Evidence-based psychological treatments for insomnia in older adults.

The review describes evidence-based psychological treatments (EBTs) for insomnia in older adults. Following coding procedures developed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology, two treatments were found to meet EBT criteria: sleep restriction-sleep compression therapy and multicomponent cognitive-behavioral therapy. One additional treatment (stimulus control therapy) partially met criteria, but further corroborating studies are needed. At the present time, there is insufficient evidence to consider other psychological treatments, including cognitive therapy, relaxation, and sleep hygiene education, as stand-alone interventions beneficial for treating insomnia in older adults. Additional research is also needed to examine the efficacy of alternative-complementary therapies, such as bright light therapy, exercise, and massage. This review highlights potential problems with using coding procedures proposed in the EBT coding manual when reviewing the existing insomnia literature. In particular, the classification of older adults as persons age 60 and older and the lack of rigorous consideration of medical comorbidities warrant discussion in the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based psychological treatments for late-life anxiety.

This project identified evidence-based psychotherapy treatments for anxiety disorders in older adults. The authors conducted a review of the geriatric anxiety treatment outcome literature by using specific coding criteria and identified 17 studies that met criteria for evidence-based treatments (EBTs). These studies reflected samples of adults with generalized anxiety disorder (GAD) or samples with mixed anxiety disorders or symptoms. Evidence was found for efficacy for 4 types of EBTs. Relaxation training, cognitive-behavioral therapy (CBT), and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders. CBT for late-life GAD has garnered the most consistent support, and relaxation training represents an efficacious, relatively low-cost intervention. The authors provide a review of the strengths and limitations of this research literature, including a discussion of common assessment instruments. Continued investigation of EBTs is needed in clinical geriatric anxiety samples, given the small number of available studies. Future research should examine other therapy models and investigate the effects of psychotherapy on other anxiety disorders, such as phobias and posttraumatic stress disorder in older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The treatment of depression in older adults in the primary care setting: An evidence-based review.

The objective of this study was to conduct an evidence-based review of treatments for depression in older adults in the primary care setting. A literature search was conducted using PsycINFO and Medline to identify relevant, English language studies published from January 1994 to April 2004 with samples aged 55 and older. Studies were required to be randomized controlled trials that compared psychosocial interventions conducted within the primary care setting with "usual care" conditions. Eight studies with older adult samples met inclusion criteria and were included in the review. Two treatment models were evident: Geriatric Evaluation Management (GEM) clinics and an approach labeled integrated health care models. Support was found for each model, with improvement in depressive symptoms and better outcomes than usual care; however, findings varied by depression severity, and interventions were difficult to compare. Further efforts to improve research and clinical care of depression in the primary care setting for older adults are needed. The authors recommend the use of interdisciplinary teams and more implementation of psychosocial treatments shown to be effective for older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on evidence-based psychological treatments for older adults.

Psychology has a strong tradition as a science-based discipline. This tradition has also been strong in the subfields of geropsychology and clinical psychology. The convergence of these traditions leads to an expectation that mental health and aging practices will be theoretically sound and empirically tested. This Psychology and Aging Special Section on Evidence-Based Psychological Treatments for Older Adults presents findings which demonstrate that there are a number of evidence-based treatments that can contribute to exemplary care of older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoothing the trail for dissemination of evidence-based practices for youth: Flexibility within fidelity.

The role and implementation of evidence-based practice and empirically supported treatments has been hotly contested among researchers and practitioners. Using examples of and from various empirically supported treatments the authors offer suggestions for smoothing the pathway for dissemination of evidence-based practice with children and adolescents. The authors underscore that mediational analyses, treatment process studies, and the continued creation of flexible treatment manuals are important components of successful dissemination. Flexibility within fidelity is proposed as the preferred perspective that eases the transition and dissemination of empirically supported treatments from research clinics to service clinics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing key challenges in evidence-based practice in psychology.

