UQx PSYC1030.3x 4-2-3 Therapy in later life for depression and anxiety


The intervention research points to several
evidence-based psychotherapeutic interventions for anxiety in older adults, including cognitive
behavioral therapy, relaxation training, and supportive therapy (Ayers et al. 2007). In cognitive behavioral therapy, or CBT, the
emphasis is on making explicit links between how you are thinking and behaving, and how
you are feeling. So if your thoughts are negative, like “Dan
didn’t stop to chat with me – he must be angry with me” or if your behaviors are
negative, such as not taking time for pleasant activities – then your emotions will also
be negative. CBT teaches patients to pay attention to shifting
negative thoughts and behaviors to shift their emotions in a positive direction. Relaxation training is very useful to combat
anxiety at any age – it involves teaching deep breathing, as well as letting go of invasive,
worrying thoughts. Supportive therapy is of particular use for
patients in crisis and involves improving, reinforcing, or sustaining a patient’s physiological
well-being or psychological self-esteem and self-reliance. An encouraging and supportive relationship
with the patient is key in this therapeutic approach. Older adults have in many international surveys
expressed a distinct preference for psychotherapy over medication, for example in an Australian
study by Woodward and Pachana in 2009, particularly if they have physical illnesses which require
medications. Avoiding polypharmacy, or multiple medications,
where possible, helps decrease the chance of adverse medical reactions or side effects
in older people. Several psychotherapies also are effective
with older adults with depression: cognitive behavioral therapy again, as well as interpersonal
psychotherapy, problem-solving therapy, and brief psychodynamic psychotherapy (Ellison
et al. 2012). Interpersonal psychotherapy, or IPT, is a
highly structured and time-limited therapy approach that focuses on helping the patient
to resolve interpersonal problems, which are thought to underlie depression. Problem-solving therapy, as its name suggests,
is a form of CBT aimed at improving an individual’s ability to cope with stressful life experiences,
and improve depressed or anxious mood. In this approach the therapist tries to give
the patient more positive coping strategies to replace those which may be unhelpful or
maladaptive. The goals of brief psychodynamic therapy include
increased client self-awareness and improved understanding of the influence of past experiences
on present behavior. This is a time-limited intervention which,
while focused on past experiences, is nevertheless oriented to current goals such as better coping
with anxiety or depression. Other approaches that can be fruitfully combined
with these empirically based psychotherapies include increasing physical activity, mindfulness
approaches, and strategies to increase social interaction. Also, particularly for older adults who are
experiencing severe levels of depression or anxiety, any of these therapies may be combined
with medications, and this is often the most effective intervention in such circumstances. Interdisciplinary treatment models are highly
effective with older persons, particularly those with complex mental illnesses and dementia
(Zeiss & Gallagher-Thompson, 2003). Many studies, in settings ranging from inpatient
settings to general practice, support interdisciplinary models. Usually, interdisciplinary teams involve a
physician, nurse, psychologist and other allied health professionals such as occupational
therapists, physical therapists, and social workers. Examples of health care services where interdisciplinary
teams are most effective include services treating complex long-standing psychiatric
conditions such as schizophrenia, memory clinics where the source of memory issues may be from
various physical or psychiatric causes, or end of life treatment in case of terminal
illness.

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