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Phobia of old people

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Phobias are common in later life, yet treatment research in this population remains scant. The efficacy of exposure therapy, in combination with other Cognitive-Behavioral Therapy CBT components, in the treatment of specific phobia with a middle and older aged sample was examined.

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Sixteen adults aged 45—68 with DSM-IV diagnosis of a specific phobia Phobia of old people a manualized intervention over ten weeks, and were compared with a control group. Results indicated significant time effects in the treatment group for the primary outcome variables of phobic severity and avoidance as well as secondary outcome variables including depression and anxiety. Symptom presence and severity also significantly declined in the treatment group.

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No significant changes in state anxiety were noted across the treatment period. Such results provide support for the efficacy of exposure combined with CBT treatment for specific phobia in middle to older aged adults. Anxiety disorders in older adults have received relatively little empirical Phobia of old people in the treatment literature.

Although most current prevalence estimates suggest that anxiety disorders later in life may be less frequent, high relative prevalence rates for anxiety compared to other mental disorders and the significant negative impact of anxiety on Phobia of old people lives of older people argue for its importance. Anxiety disorders have been found to be twice as frequent as affective disorders, and 4—8 times more frequent than major depressive disorders, in older samples Beck and Stanley These disorders have also been reported to be more prevalent than depression or severe cognitive impairment among older adults Regier et al Anxiety symptoms are associated with reduced quality of life, increased mortality, impaired ability to carry out Instrumental Activities of Daily Living IADLspoorer health, more chronic illness, and elevated levels of reported pain in older cohorts reviewed in Scogin et al Findings that older Phobia of old people with phobic or panic disorders have higher relative risk of ischemic heart disease, stroke, and death by suicide indicate that anxiety disorders may be associated with greater morbidity and mortality, underscoring the importance of addressing anxiety issues in this population Krasucki et al ; Stanley and Beck Finally, older adults have been found to experience symptoms of anxiety disruptive enough to require intervention, even if insufficient to warrant formal diagnosis Himmelfarb and Murrell Indeed, Schaub and Linden suggest that while the contribution of anxiety to the spectrum of mental disorders seems to decrease with age, anxiety symptoms are an almost daily experience for many older people.

Findings are inconsistent with respect to the relative prevalence of various anxiety disorders in older cohorts.

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Several studies have reported phobias to be the most common anxiety disorder among older people eg, Regier et alwhereas others have not eg, Bland et al However, more recent research by Ritchie et al. The overall prevalence of specific phobias as well as their prevalence relative to other phobia subtypes in later life is also somewhat unclear.

The highest prevalence rates have been found by Lindesay, Phobia of old people and Murphywho report a Although investigation of effective ways to address anxiety in this population is critical, treatment research has remained scant.

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Most research in this area has primarily focused on older people with anxiety symptoms rather than diagnoses eg, De Berry et al ; Scogin et al ; uncontrolled clinical case reports eg, Thyer ; Rowan et al and treatment studies lacking a no treatment control condition eg, King and Barrowclough ; Stanley, Beck and Glassco The existing research base has provided some evidence Phobia of old people the utility of CBT for self-report anxiety symptoms in community samples of older people see McCarthy et al ; Hersen and van Hasselt however well-controlled research investigating the efficacy of established treatments in clinical samples over the age of 50 remains sparse.

Perhaps the most controlled and comprehensive study in the area of late-life anxiety is that conducted by Stanley et al investigating the efficacy of CBT for late-life GAD. Stanley et al recruited 85 adults aged 60 Phobia of old people and over through media announcements.

Despite evidence that phobic disorders are one of the most common anxiety diagnoses among this population group Ritchie et al and are one of the easiest to treat among younger samples Antony and Barlowthey have remained almost unstudied in older populations, with case studies eg, Thyer lending only limited understanding of treatment efficacies in this age group.

The current study aims to extent existing treatment protocols, including exposure therapy components, for specific phobias to a sample of older adults in order to assess the efficacy of such techniques among this population. The impact of age upon outcome is also of interest, and inclusion of a middle aged and older sample will allow comparison of treatment effect on the basis of the Phobia of old people variable.

