CBT for low-income and elderly patients. Patricia A. Arean, Ph.D.

February 7, 2008 FSA/CATALAC training Overview What is CBT CBT for older adults Incorporating case management

February 7, 2008 FSA/CATALAC training Cognitive 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 for older adults weekly sessions (this is flexible) Perceptions and appraisals Activity level Time management Assertiveness Safety

February 7, 2008 FSA/CATALAC training Perceptions and Appraisals Balanced view of the world Using depression as a signal Weighing the evidence

February 7, 2008 FSA/CATALAC training Activity Level Pleasant activities Education about depression Socialization

February 7, 2008 FSA/CATALAC training Time Management Scheduling have-tos and want-tos Balancing day with both activities Planning around difficult days Scheduling homework

February 7, 2008 FSA/CATALAC training Assertiveness Expressing needs Moving from passive to active Asking for help Asking for more information

February 7, 2008 FSA/CATALAC training Safety Planning outings Home security Preventing financial abuse Self defense

CBT for older adults A session by session guide

February 7, 2008 FSA/CATALAC training Subdivisions of CBT Introductory phase: socializing patient to CBT while getting an assessment of strengths and weaknesses Middle phase: skill development Termination phase: relapse prevention

February 7, 2008 FSA/CATALAC training Session #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 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 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 Termination 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 management Very important in CBT for low-income Assessment 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.