With its promise of enhancing the effectiveness of services, evidence-based practice in psychology (EBPP) appears to offer much to psychologists, patients, and policymakers. The purpose of this article is to examine some of the key challenges facing psychologists who wish to provide evidence-based treatment services, including how research evidence is used in EBPP, whether the results of the treatment research literature can be generalized to typical clinical practice, and how effective evidence-based treatments are in clinical practice. On the basis of recent evidence-based initiatives and treatment research, there is a solid scientific basis for EBPP, although much more research is necessary on the treatment of relatively mild, but common, clinical conditions and on the transporting of evidence-based treatments into clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do haphazard reviews provide sound directions for dissemination efforts?

Comments on The dissemination and implementation of evidence-based psychological treatments: A review of current efforts (see record 2010-02208-010) by Kathryn R. McHugh and David H. Barlow. The lead article in the February–March issue by McHugh and Barlow (2010) emphasized the need for “dissemination and implementation of evidence-based psychological treatments.” The authors identified a number of intervention programs as evidence based and in need of dissemination. One is multisystemic therapy (MST). They claimed that this program is among “the most successful dissemination efforts . . . pursued by treatment developers” (p. 79). McHugh and Barlow’s (2010) discussion of the implementation of MST in Hawaii is troubling, because it neglected to mention concerns about the perceived lack of cultural sensitivity of the MST program in that state. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Commentary on evidence-based psychological treatments for older adults.

This article comments on the articles in the Special Section on Evidence-Based Psychological Treatments for Older Adults (see records 2007-03358-002, 2007-03358-003, 2007-03358-004, 2007-03358-005, and 2007-03358-006). The articles apply criteria developed by the Society of Clinical Psychology to evaluate treatments for late-life anxiety, insomnia, behavior disturbances in dementia, and caregiver distress. The articles document that there are evidence-based psychological treatments that can help older adults. However, there are 2 substantial hurdles: evidence and access. Gaps in the evidence, as mentioned by the authors of the articles in the special section, result from disproportionate research attention to some psychotherapies and some mental disorders, with corresponding lack of research about other treatments and disorders. The challenge for access is to ensure that older adults with treatable mental disorders will get connected to psychologists trained in these evidence-based therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A haphazard reading of McHugh and Barlow (2010).

Replies to comments on Do haphazard reviews provide sound directions for dissemination efforts? (see record 2010-24768-012) by Eileen Gambrill and Julia H. Littell on the current authors' article The dissemination and implementation of evidence-based psychological treatments: A review of current efforts (see record 2010-02208-010) by Kathryn R. McHugh and David H. Barlow. In their commentary, Gambrill and Littell (2010, this issue) suggested that we provided misleading guidance on the selection of treatments for dissemination in our recent article (McHugh & Barlow, February– March 2010) on the dissemination and implementation of evidence-based treatments. These authors misread our article as an affirmation of the evidence base of the treatments involved in the dissemination and implementation efforts we described. In fact, we explicitly disclaimed in the third paragraph that “we do not revisit controversies surrounding the identification or appropriateness of [evidence-based psychological treatments] . . . rather, we focus on the status and adequacy of [dissemination and implementation] efforts currently under way (McHugh & Barlow, 2010, p. 73). Thus, our review was not intended as a guideline for which treatments to disseminate, nor was it a thorough review of the evidence base for the treatments included in the efforts we reviewed. We chose several programs for illustrative purposes as representative efforts from three general domains: national, state, and investigator initiated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically guided coordination of multiple evidence-based treatments: An illustration of relevance mapping in children's mental health services.

Objective: Despite substantial progress in the development and identification of psychosocial evidence-based treatments (EBTs) in mental health, there is minimal empirical guidance for selecting an optimal set of EBTs maximally applicable and generalizable to a chosen service sample. Relevance mapping is a proposed methodology that addresses this problem through structured comparison of client characteristics in a service sample to participant characteristics from studies of EBTs. Method: The authors demonstrate the feasibility of relevance mapping using data from 1,781 youths in a statewide mental health system and a study data set including 437 randomized clinical trials. Relevance mapping (a) reveals who is “coverable” by any EBT, under different definitions of matches between study participants and clients, and (b) identifies minimum sets of treatments needed to serve maximum numbers of clients, across different levels of analysis for defining treatment operations. Results: In the illustration sample, all problems targeted by the study data set review were fully coverable when matching only required clients to have the same problem as EBT study participants. At the other extreme, when matching also required age, gender, ethnicity, and setting, the percentage of noncoverable youths increased to 86% in this sample. Two minimal sets of only 8 EBTs were identified that, when added to the one EBT already in place in that system, covered 100% of coverable youths when matching required problem, age, and gender. Conclusions: This methodology offers promise for the empirically guided selection and coordination of EBTs, thereby addressing one aspect of the gap between knowledge and practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Evidence-based psychological treatments for disruptive behaviors in individuals with dementia.