The treatment group consisted of 16 subjects between 45 and 68 years of age, with a mean age of 55 years. The group consisted of 3 males and 13 females. Although this clearly represents a significant Phobia of old people across gender, this was expected given that research has suggested that phobias are much more common in women than men eg, Arnarson et al In terms of inclusion and exclusion criteria, the current study has aimed to find a more balanced approach in line with recent suggestions in the literature for improved effectiveness and generalizability of results eg, Guthrie As such, subjects were not excluded if they had current co-morbid diagnoses if such conditions did not require more immediate treatmentwere currently taking anxiety medications as long as dosages remained stablehad a past history of alcohol use, did not complete all sessions within the designated time periods, or had previously been involved in anxiety treatment programs.

Subjects were excluded if they were outside the ages of 45—75 years of age, had other major psychiatric or cognitive problems requiring immediate treatment, psychotic or organic illnesses, major untreated substance abuse, or disease of the heart or lungs. People Phobia of old people flying phobia, injection phobia and blood phobia were also specifically excluded from this study due to the practical difficulties with exposure techniques for these phobic stimuli.

Approximately 44 people completed phone-screening interviews after expressing an interest in the project.

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Of the 28 deemed eligible for participation, 5 declined further participation and 23 completed the initial interview and were accepted into Phobia of old people program.

Of these 23, 4 withdrew prior to treatment commencement and 2 withdrew in weeks 4 and 5, leaving 16 participants having completed treatment. Of the 50 participants that indicated they were willing to participate in follow-up studies, the first 24 subjects able to be contacted by telephone by the researcher were administered the phobia section of the SCID-IV and sent questionnaires identical to those given to the treatment and wait-list groups outlined above. Thus the control group consisted of 13 subjects between 52 and 70 years of age, with a mean age of 59 years.

The group consisted of 1 male and 12 females. These control group participants were then sent an identical questionnaire after a period of 10 weeks to assess change in variables of interest over this period in an untreated sample.

The Mini-Mental Status Exam MMSE Folstein et al was utilized to screen for gross cognitive impairment; participants scoring less that 24 were to be excluded from the study none met this criteria. The Fear Questionnaire FQ Marks and Matthews is a self-report measure designed to Phobia of old people change in patients with phobias.

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The Symptom ChecklistRevised SCLR Derogatis is a self-report measure of psychological symptom patterns and provide an estimation of current, point-in-time psychological symptom status Derogatis This measure has also been used in a number of studies with older adults, and has been found to be sensitive to post-treatment improvements in general functioning among older people Scogin et al Screening of subjects Phobia of old people conducted initially via telephone.

Telephone screening questions addressed specific, easily identified exclusionary criteria such as phobia type, age, present involvement in psychotherapy and presence of serious contraindicative medical conditions. Following initial phone screening, participants were asked to attend a face-to-face interview.

This phase included signing of consent forms, assessment of the onset and history of their phobic symptoms and further assessment of treatment suitability, including the administration Phobia of old people the MMSE and the SCID-IV screening and diagnostic instruments.

Subjects passing screening processes were then alternately allocated to one of two conditions: A single crossover approach was employed, whereby those subjects in wait-list Phobia of old people groups received treatment subsequent to first round completions. Participants in the treatment group were administered questionnaires at the conclusion of the initial group session session one and following the final individual exposure session session ten.

A mid-treatment questionnaire was also administered at the conclusion of the final group session session fivewhich contained the same questionnaires as pre and post sessions but omitted the more laborious SCLR.

The treatment program involved a total of 10 sessions, including 5 group-training sessions initially, followed by 5 sessions of individual therapy.

Each session both group and individual was approximately 1. Group sessions were conducted in small groups of 2—7 members. Each group session was facilitated by two registered psychologists enrolled in postgraduate studies at the University of Queensland. The first author Woodward facilitated one group with another postgraduate psychologist, while the other three groups were run with two postgraduate psychologists. Individual sessions Phobia of old people then conducted one-on-one by group therapists, so that each subject had previously had contact with their individual therapist during group sessions.

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A manualized treatment approach was utilized, based on the treatment protocols of several authors, including Borkovec and Costello ; Antony, Craske, and Barlow ; Craske, Antony and Barlow ; Antony and Barlow This was followed by primary session content, including either presentation of psycho-educational material or introduction and practice of a new skill.

