Geriatric Psycho-Oncology Assessment Issues and Interventions

2021 ◽  
pp. 671-677
Author(s):  
Kelly M. Trevino ◽  
Rebecca M. Saracino ◽  
Andrew J. Roth ◽  
Yesne Alici ◽  
Christian J. Nelson
Keyword(s):  
Older Adults ◽  
Side Effects ◽  
Behavioral Therapy ◽  
Psychological Impact ◽  
Anxiety And Depression ◽  
Social Changes ◽  
Problem Solving Therapy ◽  
Assessment And Treatment ◽  
Psychological Difficulties

Older adults make up more than half of the cancer diagnoses and even a greater percentage of cancer survivors. The combined issues of aging and cancer can lead a significant number of these patients to experience emotional distress as they manage the comorbidities related to aging, the psychological impact of a cancer diagnosis, and the acute and long-term side effects of treatment. Anxiety and depression are common in older adults with cancer, and there are unique aspects when considering these constructs in this group. Many older adults experience physical and social changes that may leave them vulnerable to psychological difficulties. The assessment of anxiety and depression can be challenging as many symptoms of these constructs overlap with the comorbidities of aging and the side effects of treatment. The psychotherapy and psychopharmacologic treatments should be tailored to the unique needs of this population. More directive, structured psychotherapies such as cognitive behavioral therapy (CBT) and problem-solving therapy (PST) tend to be more effective for older adults than open-ended, explorative approaches. Psychopharmacologic treatments should be started at lower doses and titrated slowly. With the continued growth in this population, combined with the unique aspects of assessment and treatment, it is important to understand the basic psycho-oncology principles of working with older adults with cancer.

scholarly journals Terapia cognitivo-conductual en la fibromialgia

2020 ◽  
Vol 4 (1) ◽  
pp. 19
Author(s):  
Bárbara Dinorah Hidalgo Martínez ◽  
Viorkis Pérez Ortiz ◽  
María Caridad Olivera Cardoso ◽  
Lidia López Aristica ◽  
Liset Betancourt Castellanos ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Psychological Impact ◽  
Behavioral Approach ◽  
Cognitive Behavioral ◽  
Anxiety And Depression ◽  
Hospital Anxiety ◽  
Palabras Clave ◽  
Before And After ◽  
Cognitive Alterations

  La fibromialgia es una enfermedad con fuerte impacto psicológico, de evolución crónica que provoca dolor, rigidez e hipersensibilidad en músculos, tendones y articulaciones por más de tres meses de evolución. Generalmente está asociada a alteraciones cognitivas, disminución del sueño, astenia, ansiedad y depresión a diferentes grados. Aunque la etiología no se conoce con exactitud, el diagnóstico es clínico por exclusión. En este estudio se determinó la eficacia de la terapia cognitivo-conductual (TCC) en pacientes con fibromialgia en el Hospital Básico Miguel H. Alcívar de Bahía de Caráquez, Ecuador. El estudio fue descriptivo y prospectivo en 30 pacientes diagnosticados de fibromialgia, en el periodo de mayo a septiembre de 2017. La mayoría de los pacientes fueron mujeres entre 30 y 40 años de edad, cuyo síntoma principal fue el dolor generalizado, con espectro ansioso-depresivo. Se utilizó el test de ansiedad y depresión hospitalaria para diagnosticar la presencia de ansiedad y depresión antes y después de la terapia. Los pacientes con fibromialgia fueron tratados con hipnosis, con un enfoque cognitivo conductual, en el 70,1 % los síntomas desaparecieron o mejoraron durante los meses en los que mantuvieron el tratamiento, lo cual demuestra la efectividad del tratamiento con TCC en pacientes con fibromialgia.   Palabras clave: Fibromialgia, depresión, ansiedad, terapia cognitivo-conductual, hipnosis.   Abstract Fibromyalgia is a disease with a strong psychological impact, of chronic evolution that causes pain, stiffness and hypersensitivity in muscles, tendons and joints, for more than three months of evolution. It is generally associated with cognitive alterations, decreased sleep, asthenia, anxiety and depression to different degrees. Although the etiology is not exactly known, the diagnosis is clinical by exclusion. In this study, the efficacy of cognitive-behavioral therapy (CBT) was determined in patients with fibromyalgia at the Basic Hospital Miguel H. Alcívar de Bahía de Caráquez, Ecuador. The study was descriptive and prospective in 30 patients diagnosed with fibromyalgia, in the period from May to September 2017. Most of the patients were women between 30 and 40 years of age, whose main symptom was generalized pain, with an anxious spectrum- depressant. The hospital anxiety and depression test was used to diagnose the presence of anxiety and depression before and after therapy. Fibromyalgia patients were treated with hypnosis, with a cognitive behavioral approach, in 70.1% the symptoms disappeared or improved during the months in which they maintained the treatment, which demonstrates the effectiveness of CBT treatment in patients with fibromyalgia.   Keywords: Fibromyalgia, depression, anxiety, cognitive-behavioral therapy, hypnosis.

