2024 NJ Psychologist Spring

NJ PSYCHOLOGIST

The Professional Journal of the New Jersey Psychological Association

In this issue:

SpecialSection: Geropsychology: Understandingand HelpingOlderAdultsand theirFamilies

TheScopeandEffectsofAgeism(1CE)

UnlockingHope:AdvancementsinAlzheimer's DiseaseTestingandTreatment

UnderstandingtheImpactofDementiaon FamilyDynamics

Dementia:LostandFound

DisparitiesinTreatmentAmongGeriatric LGBTQ+Individuals

AgingwithPride:UnderstandingandHealing BabyBoomerLGBTQ+MentalHealthThrough ContemporaryPsychotherapeuticInterventions

CognitiveDecline&theImportanceof AudiologicalAssessment

PreventingDementiainOlderAdulthood:Isit Possible?

ProlongedGriefDisorderinOlderPeople: ImplicationsforClinicians

TherapeuticConsiderationsofGrief ExperiencesinOlderAdults

HowDoYouKnowWhenItIsDementia?

ExecutiveBoard

President:MarcGironda,PsyD

President-Elect:TBD

Past-President:BrianaCox,PsyD

Secretary:AlexandraMillerClark,PsyD

Treasurer:AnastasiaBullock,PsyD

Parliamentarian:BonnieMarkham,PhD,PsyD

Members-At-Large: (A)DeirdreWaters,PsyD

(A)LaurenGerardi,PhD (A)TBD

(N)StacieShivers,PsyD (N)KellyMoore,PsyD (N)MarilynLyga,PhD

SpecialRepresentatives:

APACouncilRepresentative:RhondaAllen,PhD

ECPChair:JaxGallios,PsyD

NJPAGSChair:MaryIsaacCargill

AffiliateCaucusChair:PhyllisBolling,PhD

CODICo-Chairs:PhyllisBolling,PhD&StacieShivers,PsyD(EB Liaison)

ExecutiveDirector:SaraTedrickParikh,PhD

DirectorofProfessionalAffairs:SusanC McGroarty,PhD

AffiliateOrganizationRepresentatives:

Essex/UnionCountyAssociationofPsychologists:TBD NortheastCountiesAssociationofPsychologists: NorineMohle,PhD

MercerCountyPsychologicalAssociation:TBD MiddlesexCountyAssociationofPsychologists:TBD Monmouth/OceanCountyPsychologicalAssociation:TBD

MorrisCountyPsychologicalAssociation: HayleyHirschmann,PhD

Somerset/Hunterdon/WarrenCountyPsychological Association:TBD

SouthJerseyPsychologicalAssociation:AngePuig,PhD

EditorialBoard:

Editor:NourimanGhahary,PhD

HomestudyCEArticleEditor: DennisFinger,EdD

EditorialBoardMembers: AaronGubi,PhD

AnthonyTasso,PhD

NathanMcClelland,PhD

DonaldFranklin,PhD

ShihweWang,PhD

StaffLiaison:ChristineGurriere

We'reheretohelp!

CentralOffice:8:30am–4:00pm Phone: 973-243-9800

STAFFCONTACTINFORMATION

ExecutiveDirector:SaraTedrickParikh,PhD njpaed@psychologynjorg

DirectorofOperations:AmyChapman,PhD njpadoo@psychologynjorg

Communications:ChristineGurrierenjpacg@psychologynj.org

ContinuingEducation:KaleighWhite,PhD njpakw@psychologynjorg DirectorofProfessionalAffairs:SusanMcGroarty,PhD

President's Message

ByMarcGironda,PsyD NJPAPresident

Irecalltheexperiencevividly:amixofuncertaintyand excitementinmymind,awonderaboutwhoImightmeet,an interestinunfamiliartopics ItwasmyfirstNJPAconference MypsychologistfatherandIdrovetogether,andhecluedme intoexpectationsIshouldhave Healsotalkedabouthowhe enjoyedbumpingintocolleagueshemadeovertheyearsat previousconferencesandcatchingupwiththem Ihopedfor thesameexperience

Iwaswide-eyedwhenIfirstenteredthehotel,therewereso manypeoplewalkingaroundwhoseemedtoknoweachother sowell,wearingnametagsandribbonswithvariouspositions theyheldatNJPA.Therewerealsovendorseagertotalkabout howtheirserviceorproductwouldenhancepsychology practice.Igrabbedacupofcoffee,shuffledthroughmy conferencemapandagendapapers,andspenttimeorienting myselftotheexperience.Ispentthedaylearningaboutnew topics,sittingwithpeopleIhadnevermet,butwhoshareda loveofpsychology,anddecidingIdefinitelywantedtoreturn nextyear!

