Laura L. Phillips

Older Adults’ Preferences For Religion/Spirituality In Treatment For Anxiety And Depression

Objectives: To examine patient preferences for incorporating religion and/or spirituality into therapy for anxiety or depression and examine the relations between patient preferences and religious and spiritual coping styles, beliefs and behaviors. Method: Participants (66 adults, 55 years or older, from earlier studies of cognitive-behavioral therapy for late-life anxiety and/or depression in primary care) completed these measures by telephone or in-person: Geriatric Anxiety Inventory, Client Attitudes Toward Spirituality in Therapy, Patient Interview, Brief Religious Coping, Religious Problem Solving Scale, Santa Clara Strength of Religious Faith, and Brief Multidimensional Measure of Religiousness and Spirituality. Spearmans rank-order correlations and ordinal logistic regression examined religious/spiritual variables as predictors of preferences for inclusion of religion or spirituality into counseling. Results: Most participants (77–83%) preferred including religion and/or spirituality in therapy for anxiety and depression. Participants who thought it was important to include religion or spirituality in therapy reported more positive religious-based coping, greater strength of religious faith, and greater collaborative and less self-directed problem-solving styles than participants who did not think it was important. Conclusion: For individuals like most participants in this study (Christians), incorporating spirituality/religion into counseling for anxiety and depression was desirable.

Integration of religion into cognitive-behavioral therapy for geriatric anxiety and depression.

Religion is important to most older adults, and research generally finds a positive relationship between religion and mental health. Among psychotherapies used in the treatment of anxiety and depression in older adults, cognitive-behavioral therapy (CBT) has the strongest evidence base. Incorporation of religion into CBT may increase its acceptability and effectiveness in this population. This article reviews studies that have examined the effects of integrating religion into CBT for depression and anxiety. These studies indicate that improvement in depressive and anxiety symptoms occurs earlier in treatment when CBT incorporates religion, although effects are equivalent at follow-up. The authors present recommendations for integrating religious beliefs and behaviors into CBT based on empirical literature concerning which aspects of religion affect mental health. A case example is also included that describes the integration of religion into CBT for an older man with cognitive impairment experiencing comorbid generalized anxiety disorder and major depressive disorder. It is recommended that clinicians consider the integration of religion into psychotherapy for older adults with depression or anxiety and that studies be conducted to examine the added benefit of incorporating religion into CBT for the treatment of depression and anxiety in older adults. (Journal of Psychiatric Practice 2009;15:103–112).

Factors influencing young adults’ attitudes and knowledge of late-life sexuality among older women

Objectives: Although sexuality is valued throughout the lifespan, older womens sexual expression can be influenced by physical, mental and social factors, including attitudes and stereotypes held by younger generations. By gaining an understanding of what influences negative attitudes toward sexuality and beliefs about sexual consent capacity, the stigma associated with sexuality in late life may be reduced. Method: Using vignette methodology in an online survey, we examined older womens health and young adults’ (N = 606; mean age = 18.86, SD = 1.42, range 17–36) general knowledge and attitudes toward aging and sexuality, personal sexual behavior, religious beliefs and perceived closeness with an older adult on attitudes towards sexual behavior and perceptions of consent capacity among older women. Results: The health status of older women proved important in determining young adults’ acceptance and perception of sexual consent capacity regarding late-life heterosexual/autoerotic and homosexual behaviors. Specifically, young adults expressed lower acceptance and more doubt regarding capacity to consent to sexual expression when the older woman was described as cognitively impaired. Additionally, young adults’ personal attitudes toward late-life sexuality, but not knowledge, predicted acceptance toward sexual expression and belief in sexual consent capacity. Conclusion: Attention toward the influence of older womens cognitive health and young adults’ attitudes toward late-life sexuality may prove beneficial in designing interventions to decrease the stigma associated with sexual activity in later life.

