Week 11 Flashcards
1
Q
How did Freud view those over 50 yo? How would you respond to his claims?
A
- Thought they had decreased mental processing and were no longer educable
- Most people in their 60s are highly intelligent, generally function at a very high level
2
Q
After reading Stoffel et al. and Bryant (2016), would you say any of this stigma regarding OA remains?
A
-Yes, evidence in our culture for ongoing stigma towards OA
3
Q
How would people over 50 be different today compared to in Freud’s day?
A
- 50 used to be nearing end of life
- In last 100 years, education makes people more educable (he claimed people over 50 were not educable)
- In 1900s, only about 7% graduated from high school (if not learning, don’t build reserve)
4
Q
Why is it ironic for Freud to discuss MH in older adults?
A
- Older adults are not the most depressed age group
- Generally, people are happier when they get older; those over 70 tend to savor positivity more than younger
5
Q
T/F: generally, people’s happiness declines as they get older
A
False! Generally, people are happier when they get older
- Those over 70 tend to savor positivity more than younger
- Happiness rises slightly from 18-51 and declines slowly after, but very culturally driven. Reports vary dramatically
6
Q
What age group is at the greatest risk for any mental illness?
A
Ages 26-49
7
Q
OAs may suffer from “atypical depression” due to changes in…
A
- Sleep
- Appetite
- Weight
- Energy levels
- Sexual function
- Diffuse or localized pain
8
Q
According to German study that pitted over 200 younger (ages 20-31) vs older (65-80) on 12 different tasks testing perceptual speed, working memory, and episodic memory, who performed more consistently?
A
The older adults (65-80)
- OA less likely to make serious errors that are expensive to resolve
- Higher consistency due to learned strategies to solve task, constantly high motivation level, balanced daily routine and stable mood
9
Q
T/F: According to research, higher productivity is often witnessed in younger adults compared to older adults
A
False! higher productivity often witnessed in older adults
10
Q
What is the “dirty little secret” regarding the effectiveness of antidepressants?
A
Placebo effect has a 45-55% success rate. A more powerful side effect may cause you to think the meds are working more.
11
Q
How can clinical psychology better deal with depression not using antidepressants?
A
- help people live heroically and functioning in spite of sadness
- positive psychology
- cultivating resiliency vs. learned helplessness
12
Q
What was the only dx mentioned by Stoffel et al. specific to old age?
A
-Delirium: disturbances in consciousness, attention, cognition, and perception. Mostly an issue in medical/surgical settings, rare in community. Mostly treated by minimizing sedating meds
13
Q
According to Stoffel et al., How is delirium treated?
A
Mostly by minimizing sedating meds
14
Q
According to Stoffel: disturbance in consciousness, attention, cognition, and perception.
A
Delirium. Mostly an issue in the medical/surgical settings, rare in community. Mostly treated by minimizing meds
15
Q
How prevalent is elder abuse and neglect?
A
10%
16
Q
How does neurodegeneration occur?
A
If you lose enough brain reserve, neurodegeneration occurs
17
Q
The more cognitive/brain reserve, the greater buffer against…?
A
dementia!
18
Q
T/F: According to Bryant (2016), younger adults are more likely to have symptoms related to depression than OA
A
False. OA are more likely to have symptoms related to depression in OA : poor sleep, decreased energy, psychomotor retardation, decreased interest in living
19
Q
According to Bryant (2016), what is strongly linked to mood?
A
Energy!
20
Q
What are common medical treatments for Depression according to Bryant (2016)?
A
- Antidepressants
- ECT
- Individual Therapy
21
Q
What is ECT and how does it work?
A
- Tx for depression
- Administer paralytic
- Found that after people came out of seizures, they seemed to be in a better mood
- Advantage: no medication side effects
22
Q
What are the requirements to receiving ECT for depression?
A
Must fail 3 antidepressant drug trials first
23
Q
Advantages and side effects to ECT?