ThroughmytimeasCoCEAchair,NJPAtreasurer,andnow NJPApresident,I’veattendedmanyNJPAconferencesandstill lookforwardtothem I’mthrilledthatthisyearCoCEAandour ConferenceCommitteearerebrandingourFallConferenceas ourFallConvention Thisnamechangeindicatesa commitmentfromNJPAforaonce-a-yearexperiencethatNew Jerseypsychologistswillnotwanttomiss Aconventionmoves awayfromasolefocusoncontinuingeducation,andtowards additionalopportunitiesfornetworking,socializing,and relaxing

Thethemeforourfirstconventionis“TheFutureof Psychology.”Wewillhaveaspecialfocusonthetopicof prescriptionprivilegesforpsychologistswithspeakersfrom acrossthenationinvariouspracticesettings.Othertopics includeintegratingtechnologyintoourfield,suchasLisa Jacovsky’spresentationon“LeveragingAItoEnhancethe ClassroomorPrivatePractice.”

Tohaveagreatconvention,youneedtohaveagreatlocation CoCEAresearchedotherstateswithlargeconventionsand realizedtheyarealwayslocatedinadesignated“jewel”This mayincludealargecity,placeofhistoricalsignificance,or populartouristspot

NewJersey’s“jewel”,ofcourse,istheShore NJPAis thrilledtohostitsfirstmulti-dayconventioninAsbury Park-aniconiclocationanddestinationknownfor everythingfromthetitleofBruceSpringsteen’sfirst albumtooneofthebestculinarydestinationsaround OurconventionwilltakeplaceattheAsburyHotel,which isoneblockfromtheiconicConventionCenterinAsbury Park Thehotelisaperfectplacetospendaweekend,and includesanattachedbowlingalley,aretrodiner,live music,andarooftoplounge Itisastone’sthrowfromthe boardwalkthatextendsthroughseveraltownsinthearea, suchasOceanGrove,BradleyBeach,Belmar,Avon,and SpringLake.Iamparticularlyexcitedforanorganized morningrunontheBoardwalk;Ihopeyouwilljoinme!

Ifyouhavenotattendedaconferencein-personina while,ourFallConventionwillbethetimetodoit.Please joinusOctober25-27,2024 Ilookforwardtoseeingyou there! Find more information on page 46

Executive Director Update

BySaraTedrickParikh,PhD NJPAExecutiveDirector

In my second year with NJPA, our Committee on Legislative Affairs (COLA) is flourishing with new leadership and many new members, including several students with a passion for advocacy In April 2024, we held a retreat at the Nassau Club in Princeton. A major goal of this retreat was to get an “inside scoop” on how NJPA leaders can effectively interface with legislators to advocate for issues that are important to us and the populations we serve At the recommendation of our Government Affairs Agent, Jon Bombardieri of CLB Partners, we were pleased to welcome Assemblywoman Aura K. Dunn, who has previously worked as a staffer and lobbyist

Assemblywoman Dunn gave us several tips on effective legislator interactions First, our message should focus around a memorable data point showing the issue’s impact on constituents For example, we could develop a fact sheet about how depression predicts numerous health complications among people with diabetes, then use that to advocate for better access to mental health care

Second, Assemblywoman Dunn encouraged COLA members to develop “leave-behinds” that summarize the issue in an easyto-consume way Legislators are constantly inundated with information about important issues, so it’s useful to focus on major bullet points and visual representations She also hinted that it’s helped to give the “leave-behind” on your way out so the person you’re speaking with spends their time focused on you, not your handout

Finally, as the grown-ups of our childhood taught us, saying “thank you” goes a long way Begin every conversation by expressing appreciation for all the legislator has already done to champion mental health, and follow up interactions with a formal thank-you note. Assemblywoman Dunn said that both electronic and handwritten notes are nice for building the relationship, providing additional information, and keeping communication lines open. It’s worth noting that Assemblywoman Dunn sent Jon Bombardieri a thank-you email for having her before we were even done with our COLA retreat