Applying the Pikes Peak Model of Treatment Competency to the Use of Cognitive-Behavioral Therapies with Older Adults

2011 ◽  
pp. 67-83
Author(s):  
Forrest Scogin ◽  
Andrew Presnell
Keyword(s):  
Older Adults ◽  
Behavioral Therapy ◽  
Adult Population ◽  
Cognitive Behavioral ◽  
Problem Solving Therapy ◽  
Evidence Based Treatments ◽  
Behavioral Therapies ◽  
Cognitive Behavioral Therapies ◽  
Older Adult Population ◽  
Peak Model

Chapter 6 examines specifically the application of Beck’s cognitive-behavioral therapy (CBT) and problem-solving therapy (PST), an adaptation of cognitive-behavioral techniques, with the older adult population. It also uses the Pikes Peak Model to identify the focal areas needed for competent delivery of these treatments with older adults. It also covers the Pikes Peak Model, which outlines six areas to be considered in the competent application of treatment: applying interventions with appropriate modifications, using evidence-based treatments, developing appropriate treatments when there is a lack of evidence available, proficiently employing common late-life intervention, using interventions to enhance the health of diverse elderly persons, and intervening across settings.

Assessment of Anxiety in Long-Term Care Residents: Issues and Strategies

2020 ◽  
pp. 009141502094332
Author(s):  
Marissa A. Pifer ◽  
Daniel L. Segal ◽  
Dylan J. Jester ◽  
Victor Molinari
Keyword(s):  
Older Adults ◽  
Anxiety Disorders ◽  
Long Term Care ◽  
Self Report ◽  
Term Care ◽  
Measurement Tools ◽  
Assessment And Treatment ◽  
Clinically Significant ◽  
Growing Population

The experience of clinically significant anxiety and anxiety disorders represent significant and often debilitating problems for many residents in long-term care (LTC) settings. However, anxiety problems often go undetected and untreated in this growing population. The purposes of this paper are to examine the prevalence and impact of anxiety problems among residents in LTC facilities, describe the efficacy of the current instruments that are used to detect anxiety in these settings, and provide clinical guidance for the thorough assessment of anxiety. Regarding measurement tools, the GAI, GAI-SF, GAS-LTC, and the BADS are the only self-report measures designed for older adults that have been successfully validated for use with older adults living in LTC settings. Clinicians should focus on ways to educate LTC directors and staff to emphasize the importance of screening and assessing for anxiety, using validated measures, to improve the assessment and treatment of anxiety in their residents.