A
- Advantage: no medication side effects
- Main side effect: interrupt STM; brain can’t process memories before ECT or few hours after
24
Q
Bryant (2016) states that people receiving antidepressants first need a psychological assessment. Is this true? Do most people have formal assessments first?
A
NO. It is usually not a psychiatrist who prescribes
25
The following are all symptoms of what:
- Decreased engagement with increasing avoidance
- Comorbidity with physical illness masks symptoms
- Decline in cognition/executive function
Depression
26
Occupational Performance deficits relating to depression include...
- Diminished pleasure
- Loss of energy
- Decreased attn to ADL's
- Withdrawal and isolation
- Poor sleep
- Eating too much or too little
- Poor executive fxn
27
Who experiences symptoms with depression?
Everyone! Not just old people
28
What saves OAs with depression from committing suicide?
They don't have the energy too.
29
Who is most successful with committing suicide? Older male adults or older female adults?
Older male adults
30
T/F: Most people taking antidepressant meds see a MH professional regularly
False! Less than 1/3 of people taking antidepressants have seen a MH professional in the last year
31
Who is receiving tx for depression more? Men or women?
Women. 2X more women seeking tx for depression
32
What race receiving most tx for depression?
White peeps.
33
In a study by Lenze et al. (2014), mindfulness-based stress reduction (MBSR) helped to treat what population?
Mindfulness-based stress reduction (MBSR) helped treat those with anxiety (decreased anxiety, improved executive function and memory)
34
Effective tx for dementia focus on...
Pleasant events and positive interactions (but can't be self-managed, so not a therapy undertaken by OA themselves)
35
What is IPT?
- Interpersonal therapy
| - Focuses on interpersonal events and roles
36
Interpersonal therapy (IPT) focuses on what four areas?
1. Grief and bereavement
2. role transitions
3. Role disputes
4. Interpersonal deficits
37
What is interpersonal therapy (IPT) not widely disseminated?
CBT covers it
38
What is CBT? How does it work?
-Cognitive Behavioral Therapy
-Uses information processing framework
-Look at problem, find out why you react a certain way, find how to look at it in a different way
-
39
What is the key to CBT?
Key is to challenge distortions in order to achieve one's goals
40
T/F: CBT is an individual process
False. CBT is a collaborative process that include therapeutic strategies (explore meaning, identify consistent theme, connect present and past experiences)
41
Why is CBT more effective for mild than major depression?
- Takes energy to get to therapy apt
| - Hard to dig oneself out of negative through process
42
T/F: CBT becomes less effective as individuals age
True
43
In CBT for depression, how can you help the pt explore thoughts, appraisals, and assumptions?
Through questioning and helping to develop more adaptive thoughts
44
What are the different phases of CBT when using for depression
1. Early phase: identify
2. Middle phase: challenge and restructure
3. Final phase: review skills and negotiate ending
45
What issue may you look at with OA when using CBT?
Various life transitions e.g., retirement, empty nest
46
Strengths and limitations of CBT with OA?
Strength: effective, aging brain not an issue
Limitations: Income is an issue, CBT insufficient for those with low income who need help with basic needs
e.g., difficult to reframe "I'm hungry" or "I'm homeless"
47
In what kind of therapy would you encourage one to reflect back and integrate the present into a meaningful life narrative?
Reminiscence Therapy
48
In which type of therapy would you encourage one to replace negative beliefs with positive reflections
Life review therapy
49
In which type of therapy would you focus on the present, ID and generate solutions to problems
Problem solving therapy
50
What type of therapy is this discussing:
Core concepts of loss, attachment, and patterns of early influence a powerful means of understanding conscious and unconscious feelings; goal to develop insight/ evidence sparse
Short-Term Psychodynamic Therapy
51
T/F: CBT has been shown to be more effective for treating anxiety than depression
False! CBT is more effective for treating depression than anxiety.
