CBT for low-income and elderly patients.

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

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

3. 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

4. Cognitive Behavioral Therapy for older adults • 12-16 weekly sessions (this is flexible) • Perceptions and appraisals • Activity level • Time management • Assertiveness • Safety February 7, 2008 FSA/CATALAC training

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

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

7. 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

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

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

10. CBT for older adults A session by session guide

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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. February 7, 2008 FSA/CATALAC training