Treatment of PTSD in Older Adults: Do Cognitive-Behavioral Interventions Remain Viable?

Abstract

The literature examining trauma among older adults is growing, but little is known about the efficacy of empirically supported interventions for PTSD within this population. Clinical writing on this topic often implies that cognitive-behavioral treatments may be ineffective or inappropriate for older adults with PTSD given physical and/or cognitive vulnerabilities. Review of the limited research in this area, however, provides little support for the claim that cognitive-behavioral interventions are ineffective in treating PTSD among the elderly. In an effort to explicate specific issues related to treatment process and outcome among older survivors of trauma, a case series is presented outlining the treatment of three older adults within the context of a structured, cognitivebehavioral group intervention. Observations from this case series suggests that cognitivebehavioral interventions continue to be useful in treating PTSD with this population. Specific treatment issues unique to older adults are explored and recommendations for future research are discussed. Keywords PTSD; older adults; cognitive behavior therapyResearch over the past decade has advanced our understanding of posttraumatic stress disorder (PTSD) considerably, and treatment development efforts have resulted in a number of therapeutic approaches with robust support for their efficacy (Keane, Marshall, & Taft, 2006). Review of this literature, however, indicates that treatment efforts primarily have targeted young to middle-aged adults. As such, our understanding of how to treat PTSD among older adults -generally conceptualized as those individuals age 65 and olderremains in its nascent stages. In this review, we examine literature pertaining to the treatment of PTSD in older adults and highlight the potential strengths of this population. We then present a case series detailing treatment process and outcome in three older individuals within a cognitive-behavioral group intervention. We conclude with a discussion of possible next steps in developing the literature on the treatment of PTSD in older trauma survivors.

The Driving Behavior Survey: Scale construction and validation

“…Taylor & Koch, 1995; J. Taylor et al, 2002), relevant clinical materials (e.g., Antony, Craske, & Barlow, 2006; Blanchard & Hickling, 2004), standardized driving assessments (e.g., Practical Driving Assessment), and the authors’ clinical experience in the assessment and treatment of driving-related anxiety (Beck et al, 2008; Beck, Coffey, Foy, Keane, & Blanchard, 2009; Clapp & Beck, in press ; Grant, Beck, Marques, Palyo, & Clapp, 2008). Emphasis was placed on developing a broad range of items with potential relevance to the conceptualization of anxious driving behavior (Clark & Watson, 1995; Loevinger, 1957).…”

From mind wandering to involuntary retrieval: Age-related differences in spontaneous cognitive processes

“…By contrast, there has been virtually no research on age-related differences in earworms or involuntary semantic memory, so we do not consider these phenomena further. Similarly, there is little research on intrusive memories in older adults other than in the context of post-traumatic stress disorder (Clapp & Beck, 2012). Because the present review is concerned with healthy aging, consideration of psychological disorders is beyond our scope.…”

Exposure-Based CBT for Older Adults After Fall Injury: Description of a Manualized, Time-Limited Intervention for Anxiety

“…Advances have been made in adapting CBT for older adult populations (e.g., Clapp & Beck, 2012; Mohlman & Gorman, 2005; Stanley, Diefenbach, & Hopko, 2004; Wetherell, Ayers, et al, 2009). Further encouragement to adapt PE came from clinical work with older trauma survivors (Hyer & Sohnle, 2001), research with bereaved older adults (Harkness, Shear, Frank, & Silberman, 2002), and research with older military veterans (Thorp, Stein, Jeste, Patterson, & Wetherell, 2012; Yoder et al, 2013).…”