-Moderate effectiveness for anxiety, not as robust for younger adults
52
T/F: Psychological interventions for late life generalized anxiety disorder are stronger than pharmacological interventions
False. Pharmacological interventions for GAD in late life stronger than psychological interventions
53
Why do majority of OA fall?
Because they are not paying attn
54
Why are there still concerns that CBT is less effective for older adults?
Some fear that OA cannot meet cognitive demands. DUMB. Can enhance with memory aids, visual aids, booster phone calls
55
T/F: Mixed anxiety and depression is more common than either individually
true
56
In one study, the effectiveness of group therapy for tx of mixed anxiety and depression diminished after tx. Why might this be?
- Non-specific effects of group participation may have led to these results
- Being with others seemed to help, so results decreased when alone again
57
What was the most effective tx for carer stress (caretakers of those with dementia)?
CBT appears most effective, but with highly trained instructors. CBT with relaxation showed best long term effects at follow up
58
Effectiveness of CBT on lower income populations?
Ineffective
59
How does the effectiveness of Internet based CBT education compare to that of regular CBT?
Results show equally good response. But bias that older adults won't like or use technology
60
These types of modalities for depression/anxiety look at tolerance, not reappraisal
Mindfulness based therapies! They are spreading. Not immediate problem-solving. First look at just accepting/tolerating the though
61
Why might mindfulness tx be a good fit for OA?
Developmental changes associated with aging e.g., reevaluating priorities, reflecting on life, may provide good match. Maybe wisdom?
62
This type of therapy balances acceptance of thoughts and emotions with value directed behavior change
Acceptance and commitment therapy (ACT). Similar effectiveness to CBT, but fewer dropouts in ACT in study
63
Benefits to mindfulness...?
- Stress reduction
- Boosts to working memory
- Focus
- Boosts cognitive flexibility
- Improves relationship satisfaction
- Boosts self-insight, morality, intuition and fear modulation, immune function, improves well being and reduces psychological distress, improves information processing speed, decreases task effort, decreases distractibility
So everything.
64
What is considered the forgotten psychological tool?
Forgiveness
65
Why is forgiveness important for OA?
- They tend to reflect on their lives and who they have hurt and who has hurt them, with resulting anger, hopelessness, and despair
- Self-forgiveness can alleviate chronic rumination and improve mental health
- Important for successful aging. OA appear more motivated to forgive
66
What is the goal of forgiveness according to Foulk ?
Goal is to develop new "positive intention" story about the self and others to decrease blame and enhance forgiveness
-Individuals generate a "grievance story" blaming themselves or others how they feel.
67
In mindfulness-based forgiveness group for OA (Foulk 2017), what did results show?
-Improvements in mindfulness/self-compassion, psychological well-being and rumination, but not on depression scale
68
What are the 4 basic ways mindfulness works?
1. Attention regulation: improved executive attn, less distractions, improved orienting and conflict monitoring. Greater ability to step out of own skin and see problems in new light to help others cope
2. Body awareness: ability to notice subtle body sensations which may lead to better awareness of emotions
3. Emotion regulation: Facilitates return to baseline following reactivity--brain activity associated with positive emotions. Learning causes new rxn response
4. Reappraisal, extinction, reconsolidation: Reappraisal --stressful events reconstructed as beneficial, meaningful, or benign; extinction--doesn't erase initial association, but forms new memory trace
All strategies allow mind and neural pathways to be changed, allowing for more adaptive response to stress
69
How does mindfulness work?
- We can engage in mental exercises as well as physical ones!
- Not trying to fix anything or make it go away
- We can think of happiness as a skill--the more we practice, the more we cultivate and the more we can be happy
- You can practice to be happy and good with people!
70
What is the best thing you can do for the brain?
Exercise!
71
What is meant by change in perspective on self relating to mindfulness?
Mindful meditation allows for the shift to the observer perspective--crucial to growth
-Various brain components are activated during medication--interrelated and allow for emotional processing and regulation , allowing for nonjudgmental stance with greater acceptance and openness
72
How does mindfulness facilitate self-compassion?