Predicting Quality of Life in Veterans with Heart Failure: The Role of Disease Severity, Depression, and Comorbid Anxiety

This study focused on the relative contribution of heart failure (HF) disease severity, depression, and comorbid anxiety to quality of life for 96 ambulatory HF veterans (48 with and 48 without depressive symptoms). Primary analyses sought to predict HF quality of life using constructs including depression symptoms, comorbid anxiety symptoms, HF severity, medical-illness burden, and demographic factors. Multiple regression procedures found 3 significant predictors of better quality of life, including HF severity (β = −13.33, p < .001), depressive symptoms (β = −2.34, p = .003), and age (β = 0.76, p < .01). These results suggest that disease severity and depression, but not necessarily comorbid anxiety, significantly affect quality of life for HF patients. As HF is a progressive, deteriorating condition, mental health interventions, especially those that target depression, might offer opportunities for improved quality of life for HF patients.

An evaluation of the brief multidimensional measure of religiousness/spirituality in older patients with prior depression or anxiety

The Primary objective of the study was to examine the psychometric properties of the Brief Multidimensional Measure of Religiousness and Spirituality (BMMRS) in older adults. Older adults (N = 66) completed a survey in-person or over the phone. Measures included the BMMRS, Religious Problem Solving Scale, Brief Religious Coping Scale, Functional Assessment of Chronic Illness Therapy – Spiritual Well-being, Satisfaction with Life Scale, Geriatric Anxiety Inventory, and Geriatric Depression Scale. Cronbachs alphas evaluated internal consistency, zero-order correlations tested construct validity, and multiple regressions assessed the association of BMMRS domains with well-being. Most BMMRS domains were reliable and valid. Collectively, they explained 26% to 68% of the variance in well-being and psychological symptoms. Daily spiritual experiences uniquely predicted spiritual well-being, satisfaction with life, and depressive symptoms. The BMMRS is useful in older populations and may help identify those who could benefit from religious or spiritually integrated therapy.

Systematic Review of the Effects of Religion-Accommodative Psychotherapy for Depression and Anxiety

Integrating religion into psychotherapy may improve treatment for depression and anxiety. This review systematically examines clinical trials of religion-accommodative psychotherapy for depression or anxiety. Results indicate that integrating religion into psychotherapy does not lead to significantly more improvements in depression or anxiety than equivalent therapy without religious components. However, when compared with less stringent control groups, such as supportive psychotherapy, religion-accommodative therapy may be more effective, at least immediately post-treatment. Results from the 11 studies reviewed indicate that psychotherapy integrating religion is at least as effective for treating depression and anxiety as other forms of psychotherapy. Conclusions were limited by lack of power, comparable control groups, focus on anxiety, and treatment manuals.

Care Alternatives in Prison Systems Factors Influencing End-of-Life Treatment Selection

The authors examined age at the end of prison sentence, race, and psychosocial factors on end-of-life treatment preferences among 73 male inmates (28 nonlifers, 45 lifers) from the Alabama Aged and Infirmed Correctional Facility. All measures (e.g., Brief Symptom Inventory, Death Anxiety Scale) were administered in an interview format. A significant amount of variance in treatment preferences for cardiopulmonary resuscitation, feeding tube, and palliative care was predicted by race, lifer status, and death anxiety. Inmates who were members of minority groups, nonlifers, and those with high death anxiety expressed greater desire for a feeding tube, whereas inmates who were Caucasian or lifers expressed a greater desire for palliative care. Given the aging of the inmate population and increasing health care costs, further exploration of end-of-life treatment preferences among older inmates is warranted.

Does religiousness and spirituality moderate the relations between physical and mental health among aging prisoners

We examined positive and negative religious coping as moderators of the relation between physical limitations, depression, and desire for hastened death among male inmates incarcerated primarily for murder.

Living Well with Living Wills: Application of Protection Motivation Theory to Living Wills Among Older Caucasian and African American Adults

Using protection motivation theory, we examined racial differences in intent to complete a living will, rational problem solving (e.g., information seeking), and maladaptive coping responses (i.e., wishful thinking) to a health crisis. Sixty healthy, older adults without living wills responded to written vignettes, including information about living wills as an effective coping mechanism to avoid a health crisis. Use of adaptive coping responses predicted intent to execute a living will. A significant race-by-threat interaction predicted use of rational problem solving, with Caucasians more likely to seek information in response to perceived threat in comparison with African Americans. A significant race-by-adaptive-coping interaction predicted maladaptive coping, indicating that Caucasians were more variable in their maladaptive responses. The effectiveness of health care messages regarding living wills for older adults may be enhanced by focusing on racial differences in response to perceived health threat and perceived adaptive coping information.