Systematic Review of the Clinical Application of Exposure Techniques to Community-Dwelling Older Adults with Anxiety

Abstract

Although exposure techniques are a first-line intervention for anxiety, clear evidence is lacking for their efficacy in treating the prevalent and debilitating condition of late life anxiety. This study sought to review the current literature on use of exposure with community-dwelling older patients. Searches of electronic databases were conducted to identify articles published through December 7, 2016. Inclusion criteria were: 1) sample age ≥ 55, 2) therapy that included exposure, 3) anxiety as a target of the treatment. Exclusion criteria were: 1) not available in English, 2) no quantitative data, 3) inpatient setting. Methodological data and findings were extracted from the articles chosen for review. The 54 eligible articles presented a total of 15 case studies, 10 uncontrolled trials, 24 controlled trials, and 6 secondary studies. A majority of the studies were conducted in the U.S.A with participants who received individual treatment. In vivo and imaginal exposure were the most frequently delivered techniques, and most treatments were multicomponent. Most studies found a reduction in anxiety symptoms. While the surveyed research provides a preliminary foundation of evidence for mental health practitioners who wish to incorporate exposure into treatment plans, the review highlights important gaps that need to be addressed.

Intervention, consultation, and other service provision: A foundational geropsychology knowledge competency.

“…Behavioral Activities Intervention (BE-ACTIV; Meeks et al, 2008; Meeks et al, 2019) is an example of using BA in nursing home settings, among depressed older clients who have sufficient cognitive abilities to consent to treatment. Exposure interventions (i.e., imaginal, in-vivo, interoceptive, or virtual reality exposure, exposure with response prevention, prolonged exposure) are useful in treating anxiety disorders, OCD, and PTSD in older adults either alone or in conjunction with other CBT interventions (Jayasinghe et al, 2017). Sleep Restriction-Sleep Compression is an EBT for treating late life insomnia (McCurry et al, 2007).…”

Exposure therapy.

“…For example, it has been shown that exposure therapy with pregnant women neither leads to complications in pregnancy nor increases risk of miscarriage (see Arch et al, 2012). Research in older adults suggests that exposure is as suitable for them as it is for younger adults with comparably few health complications (Flint, 1998;Jayasinghe, et al, 2017). Although less extensive, a large clinical trial (N = 60) demonstrated that PE for PTSD was safe when conducted with individuals who had experienced prior myocardial infarctions (Shemesh, et al, 2011).…”

“It’s not how old you are, it’s how you are old”: Australian clinical psychologists’ experiences of working with older adults.

“…Various clinical issues have been previously recognized and broadly include: deciding which modifications to psychotherapy to implement (if any) and when (Greenwood, 2014; Jayasinghe et al, 2017; Rehm, Stargatt, Willison, Reser, & Bhar, 2017; Wuthrich, 2017); navigating age-related challenges in terms of older adults’ access to services, older adults’ therapeutic needs, or disentangling medical and psychological issues (Cloosterman, Laan, & Van Alphen, 2013; Hillman & Stricker, 2002; Pachana, Mitchell, & Knight, 2015); adopting a systemic approach if required while remaining aligned with confidentiality responsibilities (Knight & Poon, 2008); and accommodating potential generational factors (e.g., stoicism, underdeveloped awareness of psychological concepts, or deference to the psychologist; American Psychological Association [APA], 2014). Depending on older adults’ individual circumstances, various ethical challenges can also arise (e.g., informed consent, confidentiality, elder abuse, and euthanasia; Bush, Allen, Heck, & Moye, 2015).…”