscientist, and as EST gero-specialist. We present data on this model and discuss several cases.
Presenter: Stephen O’Connor, PhD
Authors: Stephen O’Connor, University of Washington, Lisa Brenner, MIRECC of the VA Rocky Mountain Network, Kate Comtois, and Karin Janis, University of Washington
Abstract: Dissemination of therapeutic frameworks that target specific mental health concerns may provide a useful alternative to training in structured clinical treatments, which require clinicians to adopt rigid adherence guidelines with regard to clinical skills used in-session. From a training perspective, therapeutic frameworks help to guide clinician behavior towards necessary in-session objectives without requiring a sea change in how treatment is delivered. This may have implications for likelihood of clinician uptake and maintenance across time. One such therapeutic framework, the Collaborative Assessment and Management of Suicidality (CAMS), has recently been studied in a small randomized trial for patients with persistent suicidal ideation following hospitalization. At 12 months post-treatment, CAMS patients showed significantly better and sustained reductions in suicidal ideation, overall symptom distress, and increased hope in comparison to enhanced care as usual patients. Of note, clinicians from different training backgrounds (case management, psychiatry, psychology) were able to establish adherence to CAMS within a short period of time (mean = 4.75 sessions, with four consecutive sessions being the minimum number in which a clinician can establish adherence) and maintained high ratings of adherence throughout the trial. Implications for training in therapeutic frameworks such as CAMS will be discussed.
Presentation: Katherine TImmons, MS
Authors: Katherine Timmons, and Thomas Joiner, Florida State University
Abstract: Although evidence based psychosocial interventions are advocated by researchers, clinicians have shown resistance to adopting manualized psychotherapy approaches. One proposal to increase adoption of evidence based practices is the development of individualized, modular treatment plans that allow clinicians to flexibly adapt evidence based interventions. The current study used two recent analytic advances to examine the effectiveness of modular psychotherapy in a community clinic. First, global functioning outcomes were examined for patients who received modular psychotherapy compared to patients receiving manualized psychotherapy. A propensity score weighting procedure was employed to correct for the lack of random assignment. Results indicated that patients in both groups did not differ significantly on global improvement outcomes, although patients who received modular therapy attended significantly more sessions. Second, a benchmarking analysis was conducted to compare the outcomes for patients receiving modular psychotherapy in the current sample to outcomes from prior treatment studies. Results indicated that global improvement in the current sample was broadly comparable to meta-analytic benchmarks. Limitations and treatment implications were also discussed. Overall, the results suggest that modular psychotherapy is a viable treatment option and demonstrate the use of two analytic strategies for assessing treatment outcomes with non-experimental data.