Cognitive Behavior Therapy for Older Adults: Practical Guidelines for Adapting Therapy Structure

Cognitive behavioral therapy (CBT) has been shown to be an effective approach for a wide range of problems affecting older adults. While a variety of empirical and clinical papers have examined modifications to the content and delivery of CBT to enhance its efficacy with older adults, changes to the structure of therapy with this population have not been as widely discussed. Issues around optimizing the structure of CBT with older adults are presented, along with suggestions for realizing these changes within a clinical context.     

Behavior Ratings and Observations of Externalizing Symptoms in Girls: The Role of Child Popularity with Adults

This study examined staff ratings and live observations of externalizing behavior in 149 girls with and without attention-deficit/hyperactivity disorder (ADHD), who participated in all-female naturalistic research camps. Girls' popularity with adult camp staff was hypothesized to explain discrepancies between ratings and observations. Compared to behavior observations, staff ratings overestimated the externalizing behavior of girls who were disliked by staff. In contrast, ratings and observations were consistent for girls who were liked by staff. Among girls who were disliked by staff, unpopularity with peers predicted a larger discrepancy between staff ratings and observations, but peer status made little difference in rating–observation discrepancies of girls liked by staff. All results held after controlling for the participants' ADHD versus comparison status. Results suggest that staff ratings may be biased by personal feelings about children and that direct observations may be more immune to such bias.     

Bias in older adults’ driving self-assessments: The role of personality

A convenience sample of 50 older drivers (M_age = 73.14, SD = 4.85) completed the Myers-Briggs Type Indicator® (MBTI®) Step III™ instrument and rated their own driving abilities (compared to all other drivers, same age drivers, and their own driving 20 years prior) and their ability to perform 68 specific driving-related behaviors. Each subject’s driving performance was also evaluated in a comprehensive on-road assessment conducted by a certified driving rehabilitation specialist, who rated the same 68 driving behaviors as well as driving performance. Drivers identified by the MBTI Step III instrument as Extraverted, Sensing, and (above median) Confident rated their driving significantly more favorably than Introverts, Intuitives, and below median Confidence drivers. Step III Sufficiency scales were associated with on-road performance: drivers with scores indicating low Confidence, low Stamina, or critical high levels of Compensatory Strain received significantly lower evaluations. Drivers with a Sensing preference or critical Strain score rated their driving significantly more favorably than evaluators did. These findings present preliminary evidence for the utility of personality assessments in identifying self-serving bias in driving self-evaluations, essential for safe self-regulation of driving.     

Cognitive-behavioral therapy for geriatric compulsive hoarding

This investigation examined response to a manualized cognitive-behavioral therapy (CBT) protocol for compulsive hoarding (Steketee & Frost, 2007) in a sample of 12 adults over age 65. All participants were cognitively intact, not engaging in any other psychotherapy, and had compulsive hoarding as their primary problem. All received 26 sessions of individual CBT over the course of 17 weeks. The primary outcome measures were the Savings Inventory-Revised and UCLA Hoarding Severity Scale, which were administered at baseline, mid-treatment, post-treatment, and 6-month follow-up. Other outcomes included Clinical Global Impression (CGI) scores, depression, anxiety, disability, and clutter image ratings. Results demonstrated statistically significant changes on hoarding severity and depression. However, only three of the twelve participants were classified as treatment responders at post-treatment, and their gains were not maintained at 6-month follow-up. CGI, anxiety, disability, and clutter ratings were unchanged at post-treatment and follow-up. No participants dropped out, but homework compliance was variable and correlated with decreases in hoarding severity. Findings suggest that older adults with compulsive hoarding may require an enhanced or alternative treatment.     