Take-home tasks were then Phobia of old people and explained. The manuals used in this study are available from the first author Pachana. Several researchers have suggested minor alterations in treatment process that may enhance outcome when working with older adults Koder et al ; Hinrichsen and Dick-Siskin ; Garner Specifically, it has been suggested that older people may need longer socialization into therapy with a greater emphasis on treatment rationale, a slower pace of therapy, and greater reliance Phobia of old people the utilization of memory aids and reinforcement strategies, such as summaries, handouts, and verbal repetition of themes and issues throughout therapy.

It has also been suggested that older people can be comforted by knowing that there is a plan of action that will guide weekly meetings and through selection of realistic and concrete goals. The current treatment approach was designed with the above recommendations in mind. Early sessions were devoted to psychoeducation and a thorough introduction to the program, with active session content not introduced until session three.

During the early sessions, time was allowed for group members to discuss how they might have acquired their phobia, and discussion of weekly encounters with phobic stimulus was maintained throughout all sessions to allow a chance for shared experiences and encouragement between group members to occur. Throughout the sessions, a clear treatment rationale was offered for all techniques. In terms of treatment components, it was determined that session content Phobia of old people incorporate both in-vivo exposure techniques, which have consistently been found to be the cornerstone of phobia treatment, and other treatment components, such as psychoeducation, anxiety management and cognitive and relaxation procedures.

Although evidence for the utility of exposure therapy in older adults is currently limited to several single-subject case studies eg, Thyerconsistent evidence of strong treatment effects for this Phobia of old people among younger people argues for its inclusion in the current treatment approach.

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Similarly, although the efficacy of including cognitive and relaxation components in phobia treatment protocols has not been firmly established, there were salient reasons for their inclusion in the current study.

Relaxation training, for example, has been found to significantly reduce stress-related disorders, psychosomatic symptoms, self-reported tension levels and state anxiety in older people De Berry ; De Berry et al ; Scogin et Phobia of old people Finally, studies utilizing cognitive techniques for both anxiety King and Barrowclough and depression Koder et al have been found to be effective in older populations. Of the 19 clinical Phobia of old people that commenced the treatment program, 16 completed the total of 10 sessions.

Of these, 12 completed within a two-week window of the 10 weeks allocated, while 4 took longer to complete due to cancellations or personal circumstances. It should be noted, however that all 16 clinical participants completed the same number of sessions, of the same approximate duration.

All 13 wait-list controls completed initial and follow-up questionnaires. Mean scores on all outcome measures are included in Table 1.

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Posthoc analysis revealed significant differences between all time points. The SCLR was not administered at time two, and thus comparisons between mid-point time periods are not possible. Although violations of the assumptions of parametric statistical procedures suggested that non-parametric Phobia of old people would, in this instance, be a more appropriate indicator of treatment outcome, a lack of non-parametric alternatives to the ANOVA meant that parametric options were necessary.

It should be noted, however, that such procedures are at best exploratory and the reliability of the results significantly limited by such violations.

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This suggests that the impact of time on outcome variables differed between treatment groups. Post-hoc pair-wise comparisons between time one and time three scores for the control group were conducted using the non-parametric Wilcoxin Signed Ranks Test due to the normality assumption violations mentioned above. These results confirm that unlike the significant reductions in the treatment group in phobic avoidance, phobic severity and anxiety as measured by the GAI across time as noted abovethere were no significant changes on phobic avoidance or severity across time, and a significant increase in general Phobia of old people from time one to time three, for the control group sample.

The current study has demonstrated the potential beneficial effects of a CBT-based program for the treatment of specific phobias in a small sample of mid to older aged adults.

Although past research has supported the extension of established treatment protocols for other anxiety symptoms and disorders to older people, none have examined the treatment of specific phobias among older Phobia of old people. Among the treatment group of the current sample, improvements were noted post-treatment on almost all outcome variables, including phobia avoidance, phobia severity, anxiety as measured by the anxiety-depression scale of the FQ, the GAI and STAI-Traitdepression and overall symptom presence and severity.

Interestingly, state anxiety did not exhibit significant reductions across the treatment period.


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