cbt for low-income and elderly patients. patricia a. arean, ph.d
TRANSCRIPT
CBT for low-income and elderly CBT for low-income and elderly patients.patients.
Patricia A. Arean, Ph.D.
February 7, 2008 FSA/CATALAC training
Overview Overview
What is CBTCBT for older adultsIncorporating case management
February 7, 2008 FSA/CATALAC training
Cognitive Behavioral TherapyCognitive Behavioral Therapy
Based on combination of construct theory and learned helplessness;
Coping skills we learn as we develop influence how we cope now;
Include cognitive skills, mood regulation skills, and interpersonal skills;
Thee skills can change any time, based on experience and our appraisal of the experience.
February 7, 2008 FSA/CATALAC training
Cognitive Behavioral Therapy Cognitive Behavioral Therapy for older adultsfor older adults
12-16 weekly sessions (this is flexible)Perceptions and appraisalsActivity levelTime managementAssertivenessSafety
February 7, 2008 FSA/CATALAC training
Perceptions and AppraisalsPerceptions and Appraisals
Balanced view of the world
Using depression as a signal
Weighing the evidence
February 7, 2008 FSA/CATALAC training
Activity LevelActivity Level
Pleasant activities Education about
depression Socialization
February 7, 2008 FSA/CATALAC training
Time ManagementTime Management
Scheduling have-tos and want-tos
Balancing day with both activities
Planning around difficult days
Scheduling homework
February 7, 2008 FSA/CATALAC training
AssertivenessAssertiveness
Expressing needs Moving from passive
to active Asking for help Asking for more
information
February 7, 2008 FSA/CATALAC training
SafetySafety
Planning outings Home security Preventing financial
abuse Self defense
CBT for older adultsCBT for older adults
A session by session guide
February 7, 2008 FSA/CATALAC training
Subdivisions of CBTSubdivisions of CBT
Introductory phase: socializing patient to CBT while getting an assessment of strengths and weaknesses
Middle phase: skill developmentTermination phase: relapse prevention
February 7, 2008 FSA/CATALAC training
Session #1Session #1
Education about CBT and how will work together
Assessment of strengths and areas in need of improvement
Begin to make a formulation about the patient, and start to consider how will tailor CBT to patient preferences
Patient begins gathering information
February 7, 2008 FSA/CATALAC training
Early sessionsEarly sessions
Varies from manual to manual;Introduce one skill at a time, depending on
the patient’s strengths and needs (usually Behavioral Activation);
Collecting information from the patient about how they see the world, who is important in their lives, what they do well, what they need some help with.
February 7, 2008 FSA/CATALAC training
Middle sessionsMiddle sessions
Taking the newly learned skills and applying them;
Much like consultation as new problems arise, encourage use of the skills and review how they help.
February 7, 2008 FSA/CATALAC training
TerminationTermination
Once they lean the skills, then time to reduce frequency of visits;
Come up with a plan to monitor continued progress;
Identify and create a plan that addresses relapse prevention.
February 7, 2008 FSA/CATALAC training
Incorporating case Incorporating case managementmanagement
Very important in CBT for low-incomeAssessment also includes needs assessment;As work on socio-economic-political
problems, integrate CBT concepts into the plan
Often have to start with case management first with CBT light to get started.