title: Exposure-Based CBT for Older Adults After Fall Injury: Description of a Manualized, Time-Limited Intervention for Anxiety.
abstract: Fall accidents among older adults can be devastating events that, in addition to their physical consequences, lead to disabling anxiety warranting the attention of mental health practitioners. This article presents "Back on My Feet," an exposure-based cognitive-behavioral therapy (CBT) protocol that is designed for older adults with posttraumatic stress disorder (PTSD), subthreshold PTSD, or fear of falling resulting from a traumatic fall. The protocol can be integrated into care once patients have been discharged from hospital or rehabilitation settings back to the community. Following a brief description of its development, the article presents a detailed account of the protocol, including patient evaluation and the components of the eight home-based sessions. The protocol addresses core symptoms of avoidance, physiological arousal/anxiety, and maladaptive thought patterns. Because older patients face different coping challenges from younger patients (for whom the majority of evidence-based CBT interventions have been developed), the discussion ends with limitations and special considerations for working with older, injured patients. The article offers a blueprint for mental health practitioners to address the needs of patients who may present with fall-related anxiety in primary care and other medical settings. Readers who wish to develop their expertise further can consult the online appendices, which include a clinician manual and patient workbook, as well as guidance on additional resources.
authors.affiliation: Weill Cornell Medical College.
authors.forename: Nimali
authors.initials: N
authors.lastname: Jayasinghe
authors.affiliation: Weill Cornell Medical College.
authors.forename: Martha A
authors.initials: MA
authors.lastname: Sparks
authors.affiliation: Weill Cornell Medical College.
authors.forename: Kaori
authors.initials: K
authors.lastname: Kato
authors.affiliation: Weill Cornell Medical College.
authors.forename: Kaitlyn
authors.initials: K
authors.lastname: Wilbur
authors.affiliation: Weill Cornell Medical College.
authors.forename: Sandy B
authors.initials: SB
authors.lastname: Ganz
authors.affiliation: Weill Cornell Medical College.
authors.forename: Gabrielle R
authors.initials: GR
authors.lastname: Chiaramonte
authors.affiliation: Weill Cornell Medical College.
authors.forename: Bradford L
authors.initials: BL
authors.lastname: Stevens
authors.affiliation: Weill Cornell Medical College.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Barie
authors.affiliation: Weill Cornell Medical College.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Lachs
authors.affiliation: Weill Cornell Medical College.
authors.forename: Michael
authors.initials: M
authors.lastname: O'Dell
authors.affiliation: Weill Cornell Medical College.
authors.forename: Arthur T
authors.initials: AT
authors.lastname: Evans
authors.affiliation: Weill Cornell Medical College.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Bruce
authors.affiliation: Weill Cornell Medical College.
authors.forename: JoAnn
authors.initials: J
authors.lastname: Difede
keywords: anxiety; older adults; prolonged exposure therapy; unintentional falls