Mark Floyd

Cognitive Therapy for Depression: A Comparison of Individual Psychotherapy and Bibliotherapy for Depressed Older Adults

Thirty-one community-residing older adults age 60 or over either received 16 sessions of individual cognitive psychotherapy (Beck, Rush, Shaw, & Emery, 1979) or read Feeling Good (Burns, 1980) for bibliotherapy. Posttreatment comparisons with the delayed-treatment control indicated that both treatments were superior to a delayed-treatment control. Individual psychotherapy was superior to bibliotherapy at posttreatment on self-reported depression, but there were no differences on clinician-rated depression. Further, bibliotherapy participants continued to improve after posttreatment, and there were no differences between treatments at 3-month follow-up. Results suggest that bibliotherapy and that individual psychotherapy are both viable treatment options for depression in older adults.

Recurrence of Posttraumatic Stress Disorder in Late Life: A Cognitive Aging Perspective

Clinical experience with older adults shows that many will experience PTSD symptoms in older adulthood because of trauma exposure early in life. Some of these patients struggled with PTSD in the distant past and remained symptomfree for decades only to have a recurrence of PTSD in late life. This paper outlines a cognitive aging explanation for the recurrence of PTSD. It is proposed that the age-related decreases in attention make the intrusion of trauma-related memories more likely. The increase in intrusive memories, combined with age-related decreases in working memory, explicit memory, and prospective memory, increases the subjective distress associated with the memories and results in a recurrence of PTSD.

Two-year follow-up of bibliotherapy and individual cognitive therapy for depressed older adults.

This study examined the stability of treatment gains after receiving either cognitive bibliotherapy or individual cognitive psychotherapy for depression in older adults. A 2-year follow-up of 23 participants from Floyd, Scogin, McKendree-Smith, Floyd, and Rokke (2004) was conducted by comparing pre-and posttreatment scores with follow-up scores on the Hamilton Rating Scale for Depression (HRSD) and the Geriatric Depression Scale (GDS). Results indicated that treatment gains from baseline to the 2-year follow-up period were maintained on the HRSD and GDS, and there was not a significant decline from posttreatment to follow-up. There were no significant differences between the treatments on the GDS or HRSD at the 2-year follow-up; however, bibliotherapy participants had significantly more recurrences of depression during the follow-up period.

The Dysfunctional Attitudes Scale: factor structure, reliability, and validity with older adults

The Dysfunctional Attitudes Scale Form A (DAS-A), a self-report measure of depression-related attitudes, has been used in numerous depression studies. The DAS-A has a two-factor structure that has been found consistently with college student samples and clinically depressed samples of middle-aged adults, but it has not been validated with older adults. The present study examined the factor structure with a sample of 100 depressed older adults (average age = 68.19; average initial Hamilton Rating Scale for Depression [HRSD] score = 16.72) who participated in a depression treatment study. Results indicated the factor structure established with younger adults was not replicated with older adults. Furthermore, the factor structure with older adults was uncertain: a single factor structure, two-factor structure, and three-factor structure were essentially of equal validity. The uncertainty of the latent structure of the DAS-A suggests that it should be interpreted with caution whenever used with older adults.

Two-year follow-up of self-examination therapy for generalized anxiety disorder.

This study examined the stability of treatment gains after receiving self-examination therapy (SET) [Bowman, D. (1995). Innovations in clinical practice: a source book. Professional Resource Press.] for generalized anxiety disorder. A 2-year follow-up of 16 participants from Bowman, Scogin, Floyd, Patton, and Gist [J. Counsel. Psychol. 44 (1997) 267] was conducted by comparing pre- and post-treatment measures with follow-up measures from the Hamilton Anxiety Rating Scale-Revised (HARS-R), the State-Trait Anxiety Inventory (STAI), and the SET quiz. Results indicated treatment gains from baseline to the 2-year follow-up period were maintained on all measures, and there was not a significant decline from post-treatment to follow-up on the HARS-R and STAI. These results suggest that SET for treatment of generalized anxiety disorder (GAD) may be effective in both the immediate and long-term reduction of GAD symptoms.

The existential effects of traumatic experiences: A survey of young adults

This study examined the relation between exposure to trauma and attitudes toward existential issues. Participants were 504 undergraduate students (average age = 19.67) who answered questions on exposure to trauma, fear of death, overall distress, and meaning in life. Results indicated that those with a history of trauma exposure had higher levels of overall distress, but there were no differences in death anxiety or meaning in life. The results suggest that the positive outcomes (less fear of death and increased meaning in life) associated with exposure to traumatic events may be relatively rare, especially amongst younger adults.

Residual Geriatric Depression Symptoms: A Place for Psychotherapy

Geriatric depression is a relatively commonly occurring mental disorder. A subpopulation of depressed older adults are those who have engaged in or completed pharmacotherapy, yet continue to experience depressive symptoms. We review the prevalence, psychosocial effects, and treatment of residual symptoms of depression in older adults. Data from previous studies conducted by our group are presented to support our contention that residual symptoms of geriatric depression are treatable through psychosocial means.

Paraphasias in cognistat: Pathognomic sign or ethnic-linguistic artifact?

Abstract Paraphasias on the Cognistat (Northern California Neurobehavioral Group, 1995) memory subtest were examined in a sample of geriatric veterans (average age = 77). “Robert” and “parrot” were the most frequently occurring paraphasias for the target words robin, carrot, piano, and green. Paraphasias were also common (35%) for patients with no deficits on Cognistat. Paraphasia production could not be explained by differences in hearing ability, education level, or neuropsychological deficits. Paraphasia frequency and type varied by ethnic group: European-Americans were less likely to have a paraphasia, Hispanic-Americans were more likely to have a “Robert” or “parrot” paraphasia, and African-Americans were more likely to have a paraphasia other than “Robert” or “parrot.” Additional research is needed to determine the cause of paraphasias on the Cognistat and the clinical significance of paraphasias for each ethnic group.