scholarly journals REDUCING DYSFUNCTIONAL BELIEFS ABOUT SLEEP PROVIDES LONG-TERM BENEFIT IN OLDER ADULTS WITH INSOMNIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S526-S527
Author(s):  
Yeonsu Song ◽  
Constance Fung ◽  
Joseph Dzierzewski ◽  
Michael Mitchell ◽  
Karen Josephson ◽  
...  
Keyword(s):  
Older Adults ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Severity Index ◽  
Post Treatment ◽  
Sleep Diary ◽  
Dysfunctional Beliefs ◽  
Long Term Impact ◽  
Beliefs And Attitudes

Abstract Cognitive behavioral therapy for insomnia (CBTI) is recommended as first-line treatment in older adults. Changing dysfunctional beliefs and attitudes about sleep is an important component of CBTI, but the long-term impact of these changes are unknown, particularly in older adults. Methods involved secondary analyses of data from a large randomized controlled trial comparing CBTI (provided in 5 weekly sessions) to sleep education control, among older veterans with insomnia (N=159, mean age 72.2 years, 97% male, 79% non-Hispanic white). The purpose was to examine whether changes in a validated scale of Dysfunctional Beliefs and Attitudes about Sleep (DBAS) with CBTI treatment (baseline to post-treatment) was associated with later changes in self-reported sleep (post-treatment to 6 months follow-up). Sleep measures included Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and 7-day sleep diary measures. Analyses compared the slope of change in DBAS (baseline to post-treatment) between CBTI and control with respect to the slope of change in sleep outcomes (post-treatment to 6-months). Compared to controls, the CBTI group had stronger associations between DBAS improvement (baseline to post-treatment) and subsequent PSQI improvement (post-treatment to 6-months) (difference in slopes=1.3, 95% CI=[.52,2.1], p=0.001). This pattern of significant results was also found for ISI (difference in slopes=1.8, 95% CI=[.58,3.0], p=0.004) and ESS (difference in slopes=1.0, 95% CI=[.25,1.7], p=0.009). Slopes were not different for sleep diary measures. These findings suggest that changing dysfunctional beliefs and attitudes may continue to confer sleep benefits well after completion of CBT-I in older adults.

scholarly journals Virtual Reality-Assisted Cognitive Behavioral Therapy for Anxiety Disorders: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Jinlong Wu ◽  
Yi Sun ◽  
Gongwei Zhang ◽  
Zhenhui Zhou ◽  
Zhanbing Ren
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Anxiety Disorders ◽  
Therapeutic Effect ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Cognitive Behavioral ◽  
Anxiety And Depression ◽  
Randomized Controlled ◽  
Better Than

Objective: We aim to explore the effectiveness of virtual reality-assisted cognitive behavioral therapy (VRCBT) in the treatment of anxiety and depression in patients with anxiety disorders. We further compare the therapeutic effect of VRCBT with that of standard cognitive behavioral therapy (CBT), as well as investigate the long-term efficacy of VRCBT.Methods: As of March 3, 2020, a total of four databases (Web of Science, PubMed, PsycINFO, and Scopus) were retrieved, and two researchers independently conducted literature retrieval and research selection and performed data extraction. Methodological quality assessment was performed using the Cochrane risk of bias tool and Grading of Recommendation, Assessment, Development, and Evaluation tool (GRADE).Results: A total of 11 studies were included (n = 626; range, 25.3–43.8), and six randomized controlled trials were quantitatively analyzed. The main outcome was anxiety and depression, and the secondary outcome was the withdrawal rate and long-term effects. Meta-analysis showed that the therapeutic effect of VRCBT on anxiety was better than that of the waiting list group (WLG) (SMD = −0.92; 95% CI: −1.34, −0.50; p = 0.005, I2 = 66%, n = 276), while the therapeutic effect of VRCBT on anxiety was similar to that of standard CBT treatment (SMD = −0.26; 95% CI: −0.50, −0.01; p = 0.77, I2 = 0%, n = 150). We further found that the therapeutic effect of VRCBT on depression was better than that of the WLG (SMD = −1.29; 95% CI: −2.26, −0.32; p = 0.09, I2 = 58%, n = 74), while the effect of VRCBT was similar to that of standard CBT (SMD = −0.30; 95% CI: −0.67, −0.07; p = 0.39, I2 = 1%, n = 116). Of the five studies that reported withdrawal rates of patients during the VRCBT and CBT treatment process, the withdrawal rates of the VRCBT group and CBT group did not reach statistical significance (OR = 0.70, 1.48, p > 0.05); only two studies reported the long-term effectiveness of VRCBT in anxiety and depression on patients with anxiety disorders.Conclusion: VRCBT treatment has a specific positive effect on patients with anxiety disorders (anxiety and depression). Compared with standard CBT, similar therapeutic effects can be achieved in the treatment of anxiety disorders. However, limited randomized controlled trials were included, requiring that these results be treated with caution.