In this article, the authors review the literature regarding evidence-based psychological treatments (EBTs) for behavioral disturbances in older adults with dementia, as proposed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology. Fifty-seven randomized clinical trials were reviewed for inclusion on the basis of titles or abstract information. Forty-three were excluded either because they did not meet EBT methodological criteria or because they involved environmental or psychoeducational nursing interventions in which the psychological component could not be separately evaluated. Fourteen studies were considered for inclusion as EBTs; of these, 8 showed significant differences between treatment and control groups. Results of this review indicate that behavioral problem-solving therapies that identify and modify antecedents and consequences of problem behaviors and increase pleasant events and individualized interventions based on progressively lowered stress threshold models that include problem solving and environmental modification meet EBT criteria. Additional randomized clinical trials are needed to evaluate the generalizability and efficacy of these and other promising psychological interventions in a variety of settings with individuals who have a range of cognitive, functional, and physical strengths and limitations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review.

Transdiagnostic cognitive-behavioral group treatments for anxiety, treatments that are designed to be applicable to diagnostically mixed groups of anxiety disorder clients, have been garnering interest in recent years. At least 7 independent research teams have developed transdiagnostic anxiety treatment protocols and reported preliminary outcomes data. In this review, we outline the basic theoretical rationale underlying transdiagnostic models of anxiety and review each of the treatment protocols that have been reported to date. Finally, the efficacy of these treatments is examined using meta-analytic methods. Results indicated that overall, transdiagnostic treatments are associated with a very large pre- to posttreatment effect size, and stable maintenance of gains through follow-up. Recommendations for transdiagnostic treatment implementation are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment and treatment of sleep disorders in older adults: A review for rehabilitation psychologists.

Recent research has led to significant progress in the assessment and treatment of sleep disturbance in older adults. Similar advances have been made with sleep disorders secondary to age-related chronic illness. The assessment and treatment of sleep disorders encompasses numerous behavioral aspects. Thus, rehabilitation psychologists are ideally positioned to help apply these new advances to the growing number of older adult patients in the rehabilitation setting. The authors provide an overview of age and disease-related sleep disorders. They provide details for implementation of behavioral treatments for geriatric insomnia that is comorbid with chronic illness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Beyond efficacy and effectiveness: A multifaceted approach to treatment evaluation.

The recent shift toward evidence-based practice in psychology and other areas of health care highlights the need for strong research evidence supporting treatments. However, research evidence has usually been narrowly defined, focusing almost exclusively on treatment outcomes. Although determining the efficacy and effectiveness of treatments is an essential component of treatment evaluation, the authors propose that other areas of evaluation should also be studied as part of a more comprehensive evaluation approach. In this article, the authors integrate recommendations on how treatment evaluation can move beyond studying only outcomes into a model for multifaceted treatment evaluation. Specifically, the authors propose the need to study not only outcomes, but also provider, consumer, and economic considerations. By expanding the focus of treatment evaluation research, the authors hope to offer a model that will guide researchers in developing research evidence that will facilitate the successful widespread implementation of evidence-based approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing and Psychological Treatments.

