Counseling Older Adults with Dementia: A Survey of Therapists in Massachusetts

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.     

Effectiveness of the Hamilton Anxiety Rating Scale with Older Generalized Anxiety Disorder Patients

To expand the collection of instruments available for assessment of anxiety in the elderly, this report examined the original and revised Hamilton anxiety scales in a sample of 50 older adults diagnosed with Generalized Anxiety Disorder (GAD) and 93 normal community participants (ages 55–82). Although the revised anxiety scale had better discriminant validity (lower correlation with the revised Hamilton depression scale) than the original anxiety and depression scales, a considerable amount of shared variance still existed (41% shared variance, GAD sample alone; 17% control sample alone; 74% shared variance, both samples combined). Near-perfect group classification was possible using 7 items from the original anxiety scale and 10 items from the revised anxiety scale. Results are discussed in light of their implications for use of the Hamilton anxiety rating scale with older anxiety-disordered patients.     

AIDS prevention for intravenous drug users in the community: Street-based education and risk behavior

Conducted a study of behavior change associated with a street-based AIDS education project targeted to intravenous (IV) drug users in San Francisco. Two cross-sections were sampled from drug detoxification clinics and street locations in 1986 (n = 438) and 1987 (n = 623). Significant increases were reported in the percentage of IV drug users who used bleach to decontaminate syringes, who did not share needles in past year, and in condom use. A significant reduction in an index of the number of needle-sharing partners was reported. Respondents ranked treatment program as most important source of AIDS information prior to implementation of the program, and ranked outreach workers as most important after implementation. Findings suggest that this community-based outreach program had at least some impact on knowledge about AIDS and may have led to reductions in behaviors known to transmit HIV.     

An MMPI-based empirical model of malingering and deception

The empirically-based model of malingering and deception described by Rogers (1984b) was operationalized using MMPI and clinical interview data. Subjects (N = 159) were patients committed to an inpatient forensic hospital as ‘Incompetent to Stand Trial’ or ‘Not Guilty by Reason of Insanity’. Inter-rater reliability was acceptable for the 11 criteria used to define response styles. Each subject was categorized into one of five response style groups: ‘Reliable’, ‘Malingering’, ‘Defensive’, ‘Irrelevant’, or ‘Unclassifiable’. Factor analysis of the rating criteria yielded four factors, three of which are comparable to the assigned groups, providing some validation for the constructs underlying these groups.     

Seeing Is Believing: Using Video Feedback in Cognitive Therapy for Social Anxiety Disorder

Distorted negative self-images and impressions appear to play a key role in maintaining Social Anxiety Disorder (SAD). In previous research, McManus et al. (2009) found that video feedback can help people undergoing cognitive therapy for SAD (CT-SAD) to develop a more realistic impression of how they appear to others, and this was associated with significant improvement in their social anxiety. In this paper we first present new data from 47 patients that confirms the value of video feedback. Ninety-eighty percent of the patients indicated that they came across more favorably than they had predicted after viewing a video of their social interactions. Significant reductions in social anxiety were observed during the following week and these reductions were larger than those observed after control periods. Comparison with our earlier data (McManus et al., 2009) suggests we may have improved the effectiveness of video feedback by refining and developing our procedures over time. The second part of the paper outlines our current strategies for maximizing the impact of video feedback. The strategies have evolved in order to help patients with SAD overcome a range of processing biases that could otherwise make it difficult for them to spot discrepancies between their negative self-imagery and the way they appear on video.     

Factor Structure of the Difficulties in Emotion Regulation Scale (DERS) in Adult Outpatients Receiving Dialectical Behavior Therapy (DBT)

The Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer in Journal of Psychopathology and Behavioral Assessment, 26, 41–54, 2004) is a widely used measure of emotion regulation, however, few studies have examined the scale’s psychometric properties in clinical samples. The current study examined the latent factor structure of the scale, in addition to other psychometric properties, in a naturalistic sample of adult outpatients (n = 344) receiving dialectical behavior therapy (DBT). A number of models were fitted, including a bifactor model, which has not previously been examined with the DERS, but which may be more appropriate for addressing the study’s two primary aims. These aims were to: (1) investigate some of the prior concerns raised about the Awareness subscale items; and (2) evaluate the appropriateness of using DERS total vs. subscale scores. Results indicated that a modified bifactor model which excluded the Awareness items from the general factor fit the data best. Additional findings suggested that the DERS total score (excluding Awareness items) was reliable and had good criterion-related validity in this sample. However, the findings related to the DERS subscales were mixed. This study extends prior research on the DERS by demonstrating the utility of the scale with individuals receiving DBT for problems with emotion regulation, as well as by clarifying some of the prior questions about the scale’s latent structure.     

Determining the number of factors to retain: Q windows-based FORTRAN-IMSL program for parallel analysis

Parallel analysis (PA; Horn, 1965) is a technique for determining the number of factors to retain in exploratory factor analysis that has been shown to be superior to more widely known methods (Zwick & Velicer, 1986). Despite its merits, PA is not widely used in the psychological literature, probably because the method is unfamiliar and because modern, Windows-compatible software to perform PA is unavailable. We provide a FORTRAN-IMSL program for PA that runs on a PC under Windows; it is interactive and designed to suit the range of problems encountered in most psychological research. Furthermore, we provide sample output from the PA program in the form of tabled values that can be used to verify the program operation; or, they can be used either directly or with interpolation to meet specific needs of the researcher.