ABSTRACT
Research shows that elderly patients are fully capable of benefiting from psychotherapy, and often prefer this non-pharmacological treatment option. Further, there is consensus among geriatric clinicians and researchers that a group format for psychotherapy is likely especially helpful for the elderly. In this paper, we describe a unique group therapy program for elderly patients referred to a community outpatient setting for depression and/or anxiety. This integrated group therapy program, unlike existing programs, combines a more structured cognitive-behavior therapy (CBT) with a more process-oriented interpersonal therapy (IPT), specifically targeting the coexistence of depression and anxiety in the elderly. We present two cases of prototypical patients benefiting from the program, and also provide preliminary empirical support for the effectiveness of this group program.
Subject(s)
Aging/psychology , Anxiety Disorders/psychology , Anxiety Disorders/therapy , Cognitive Behavioral Therapy/methods , Depressive Disorder/psychology , Depressive Disorder/therapy , Models, Psychological , Psychotherapeutic Processes , Psychotherapy, Group/methods , Age Factors , Aged , Aged, 80 and over , Ambulatory Care , Anxiety Disorders/diagnosis , Combined Modality Therapy , Depressive Disorder/diagnosis , Female , Humans , Interpersonal Relations , Male , Middle Aged , Outcome and Process Assessment, Health Care , Patient Satisfaction , Psychotherapy, Multiple , Retirement , Somatoform Disorders/diagnosis , Somatoform Disorders/psychology , Somatoform Disorders/therapyABSTRACT
OBJECTIVES: There is a growing call for greater consumer participation in health care encounters. Prior research suggests that older age is associated with a greater preference for a more passive role in clinical decision-making, yet little is known about preferences for persons with mental illness. This pilot study compared preferences for involvement in decision-making between older and younger adults with serious mental illness. DESIGN: Cross-sectional observational survey. PARTICIPANTS: The authors surveyed 33 older adults (>or=50 years) and 32 younger adults (<50 years) with serious mental illness from two mental health center clinics and one residential facility for their preferences on decision-making with their psychiatrists and primary care providers. MEASUREMENTS: Measures included the Control Preferences Scale, the Autonomy Preference Index, and the Decision Self-Efficacy Scale. RESULTS: Contrary to our primary hypothesis, older adults reported a stronger desire for involvement in decision-making compared with younger adults. However, both age groups were similar in their desire for information to aid in decision-making. The majority in both age groups also preferred a collaborative role with a psychiatrist for medication decisions, an autonomous role for decisions related to psychosocial interventions, and a passive role with their primary care provider. Older and younger adults expressed similar decision self-efficacy. CONCLUSION: Our study suggests that older persons with serious mental illness have a stronger desire for involvement in decision-making than younger consumers. Additionally, role preference for involvement in decision-making varies across different clinical decisions and for psychopharmacological versus psychosocial interventions.
Subject(s)
Community Mental Health Services/statistics & numerical data , Mental Disorders/psychology , Mental Health Services/statistics & numerical data , Patient Participation/psychology , Aged , Cross-Sectional Studies , Decision Making , Educational Status , Female , Humans , Male , Middle Aged , Mood Disorders/psychology , New Hampshire , Physician-Patient Relations , Psychotic Disorders/psychology , Stress Disorders, Post-Traumatic/psychologyABSTRACT
This report reviews studies of psychosocial interventions for people with co-occurring substance use disorder and severe mental illness. We identified 45 controlled studies (22 experimental and 23 quasi-experimental) of psychosocial dual diagnosis interventions through several search strategies. Three types of interventions (group counseling, contingency management, and residential dual diagnosis treatment) show consistent positive effects on substance use disorder, whereas other interventions have significant impacts on other areas of adjustment (e.g., case management enhances community tenure and legal interventions increase treatment participation). Current studies are limited by heterogeneity of interventions, participants, methods, outcomes, and measures. Treatment of co-occurring severe mental illness and substance use disorder now has a large but heterogeneous evidence base that nevertheless supports several types of interventions. Future research will need to address methodological standardization, longitudinal perspectives, interventions for subgroups and stages, sequenced interventions, and the changing realities of treatment systems.
