The peaceful mind program: a pilot test of a cognitive-behavioral therapy-based intervention for anxious patients with dementia.

OBJECTIVES: To assess feasibility and to conduct a preliminary evaluation of outcomes following Peaceful Mind, a cognitive-behavioral therapy-based intervention for anxiety in dementia, relative to usual care. DESIGN: Pilot randomized controlled trial including assessments at baseline and 3 and 6 months. SETTING: Houston, TX. PARTICIPANTS: Thirty-two outpatients diagnosed with mild (47%) or moderate (53%) dementia receiving care through outpatient clinics at the Veterans Affairs medical center, Baylor College of Medicine, Harris County Hospital District, and community day centers for dementia, and their collaterals, who spent at least 8 hours a week with them. INTERVENTION: Peaceful Mind included up to 12 weekly in-home sessions (mean: 8.7, SD: 2.27) during the initial 3 months and up to eight brief telephone sessions (mean: 5.4, SD: 3.17) during months 3-6, involving self-monitoring for anxiety, deep breathing, and optional skills (coping self-statements, behavioral activation, and sleep management). Patients learned skills, and collaterals served as coaches. In usual care, patients received diagnostic feedback, and providers were informed of inclusion status. MEASUREMENTS: Neuropsychiatric Inventory-Anxiety subscale, Rating Anxiety in Dementia scale, Penn State Worry Questionnaire-Abbreviated, Geriatric Anxiety Inventory, Geriatric Depression Scale, Quality of Life in Alzheimer disease, Patient Health Questionnaire, and Client Satisfaction Questionnaire. RESULTS: Feasibility was demonstrated with regard to recruitment, attrition, and treatment characteristics. At 3 months, clinicians rated patients receiving Peaceful Mind as less anxious, and patients rated themselves as having higher quality of life; collaterals reported less distress related to loved ones' anxiety. Although significant positive effects were not noted in other outcomes or at 6-month follow-up, the pilot nature of the trial prohibits conclusions about efficacy. CONCLUSIONS: Results support that Peaceful Mind is ready for future comparative clinical trials.

Peaceful Mind: an open trial of cognitive-behavioral therapy for anxiety in persons with dementia.

BACKGROUND: Anxiety has a high prevalence among individuals with dementia, and it has a significant negative impact on their functioning; yet intervention studies are lacking. We developed Peaceful Mind, a cognitive-behavioral intervention for persons with dementia. In this paper, we describe the intervention and results of an open trial evaluating the feasibility and utility of the intervention and assessment procedures. METHODS: Peaceful Mind is implemented over a period of three months in the participant's home with involvement of a caregiver or "collateral." Dyads are followed for an additional three months via telephone. An assortment of simplified skills is offered, including self-awareness, breathing, behavioral activation, calming thoughts, and sleep skills. RESULTS: Nine participants were enrolled, eight completed the three-month assessment, and seven completed the six-month assessment. Overall, participants and collaterals were satisfied with the intervention and reported that they benefited in terms of anxiety, depression, and collateral distress. CONCLUSIONS: A randomized controlled trial would help determine whether this promising new treatment has a statistically significant impact on anxiety in this population.

The roles of social support and self-efficacy in physical health's impact on depressive and anxiety symptoms in older adults.

Physical illness may precipitate psychological distress among older adults. This study examines whether social support and self-efficacy moderate the associations between physical health and depression and anxiety. Predictions were tested in 222 individuals age 60 or older presenting for help with worry. Physical health was assessed through self-report (subjective) and physical diagnoses (objective). Objective physical health did not have a significant association with depression or anxiety. Worse subjective physical health was associated with increased somatic anxiety, but not with depression or worry. The relationship between subjective physical health and depressive symptoms was moderated by self-efficacy and social support. As predicted, when self-efficacy was low, physical health had its strongest negative association with depressive symptoms such that as physical health improved, depressive symptoms also improved. However, the moderation effect was not as expected for social support; at high levels of social support, worse physical health was associated with increased depressive affect.

Incorporating religion and spirituality to improve care for anxiety and depression in older adults.

Recent research has suggested that religion/spirituality may be linked to improved physical and emotional health, although the patient's motivation and method of using religious/spiritual beliefs appear to be a key factor in obtaining benefit. Studies have shown that there is a high level of religion/spirituality among older adults in the United States and significant patient-reported desire to include such beliefs in health care settings. This article provides a brief overview of the support for considering religion/spirituality in the health care of older adults and reviews potential drawbacks and methods for providers to assess and use patient beliefs to improve anxiety/depression.

