What comparison criteria are used to differentiate mental health from illness?

o  Attitudes of an individual toward themselves (self-acceptance, self-confidence)

o  Growth, development, and self-actualization (realize potentials)

o  Integration of personality (balance, coherence, resistance to stress)

o  Autonomy (internal value systems)

Be familiar with figures regarding life expectancy information, genetic longevity, and mental illness among the elderly.

·       ALE has increased to 77 yrs.  In the last 100 years alone, it has increased by 30 years. 

·       25% of longevity is attributed to genes (identical twin studies)

·       22% over 65 can be diagnosed mentally ill

Have an awareness of medication prevalence among older adults.

·       Older adults average 6 to 7 prescribed medications (polypharmacy)

Influences affecting individual differences, influences, and variability. 

·       Normative historical influences and age cohorts (may become less meaningful with time)

·       Variability (individual differences) increase with age on most dimensions.

·       Non-normative –  person specific

·       Age-graded – age norms, developmental tasks, normative time-ordered processes

·       History-graded – influences over a particular historical time (1929s depression, segregation)

Know about physical cellular limits.

·       Finite span of some cells (Hayflick Limit) Note: stem cells not affected

In regard to perceptual issues, like selective attention, know distractions, multiple targets, and response times.

·       Older people do not perform as well when difficult multiple tasks are given simultaneously

·       Selective attention –

o  slowed by distractions

o  longer to switch attention (older tend to distribute attn equally, not focused)

o  slower when targets are different modalities

o  difficulty inhibiting irrelevant info

Be aware of the aspects of aging related to intelligence changes.

·       Multidirectionality – some things improve (crystallized intelligence), some decline (response speed) –crystalized intelligence is when things in your mind don’t change…fluid intelligence may decline…

Know the characteristics of mentally healthy older people.

·       always potential for anxiety

Have an understanding of inherent interactions in psychodynamic personality theory.

·       Inherent in the interactions is the potential for anxiety.

Know the principles of behavior that Freud developed.

1.  Pleasure

2.  Reality

3.  Tension Reduction

4.  Polarity

5.  Repetition

Understand the function of defense mechanisms.

·       Reduce anxiety by avoiding the cause of anxiety.

Be able to explain how Erikson’s stages contribute to mental health of older adults.

·       Balancing alternatives generates maturity; as you find balance, you become more mature.

Know the main theorists dealing with life re-examination and time orientation.

·       You start thinking about the time remaining versus the time lived; life re-examination.

·       Neugarten – time remaining v. time lived; life re-examination.

Clarify popular assumptions about depression and aging.

·       some would assume that depression rates are higher.  The opposite appears to be true. Rate of depression does not increase with this loss.

·       Regression takes place only to a point of fixation.

Be able to identify approaches for treatment objectives.

·       1. The first objective is to achieve insight

·       2. A second objective is to modify the personality structure.

·       3. A third objective is to develop more mature defense mechanisms.

Be familiar with assessment techniques (psychodynamics)

·       Projective techniques and story-telling.

Be able to describe challenges in developing meaningful behavioral results in studies for older adults

• The challenge in developing meaningful behavioral is test-re-test reliability

Know the relationship between normal aging and behavioral modification contexts.

·       Important to understand the context to which the behavior occurred.

Be able to identify key aspects of the three theories of aging and mental health presented in class

·       Activity Theory –directly related to social activity (Havighurst); (focuses on the loss of meaningful roles.)

·       Disengagement Theory (Cumming, Newell)– needs of the elderly are different from middle age, namely, that elderly people can be excused or expected to be eccentric, free from social sanctions, and egocentric.  .

·       Continuity Theory (Maddox, Carp)— multiple pathways to life satisfaction in old age.  Behavior when old is an extension of similar patterns when younger.

Be familiar with current thinking about neuroplasticity and new learning. 

·       Test, re-test theory…

The brain of a 71-yo is about the same as a 17-yo  in its ability to make new connections.  However, most people stop learning meaningful new concepts around age 30. 

Positive reinforcement

·       causes behavior to increase in frequency.  This is done by pairing the presentation of a desirable event (M&M, praise) with desired behavior (sit down, move limb).

·       is removing a desirable event until target behavior is displayed.(“No Magic Cup until you eat your vegetables”; “We can’t leave until you put your shoes on.”)

·       Reinforcement vs punishment

·       Reinforcement increases the target behavior; punishment reduces behavior.

·       Primary reinforcers have...

