Exposure-Based CBT for Older Adults After Fall Injury: Description of a Manualized, Time-Limited Intervention for Anxiety.

Fall accidents among older adults can be devastating events that, in addition to their physical consequences, lead to disabling anxiety warranting the attention of mental health practitioners. This article presents "Back on My Feet," an exposure-based cognitive-behavioral therapy (CBT) protocol that is designed for older adults with posttraumatic stress disorder (PTSD), subthreshold PTSD, or fear of falling resulting from a traumatic fall. The protocol can be integrated into care once patients have been discharged from hospital or rehabilitation settings back to the community. Following a brief description of its development, the article presents a detailed account of the protocol, including patient evaluation and the components of the eight home-based sessions. The protocol addresses core symptoms of avoidance, physiological arousal/anxiety, and maladaptive thought patterns. Because older patients face different coping challenges from younger patients (for whom the majority of evidence-based CBT interventions have been developed), the discussion ends with limitations and special considerations for working with older, injured patients. The article offers a blueprint for mental health practitioners to address the needs of patients who may present with fall-related anxiety in primary care and other medical settings. Readers who wish to develop their expertise further can consult the online appendices, which include a clinician manual and patient workbook, as well as guidance on additional resources.

Distraction and placebo: two separate routes to pain control.

An explosion of recent research has studied whether placebo treatments influence health-related outcomes and their biological markers, but almost no research has examined the psychological processes required for placebo effects to occur. This study tested whether placebo treatment and cognitive distraction reduce pain through shared or independent processes. We tested the joint effects of performance of an executive working memory task and placebo treatment on thermal pain perception. An interactive effect of these two manipulations would constitute evidence for shared mechanisms, whereas additive effects would imply separate mechanisms. Participants (N = 33) reported reduced pain both when they performed the working memory task and when they received the placebo treatment, but the reductions were additive, a result indicating that the executive demands of the working memory task did not interfere with placebo analgesia. Furthermore, placebo analgesia did not impair task performance. Together, these data suggest that placebo analgesia does not depend on active redirection of attention and that expectancy and distraction can be combined to maximize pain relief.