日益孤独的中国老年人：一项横断历史研究

随着社会的巨大变迁, 我国老年人孤独感水平可能逐年增高。通过采用横断历史研究的方法, 对使用UCLA孤独量表(第三版)调查老年人孤独感的25篇文献进行元分析, 调查年代跨度为1995年至2011年, 共涉及13280名老年人。研究结果表明：(1)我国老年人孤独感水平随年代的变迁呈上升趋势; (2)不同婚姻状况、不同性别老年人的孤独感水平随年代均呈上升趋势; (3)老年人孤独感水平存在婚姻状况差异, 但不存在性别差异。     

前额叶在老年阶段的可塑性及相关机制

大量研究表明, 前额叶的结构和功能更容易受年老化影响; 然而, 近年来的研究发现, 前额叶的结构和功能在老年阶段具有一定的可塑性。对老年人进行认知训练, 能够延缓前额叶皮层厚度的萎缩, 提高白质完整性, 改善神经网络的功能连接和分化, 并可能通过调节多巴胺系统的活动改变前额叶皮质和皮质下结构的功能激活模式。有氧锻炼能够改善心脑血管功能, 保护和促进神经元的存活和生长, 引起前额叶灰质、白质体积的增加及功能激活的变化。认知训练与有氧锻炼等相结合的整合性训练不仅引起前额叶及相关认知功能的改变, 而且具有更好的生态学效度, 使老年人日常认知能力和生活质量得到提高。未来研究应采用多种技术手段, 从多个层面理解老年阶段前额叶的可塑性及相关机制; 加强对与前额叶关系密切的多种认知功能可塑性神经机制的研究; 并重视与整合性训练有关的前额叶可塑性。     

Self-presentation and gender on MySpace

Within the cultural context of MySpace, this study explores the ways emerging adults experience social networking. Through focus group methodology, the role of virtual peer interaction in the development of personal, social, and gender identities was investigated. Findings suggest that college students utilize MySpace for identity exploration, engaging in social comparison and expressing idealized aspects of the selves they wish to become. The public nature of self and relationship displays introduce feedback mechanisms by which emerging adults can legitimize images as associated with the self. Also, male–female differences in self-presentation parallel, and possibly intensify, gender norms offline. Our study suggests that social networking sites provide valuable opportunities for emerging adults to realize possible selves; however, increased pressure for female sexual objectification and intensified social comparison may also negatively impact identity development. A balanced view, presenting both opportunities and drawbacks, should be encouraged in policies regarding youth participation in social networking sites.     

Reinforcing efficacy of interactions with preferred and nonpreferred staff under progressive-ratio schedules

Research has not systematically assessed and validated preferences for staff in adults with developmental disabilities. Three adults with developmental disabilities (aged 32 to 43 years) identified preferred and nonpreferred staff using verbal and pictorial preference assessments. During break-point analyses with progressive-ratio schedules, all 3 had higher break points when working for positive social interaction with their preferred staff mamber than with their nonpreferred staff member.     

The Role of Spirituality in Advance Directive Decision Making Among Independent Community Dwelling Older Adults

The purpose of this grounded theory study, based on Strauss and Corbin’s (1998) grounded theory methodology, was to investigate the meaning, definition, and needs regarding the role of spirituality in end of life care among independent community dwelling older adults in relation to advance directive decision making (ADDM). Findings revealed that through the use of story telling, independent community dwelling older adults were able to define spirituality and describe the important role spirituality plays in everyday life and in ADDM. A theoretical model was constructed consisting of a mirrored basic social process, Spirituality as Connecting.     

A Spiritual Screening Tool for Older Adults

Objective The purpose of this non-experimental study was to investigate the reliability and validity of a self-administered screening tool for spiritual distress in older adults. The tool was unique in that items were consistent with a conceptual definition of spirituality presented in the professional literature and supported by theories of behavioral development for older adults. Methods Questionnaires were distributed to residents of a continuing care retirement community participating in a class on spirituality. Results The split-half reliability coefficient was found to be 0.776. Construct validity was established and a cutoff value for spiritual distress was determined. Discussion Tests for reliability and validity demonstrated confidence in use of the tool to screen for spiritual distress in older adults.