·       acquire reinforcing properties by being associated with a primary reinforcer

Understand the goal of cognitive therapy.

·       Focuses on thought distortion that produces affective disorders (depression, anxiety)

Four stages:

o  Self-labeling

o  Distorted or irrational thoughts

o  Reframe

o  Get feedback

Understand the relationship between learned responses and contingent reinforcers.

·       learned responses to the environment are not as effective and interfere with previously effective adaptations; range of adaptive behaviors may be restricted due to physical or cognitive limitations.

·       Contingent reinforcers may need to be changed (e.g., attention getting).  What worked before, no longer works.

What is response generalization?

·       applies to increasing the situations for target behavior; stimulus generalization refers to increasing the variety of effective stimuli for the target behavior.

What are types of behavioral therapies?

·       behavioral modification

·       biofeedback

·       memory training

·       Rational Emotive Therapy (Albert Ellis) – the purpose of treatment is to identify beliefs that are irrational and self-defeating

·       minor stressors (fight or flight) (i.e. fender bender, job interview, etc.)

·       single strongest predictor of mental well-being in later life. (i.e. financial strain, death of family members, etc.)

What is the focus during assessment of stress and coping, and what are methods used?

·       Focus during assessment is on vulnerabilities (personality, behaviors, beliefs) when assessing stress and coping patterns.  These can be objective or subjective (real or perceived).

·       Interview: preferred method for stress and coping assessments

Know about the elderly and how they seek mental health services.

·       Most elderly do not seek health services.

Be familiar with social support treatment.

·       Emotion-focused coping may occur early in treatment process

·       Problem-focused coping has an instrumental focus (often later in process)

·       With aging, it may become harder to get self-confidence because of extensive history of experiences.

Know the principles and stages of Cognitive Therapy with older adults.

     client is shown how to identify self-labeling (how they view themselves)

     taught to notice when they have distorted or irrational thoughts

     learn to substitute (reframe) appropriate thoughts

     get feedback for future motivation

Recount important aspects and goals of Rational Emotive Therapy.

·       focuses on resolving emotional and behavioral problems and disturbances

·       enables people to lead happier and more fulfilling lives

Be able to describe the focus for Single Session Therapy.

·       Designed to solve a very specific problem.

Who typically helps older adults to obtain assistance?

·       Assistance for older family members is often sought by younger family members.  Likewise, the family is often the first line of defense when physical or mental health problems arise.

What is the frequency of contact between older parents and their children?

·       Current studies show that older adults maintain at least weekly face-to-face contact with a child of theirs, and high rates of other direct/indirect forms of contact with several children.

Know about characteristics of later life transitions.

·       1  emptying and re-emptying the nest

·       2.  retirement

·       3.  onset of chronic physical illness

Be familiar with the concept of circular causal sequence.

·       Each member of the family social unit can be affected directly or indirectly.  They can be actor or reactor.  An appreciation of cycles of behaviors is an important aspect of family systems models – the observed behavior may have an antecedent, or may be one behavior in a chain of related events.

Recount the bases for family binding, and demonstrate some understanding of rules and boundaries.

·       Family members bind on the bases of alliances, triangles, or coalitions.

·       often a hierarchy of power in the family system and family “rules.” ...establish who in the unit is adhering to the rules, or whether they are rebels and problem makers.  When an older member changes their behavior significantly, it can alter the dynamics and roles within the family system.

·       Rules create boundaries, and family systems can become rigid or diffuse if the boundaries are not flexible.  Family members have their understanding of the rules and boundaries, why they are structured as they are, and the consequences of deviating from them. 

·       Assessment (steps):

1.   Determine the family structure (using a genogram; first thing you’d do to plan a family intervention)

2.   Family life-cycle

3.   Family interactions

4.   Family history

·       Intervention (order changes):

1.   First-order changes: target specific behavior patterns for change/do not alter the basic functioning pattern of the family structure. (Ex: education about the event, support, or problem-solving).

2.   Second order changes: alter the family structure to create a new system.  (Ex:  break family rules, or, reorganize a sub-element of decision-making). 

Be able to explain several types of family systems therapy techniques.

1.  Validation – express understanding and acceptance of each member’s feelings and beliefs; find something positive to say about each member.

2.  Reframing – teach to reframe problems as the family’s problem, not the individual’s.

3.  Structural change – altering roles to restructure or strengthen

relationships among family members.

4.  Detriangulation – shifting attention from scapegoat for two other members who are in conflict but pretend not to be.