Exposure therapy for late-life trauma.

Abstract

Despite considerable evidence from randomized clinical trials of the efficacy of exposure therapy for posttraumatic stress disorder (PTSD), frontline psychotherapists rarely use this treatment (e.g., Becker, Zayfert & Anderson, 2004;Rosen et al., 2004). This chapter describes the application of prolonged exposure (PE), an evidence-based cognitive behavior therapy (CBT) for older adult trauma survivors with PTSD. It also presents the theoretical background for exposure therapy, as well as cultural, disability, and cognitive impairment factors to consider with older adults. Before presenting this information, though, we summarize the changes to the PTSD diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013).The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) provides the following diagnostic criteria for PTSD: Criterion A

Prevalence of substance use disorder treatment facilities specializing in older adult and trauma care: N-SSATS data 2009 to 2011.

“…However, though cognitive and exposure type therapies are common for older adults diagnosed with anxiety disorders (Thorp et al, 2009), the way these therapies intersect with the well-documented cognitive deficits inherent in older adults and the SUD/PTSD populations (Bates et al, 2013; Doweiko, 2014) remains unclear. For instance, Cook, Naseem, and Thorp (2015) argue that cognitive deficits could lower the threshold for stimuli to trigger PTSD, whereas Cook and Dinnen (2015) argue that cognitive deficits in later life may exacerbate PTSD symptoms that were under control before cognitive decline. The cognitive decline theory may also explain why some only first experience PTSD later in life and many years removed from the traumatic event (Floyd, Rice, & Black, 2002).…”

“…Older adults experience specific stressors that may facilitate trauma (e.g., increased health problems, loss of loved ones, decreasing cognitive abilities; Cook & Dinnen, 2015; Cook, Naseem, & Thorp, 2015). Furthermore, there is a critical need to recognize the developmental context of trauma exposure and the cumulative effects of trauma over the course of the life span (Böttche, Kuwert, & Knaevelsrud, 2012; Ogle, Rubin, & Siegler, 2013; Ogle, Rubin, & Siegler, 2014).…”

“…America is growing older (Ortman, Velkoff, & Hogan, 2014) and by the year 2030 it is estimated that there will be 72.1 million older adults, as defined as approximately age 65 and older (e.g., Areán, 2015), with anticipated increases in substance use (Duncan, Nicholson, White, Bradley, & Bonaguro, 2010). Considering the well-established relationship between substance use disorder (SUD) and posttraumatic stress disorder (PTSD; Berenz & Coffey, 2012; Riggs & Foa, 2008; Saxon & Simpson, 2015) and the still developing knowledge of later-life PTSD (Cook & Dinnen, 2015), there is a strong likelihood that many of these older adult SUD cases will also struggle with trauma. Consequently, there is a need for the health care system (including mental health and addiction services) to become better prepared to work with this population.…”