scholarly journals Internet-Based Cognitive Behavioral Therapy for Patients Reporting Symptoms of Anxiety and Depression After Myocardial Infarction: U-CARE Heart Randomized Controlled Trial Twelve-Month Follow-up (Preprint)

2020 ◽  
Author(s):  
Sophia Monica Humphries ◽  
John Wallert ◽  
Fredrika Norlund ◽  
Emma Wallin ◽  
Gunilla Burell ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Group Differences ◽  
Anxiety And Depression ◽  
Treatment As Usual ◽  
Related Mortality

BACKGROUND The U-CARE Heart trial was one of the first randomized controlled trials to evaluate the effect of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety or depression for patients with a recent myocardial infarction. While the effects of internet-based cognitive behavioral therapy on Hospital Anxiety and Depression Scale (HADS) scores at 14 weeks postbaseline were not significant, in this study, we investigated possible long-term effects of treatment. OBJECTIVE The aim of this study was to evaluate the long-term effectiveness of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety and depression in patients 12 months after a myocardial infarction and to explore subsequent occurrences of cardiovascular disease events. METHODS Shortly after acute myocardial infarction, 239 patients (33% female, mean age 59.6 years) reporting mild-to-moderate symptoms of anxiety or depression were randomized to 14 weeks of therapist-guided internet-based cognitive behavioral therapy (n=117) or treatment as usual (n=122). Data from national registries were used to explore group differences in clinical outcomes such as cardiovascular disease and cardiovascular-related mortality for a follow-up period of up to 5 years: group differences in HADS total score 1 year post–myocardial infarction, the primary outcome, was analyzed using multiple linear regression. Secondary outcomes, such as HADS anxiety and depression subscales and the Cardiac Anxiety Questionnaire total score (CAQ), which measures heart-focused anxiety, were analyzed in the same way. Multiple imputation was used to account for missing data, and a pooled treatment effect was estimated. Adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) for data pertaining to registry outcomes. RESULTS Both groups reported lower HADS total scores 1 year after myocardial infarction than those at baseline. HADS total scores were not significantly different between the treatment and control groups 1 year after myocardial infarction (<i>β</i>=–1.14, 95% CI –2.73 to 0.45, <i>P</i>=.16). CAQ was the only measure improved significantly by internet-based cognitive behavioral therapy when compared with treatment as usual (<i>β</i>=–2.58, 95% CI –4.75 to –0.42, <i>P</i>=.02) before adjusting for multiple comparisons. The composite outcome of nonfatal cardiovascular events and cardiovascular-related mortality did not differ between groups but was numerically higher in the internet-based cognitive behavioral therapy group, who were at slightly greater risk (HR 1.8, 95% CI 0.96 to 3.4, <i>P</i>=.07). Adjusting for previous myocardial infarction and diabetes attenuated this estimate (HR 1.5, 95% CI 0.8 to 2.8, <i>P</i>=.25). CONCLUSIONS Internet-based cognitive behavioral therapy was not superior in reducing self-reported symptoms of depression or anxiety compared to treatment as usual at the 1-year follow-up after myocardial infarction. A reduction in cardiac-related anxiety was observed but was not significant after adjusting for multiple comparisons. There was no difference in risk of cardiovascular events between the treatment groups. Low treatment adherence, which might have affected treatment engagement and outcomes, should be considered when interpreting these results. CLINICALTRIAL ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-015-0689-y

scholarly journals Perception of Inappropriate Use of Proton Pump Inhibitors Among Community-Dwelling Older Adults