The role of interdependence and perceived similarity in depressed affect contagion.

This study hypothesized that perceived similarity significantly impacts depressed affect contagion only for individuals with highly interdependent self-construals. Baseline self-construal and affect were measured. Then, after reading a vignette about a depressed or nondepressed target, affect and perceived similarity were assessed. Participants reading the depressed vignette reported higher negative affect than participants reading the nondepressed vignette. Positive affect did not differ between the two conditions. For participants exposed to the depressed vignette, the hypothesized interaction between perceived similarity and interdependence significantly predicted positive affect. It appears that participants with more interdependent self-construals were more likely to "catch" the low positive affect displayed by the depressed target only if they perceived themselves as highly similar to the target.

Interpersonal reactions to suicide attempt: the role of respondent causal attributions.

Interpersonal responses to a depressed person with or without a suicide attempt were examined. It was hypothesized that the depressed person who attempted suicide would receive higher negative attributions and interpersonal rejection, and that attributions would mediate the relationship between exposure to a depressed person and rejection. Contrary to hypotheses, respondents were more willing to interact with, held higher esteem for, and endorsed lower negative attributions for the depressed person who attempted suicide. Mediation hypotheses were supported. Findings suggest that a suicide attempt may promote less negative attributions toward depressed individuals, which in turn dampen negative interpersonal reactions.

Affective and attributional features of acculturative stress among ethnic minority college students.

Little is known about the affective features of acculturative stress or its relation to attributional styles for negative events. The authors examined associations among acculturative stress, attributional style, and positive and negative affect among 96 ethnic minority college students. They hypothesized that acculturative stress would be characterized by elevated negative affect and global and stable attributions for negative events. Consistent with prediction, acculturative stress was significantly associated with negative affect and global attributions, even when controlling for other relevant predictors. Attributional style did not account for the association between negative affect and acculturative stress. Positive affect and stable and internal attributional styles were not related to acculturative stress. The authors discuss implications for reducing stress associated with acculturation.

The Peaceful Mind manual: a protocol for treating anxiety in persons with dementia.

Anxiety disorders are highly prevalent among individuals with dementia and have a significant negative impact on their lives. Peaceful Mind is a form of cognitive-behavioral therapy for anxiety in persons with dementia. The Peaceful Mind manual was developed, piloted, and modified over 2 years. In an open trial and a small randomized, controlled trial, it decreased anxiety and caregiver distress. The treatment meets the unique needs of individuals with dementia by emphasizing behavioral rather than cognitive interventions, slowing the pace, limiting the material to be learned, increasing repetition and practice, using cues to stimulate memory, including a friend or family member in treatment as a coach, and providing sessions in the home. The manual presented here includes modules that teach specific skills, including awareness, breathing, calming self-statements, increasing activity, and sleep management, as well as general suggestions for treatment delivery.

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.

Pilot sample of very early onset bipolar disorder in a military population moderates the association of negative life events and non-fatal suicide attempt.

OBJECTIVE: To examine the moderating effects of very early onset diagnostic status (

The stability of axis I diagnoses in youth across multiple psychiatric hospitalizations.

The literature has yet to reach a consensus as to the stability of severe psychiatric diagnoses in youth. Previous studies among youngsters tracked over set follow-up periods have reported diagnostic stability estimates that are similar to or slightly lower than those of adults. Less is known, however, about the stability of youth psychiatric diagnoses across multiple episodes of psychopathology, such as recurrent inpatient hospitalizations. The present study investigated diagnostic stability among inpatient youth with multiple hospitalizations through longitudinal and cross-sequential designs. Results indicate that diagnostic stability, as measured by positive concordance rates and the kappa coefficient, is highest for mood disorders, especially bipolar disorder. Externalizing disorders and schizophrenia displayed moderate to low stability, with oppositional-defiant disorder displaying the lowest stability. Substance use disorders were found to have moderate stability. Overall, across-episode diagnostic stability among hospitalized youngsters appears to be lower than that of adults. This finding appears to be due to lower stability among certain externalizing disorders and substance use disorders, whereas mood disorders display stability rates resembling those of adults. Potential explanations for and implications of these findings are discussed.