Terri L Barrera1,2,3, Jeremy P Cummings4, Maria Armento2, Jeffrey A Cully1,2,3, Amber Bush Amspoker1,2, Nancy L Wilson1,2, Michael J Mallen5, Srijana Shrestha2,6, Mark E Kunik1,2,3, Melinda A Stanley1,2,3. 1. a Houston VA HSR&D Center for Innovations in Quality , Effectiveness and Safety, Michael E. DeBakey VAMC , Houston , Texas , USA. 2. b Baylor College of Medicine , Houston , Texas , USA. 3. c VA South Central Mental Illness Research, Education and Clinical Center , Houston , Texas , USA. 4. d Southeastern University , Lakeland , Florida , USA. 5. e Minneapolis Veterans Affairs Health Care System , Minneapolis , Minnesota , USA. 6. f University of St. Thomas , Houston , Texas , USA.
Abstract
OBJECTIVES: Rural, homebound older adults are at increased risk for anxiety and depression and have limited access to mental health services. These individuals face many barriers to receiving evidence-based mental health treatment and would benefit from interventions that increase access to and efficiency of care. The aim of this study was to evaluate use of a telephone-delivered, modular, cognitive behavioral therapy (CBT) intervention for both late-life depression and anxiety delivered to rural, homebound Veterans. METHODS: Three cases are presented to illustrate the flexible adaptation of the intervention for use among older Veterans enrolled in home-based primary care, with varying symptom presentations and functional limitations. The Veterans received 7 to 9 sessions of the CBT intervention, with ordering of skill modules based on symptom presentation and determined collaboratively between patient and therapist. RESULTS: The three Veterans showed improvement in depression and/or anxiety symptoms following treatment and provided positive feedback regarding their experiences in this program. CONCLUSIONS: These results suggest that telephone-delivered CBT is acceptable to older adults and can be tailored to individual patient needs. CLINICAL IMPLICATIONS: Clinicians should consider telephone-delivered CBT as an alternate mode of therapy to increase access to mental health care for rural, homebound individuals with depression and anxiety.
OBJECTIVES: Rural, homebound older adults are at increased risk for anxiety and depression and have limited access to mental health services. These individuals face many barriers to receiving evidence-based mental health treatment and would benefit from interventions that increase access to and efficiency of care. The aim of this study was to evaluate use of a telephone-delivered, modular, cognitive behavioral therapy (CBT) intervention for both late-life depression and anxiety delivered to rural, homebound Veterans. METHODS: Three cases are presented to illustrate the flexible adaptation of the intervention for use among older Veterans enrolled in home-based primary care, with varying symptom presentations and functional limitations. The Veterans received 7 to 9 sessions of the CBT intervention, with ordering of skill modules based on symptom presentation and determined collaboratively between patient and therapist. RESULTS: The three Veterans showed improvement in depression and/or anxiety symptoms following treatment and provided positive feedback regarding their experiences in this program. CONCLUSIONS: These results suggest that telephone-delivered CBT is acceptable to older adults and can be tailored to individual patient needs. CLINICAL IMPLICATIONS: Clinicians should consider telephone-delivered CBT as an alternate mode of therapy to increase access to mental health care for rural, homebound individuals with depression and anxiety.
Authors: Yin Wu; Brooke Levis; Kira E Riehm; Nazanin Saadat; Alexander W Levis; Marleine Azar; Danielle B Rice; Jill Boruff; Pim Cuijpers; Simon Gilbody; John P A Ioannidis; Lorie A Kloda; Dean McMillan; Scott B Patten; Ian Shrier; Roy C Ziegelstein; Dickens H Akena; Bruce Arroll; Liat Ayalon; Hamid R Baradaran; Murray Baron; Charles H Bombardier; Peter Butterworth; Gregory Carter; Marcos H Chagas; Juliana C N Chan; Rushina Cholera; Yeates Conwell; Janneke M de Man-van Ginkel; Jesse R Fann; Felix H Fischer; Daniel Fung; Bizu Gelaye; Felicity Goodyear-Smith; Catherine G Greeno; Brian J Hall; Patricia A Harrison; Martin Härter; Ulrich Hegerl; Leanne Hides; Stevan E Hobfoll; Marie Hudson; Thomas Hyphantis; Masatoshi Inagaki; Nathalie Jetté; Mohammad E Khamseh; Kim M Kiely; Yunxin Kwan; Femke Lamers; Shen-Ing Liu; Manote Lotrakul; Sonia R Loureiro; Bernd Löwe; Anthony McGuire; Sherina Mohd-Sidik; Tiago N Munhoz; Kumiko Muramatsu; Flávia L Osório; Vikram Patel; Brian W Pence; Philippe Persoons; Angelo Picardi; Katrin Reuter; Alasdair G Rooney; Iná S Santos; Juwita Shaaban; Abbey Sidebottom; Adam Simning; Lesley Stafford; Sharon Sung; Pei Lin Lynnette Tan; Alyna Turner; Henk C van Weert; Jennifer White; Mary A Whooley; Kirsty Winkley; Mitsuhiko Yamada; Andrea Benedetti; Brett D Thombs Journal: Psychol Med Date: 2019-07-12 Impact factor: 10.592