Presents a comment on "Psychological Treatments" (see record 2004-21168-001) by D. H. Barlow. In his article, Barlow pointed to the need "to solidify the identification of psychology as a health care profession" by changing the terminology of practice in the health care context from psychotherapy to psychological treatments and suggested that the only persons qualified to carry out such interventions are doctoral-level psychologists. Unfortunately, there was no discussion of the health care professionals who already provide psychological treatments in health care settings and their contribution to the evidence base supporting such treatment. The authors find several aspects of the article to be problematic. Overall, the authors feel that suggesting that psychology should claim treatment of psychological disorders and psychological components of physical disorders in health care settings as exclusively its own domain ignores the research and clinical contributions of others. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: Evidence for a protective effect.

Staff retention is an ongoing challenge in mental health and community-based service organizations. Little is known about the impact of evidence-based practice implementation on the mental health and social service workforce. The present study examined the effect of evidence-based practice implementation and ongoing fidelity monitoring on staff retention in a children's services system. The study took place in the context of a statewide, regionally randomized effectiveness trial of an evidence-based intervention designed to reduce child neglect. In the study 21 teams consisting of 153 home-based service providers were followed over a 29-month period. Survival analyses revealed greater staff retention in the condition where the evidence-based practice was implemented along with ongoing fidelity monitoring presented to staff as supportive consultation. These results should help to allay concerns about staff retention when implementing evidence-based practices where there is good values–innovation fit and when fidelity monitoring is designed as an aid and support to service providers in providing a high standard of care for children and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older adults prefer less choice than young adults.

Previous research has demonstrated that older adults prefer less autonomy and seek less information when making decisions on their own relative to young adults (for a review, see M. Mather, 2006). Would older adults also prefer fewer options from which to choose? The authors tested this hypothesis in the context of different decision domains. Participants completed a choice preferences survey in which they indicated their desired number of choices across 6 domains of health care and everyday decisions. The hypothesis was confirmed across all decision domains. The authors discuss implications from these results as they relate to theories of aging and health care policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploring Unique Roles for Psychologists.

Presents a comment on "Psychological Treatments" (see record 2004-21168-001) by D. H. Barlow. Barlow highlighted unique roles that psychologists can play in mental health service delivery by providing psychological treatments--treatments that psychologists would be uniquely qualified to design and deliver. In support of Barlow's position, the authors draw from their own clinical practice with special psychiatric populations, such as adults with severe and persistent mental illness and behaviorally disordered youths, to illustrate some potential unique roles for psychologists. The authors believe psychologists are uniquely trained to design such individualized functional behavioral analysis protocols because of their training in research design, behavior analysis, learning theory, and behavior change. Psychologists may also be uniquely qualified to design, implement, and evaluate many specialized therapy techniques, as Barlow has outlined and suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving quality of life in diverse rural older adults: A randomized trial of a psychological treatment.

The efficacy of home-delivered cognitive-behavioral therapy (CBT) in improving quality of life and reducing psychological symptoms in older adults was examined in this study. One hundred thirty-four participants, predominately African American and characterized as primarily rural, low resource, and physically frail, were randomly assigned to either CBT or a minimal support control condition. Results indicate that CBT participants evidenced significantly greater improvements in quality of life and reductions in psychological symptoms. Mediation of treatment through cognitive and behavioral variables was not found despite the acceptable delivery of CBT by research therapists. These data suggest that treatment can be effective with a disadvantaged sample of older adults and extend efficacy findings to quality of life domains. Creating access to evidence-based treatments through nontraditional delivery is an important continuing goal for geriatric health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dissociations in Perceptual Learning Revealed by Adult Age Differences in Adaptation to Time-Compressed Speech.

When presented with several time-compressed sentences, young adults' performance improves with practice. Such adaptation has not been studied in older adults. To study age-related changes in perceptual learning, the authors tested young and older adults' ability to adapt to degraded speech. First, the authors showed that older adults, when equated for starting accuracy with young adults, adapted at a rate and magnitude comparable to young adults. However, unlike young adults, older adults failed to transfer this learning to a different speech rate and did not show additional benefit when practice exceeded 20 sentences. Listeners did not adapt to speech degraded by noise, indicating that adaptation to time-compressed speech was not attributable to task familiarity. Finally, both young and older adults adapted to spectrally shifted noise-vocoded speech. The authors conclude that initial perceptual learning is comparable in young and older adults but maintenance and transfer of this learning decline with age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)