- Self-kindness: being kind rather than critical to self
- Common humanity: seeing one's experience as indicative of larger experience of being human
- Mindfulness: maintaining one's thoughts in balanced awareness rather than over-identifying with them
- Compassion towards self and others is ultimately key to resolution of many issues
73
What does the term "common humanity" mean when discussing mindfulness?
-Seeing one's experience as indicative of larger experience of being human (form of self-compassion)
74
The following are all things you can do to enhance what?
- Smile
- Stay intellectually active
- Consciously relax
- Yawn
- Meditate
- Aerobic exercise
- Dialogue with others
- Faith
Your brain!
75
T/F: According to Stoffell, OA are more likely to experience poor sleep, decreased energy, psychomotor retardation, and decreased interest in continuing life. They are also more likely to report depressed mood, feelings of guilt, or worthlessness
False. OA are more likely to experience poor sleep, decreased energy, psychomotor retardation, and decreased interest in continuing life. BUT they are less likely to report depressed moods, feelings of guilt, worthlessness
76
From Stoffell, symptoms to diagnosis depression include:
SIG-E-CAPS!
S: Suicidal thoughts
I: Interests decreased
G: guilt
E: energy decreased
C: concentration decreased
A: appetite disturbances (increase or decrease)
P: psychomotor changes (agitation or retardation)
S: Sleep disturbances (increased or decreased)
77
According to Polenick, what condition is a significant public health concern with many deleterious effects on health and well-being of older adults and their families?
Late-life Depression (LLD). Has been associated with increased risk of self-neglect, morbidity, mortality, and suicide, and decreased physical, cognitive, and social functioning. Family caregivers at risk for poor mental health and increased burden, which may affect rates of recovery
78
According to Polenick, why is depression unlikely to be underdiagnosed in older adults?
Because it is often comorbid with medical illness and may be compounded by neurological and fxnal impairment
79
According to Polenick, why may OA not report depressive symptoms?
They may view it as a normal part of aging
80
According to Polenick what are some problems with antidepressants for LLD?
Although antidepressants are the most common tx form for LLD:
- OAs may hesitate to take meds for fear of dependency
- meds carry risk of harmful side effects e.g., increased risk of GI bleeding
- Dissatisfaction with antidepressants may lead to discontinue getting tx
- Medication doesn't address environmental aspects of depression
81
What does Polenick propose as alternative forms of tx to LLD than antidepressants?
Nonpharmacological behavioral models to depression e.g., behavioral activation
82
According to Polenick how to behavioral models for tx for LLD vary from medical models?
-In behavioral models, see depression as multitude of covert (and overt (social avoidance, eating patterns) behaviors that vary with individual. View depressed symptoms as depressed behaviors
83
What did Polenick find regarding effectiveness in behavioral activation for LLD (late life depression)?
-Behavioral activation interventions were associated with significantly reduced depressive symptoms and increasing healthy behaviors in OAs Found to be comparable to cognitive therapy and problem-solving effectiveness
84
According to Polenick, how practical is is the use of behavioral activation?
Studies suggest that behavioral activation is an effective tx for LLD across wide spectrum of settings Easy to understand, cost effective, can be done telephone or videoconference, requires minimal training
85
What did Polenick list as the four main challenges for implementing behavioral activation with OA?
1. Those receiving tx may need to accept rationale behind behavioral activation tx, as well as those involved in the care
2. Activities or pleasant events must provide positive reinforcement so that engagement results in increased likelihood of engaging in future
3. Successful behavioral activation tx requires following activity schedules and activity monitoring--may be labor intensive for clients, care providers, family--may lead to decreased adherence
4. Few graduate programs that offer training in
86
According to Polenick, what are behavioral activation strategies supposed to do?
Behavioral activation tx for depression aims to facilitate increased in enjoyable activities that increase opportunities to for contact with positive reinforcement