2020 ◽  
Author(s):  
Mohammad Rababa ◽  
Abeer Rababa'h
Keyword(s):  
Older Adults ◽  
Side Effects ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Primary Care Providers ◽  
Community Dwelling ◽  
Care Providers ◽  
Cross Sectional ◽  
Convenience Sample

Abstract Background Long-term use of proton pump inhibitors (PPIs) in older adults is a prevalent issue and associated with adverse health outcomes. There is limited evidence about older adults’ perception of PPI use and its associated side effects. This study aimed to examine the knowledge and awareness of older adults about PPI use and its side effects and willingness to stop PPI and its associated factors. Methods This cross-sectional study was conducted on a convenience sample of 120 older adults from three local healthcare centers located in Irbid, Jordan. Older adults’ perception of PPI use was measured by Patients’ Perceptions of Proton Pump Inhibitor Risks and Attempts at Discontinuation Survey. Results The majority of older adults were not familiar with any report linking PPI use with side effects, reported no concern related to the chronic side effects of PPI, and had not discussed the benefits and risks of PPI with their primary care providers (PCPs). Although a majority did not try to stop PPI, most older adults were willing to stop PPI due to its side effects, particularly if recommended by PCPs. Factors associated with long-term use of PPI included age, indication for gastrointestinal reflux disease (GERD), improvement of GERD symptoms, and being comfortable to reduce or stop PPI. Recommendations by PCPs to stop PPI (p = 0.049) and a greater level of concern about long-term side effects of PPI (p < 0.0001) were the only two statistically significant predictors of previous attempts to stop PPIs. Conclusions Concern about PPIs is associated with attempts to stop PPI, particularly with PCPs’ recommendation. The risks and benefits of PPIs should be discussed with PCPs to avoid making inappropriate decisions regarding PPI therapy. The Long-term use of PPIs should be carefully evaluated.

scholarly journals Anxiety and depression during the COVID-19 pandemic in Kuwait: the importance of physical activity

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Khaled E. Alsharji
Keyword(s):  
Physical Activity ◽  
Psychological Impact ◽  
Bachelor's Degree ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
Sociodemographic Characteristics ◽  
Gender Education ◽  
Multiple Regression Models ◽  
The Government

Abstract Background In Kuwait, as in much of the world, COVID-19 epidemic has been spreading since February 2020. The government of Kuwait has taken several measures to minimize virus spread. The epidemic and measures to contain it will likely psychologically influence individuals. This study investigated the prevalence of anxiety and depression symptoms in Kuwaiti nationals and expats. The study’s secondary aim was to identify the association between sociodemographic characteristics and physical activity (PA) engagement, with psychological disorders such as anxiety and depression during the COVID-19 pandemic in Kuwait. A two-section survey was used to examine sociodemographic characteristics and PA engagement, and generalized anxiety (GAD-7) and depression symptoms (PHQ-9). Results Results of this study indicated that 53.7% and 59.6% of the respondents experienced anxiety and depression. The multiple regression models significantly predicted anxiety and depression (P < 0.001). In addition, PA, gender, education, and age were significantly associated with anxiety (P < .05), while PA, gender, age, and marital status were significantly associated with depression (P < .05). Conclusions Findings suggest that the COVID-19 outbreak may have a greater psychological impact on women, younger individuals, married people, and individuals with a bachelor’s degree. However, regular PA appears to be an important immediate and long-term factor in reducing symptoms of anxiety and depression during an epidemic.

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