What You Can Do

NJPA’s broad advocacy priority for 2024 is access to care, with an emphasis on telehealth reimbursement parity, reimbursement rates for Medicaid, and expanded billing opportunities for psychologists working in hospitals We are also monitoring several bills related to mental health in schools We seek to have a vibrant mix of specialties, practice settings, and career stages among COLA, and we hope to continue offering legislative advocacy training for COLA members and all

NJPAmembers Inthemeantime,here’showyoucanput AssemblywomanDunn’sadvicetouse:

1 Whenyouseestudiesorreportsthatsupporttheimportant ofaccesstocareorhighlightareasoflimitedaccess,send themtomeatnjpaed@psychologynjorg Ideally,include “legislativeadvocacydata”inthesubjectlineandincludea1-2 sentencesummaryofthefindingandwhatissuesitrelatesto.

2 Ifyouenjoydevelopinghandoutsandsummarizingdata effectively,youcancontributetoNJPA“leave-behinds” withoutnecessarilyjoiningCOLA!Contactmeat njpaed@psychologynjorgwith“COLAleave-behinds”inthe subjectlinetoletmeknowyou’reinterestedinamorefocused contributiontoCOLA Wemayreachoutwithurgentrequests, butIwouldalsolovetostartdevelopingleave-behindsorother engagingeducationaloutreach.Youwilloftenbeabletopull fromAPAresourcesandcollaboratewithNJPA’sSenior CommunicationsDirectorChristineGurriere

3 Thankyourlegislatorsforbeingamentalhealthadvocates! Whenyourespondtoacallforadvocacy,suchasaVoterVoice request,personalizethemessagetoacknowledgewhatyour legislatorhasdoneformentalhealth(youcanoftensearchtheir websitesfor“mentalhealth”and“psychologist”tofindrelevant pressreleases).Ifyounoticeyourlegislatorsworkingon meaningfulmentalhealthlegislation,sendthemanotesharing yourappreciationfortheiradvocacy!Pleasenote:Individual memberscannotrepresentthemselvesasspeakingonbehalfof theNewJerseyPsychologicalAssociation,butthereisstillgreat powerincommunicatingasaconstituentandalicensed psychologist!

Andinthespiritofgratitude,thankyoutoour2024COLA leadership AnaBullock,PsyD,isdoingdoubledutyasNJPA TreasurerandCOLAco-chair,andshewasourEarlyCareer PsychologistnomineeforAPA’sPracticeandSPTALeadership Conference(SPTAstandsforState,Provincial,andTerritorial Association–previouslycalledStateAssociations) KellyMoore, PsyD,isservingasNJPAExecutiveBoardMember-at-Largeand COLAsecretary,afterseveralyearsofchairingourListserv MonitoringCommittee

ThankyoutoAna,Kelly,andallofour2024COLAmembersfor theworkyou’redoingtoadvocateforNewJersey!2024COLA Members:HaroldZullow,PhD;AlisonBlock,PhD;KellyMoore, PsyD(secretary);AnaBullock,PsyD(co-chair);KellyGilrain, PhD;ChristinaGoodwin,PhD;TaminaDaruvala,JD,MSW; SimoneBoyd,MA;JillBrooks,PhD

Sara Tedrick Parikh, PhD

APA Council of Representatives Report

ByRhondaAllen,PhD CouncilofRepresentatives(NJ)

(2019-24)

The Council of Representatives of the American Psychological Association of Representatives held a hybrid meeting, with most Council members convening in-person in Washington, DC, on February 23-24, 2024

This council meeting was unique by virtue of the fact that council members, who were not in their first year on council, were given the opportunity to visit their congressional representatives and speak about 3 key issues that APA is promoting: 1) Co-sponsor the Youth Mental Health Research Act (H R 5976) 2) Support $341 million in FY25 for the Department of Labor’s Wage and Hour Division to investigate and combat child labor violations 3) Support $30 million in FY25 for the Graduate Psychology Education (GPE) Program I was accompanied on this “Hill Visit” by 3 other NJ psychologists, Doctors Vanessa Bal, Milton Fuentes, and Margaret Kovera, and also Andrew Ferriera from the American Psychological Association advocacy office This was a unique and valuable opportunity for me to put the work we do on council into action that will hopefully enact legislation to benefit us all

The following is a summary of the major decisions and votes at this meeting Some of what is reported below is excerpted from a meeting summary provided to council members from APA.

Calling for an End to Involuntary Individual Isolation in Incarcerated Youth

The Council passed a resolution calling for ending the placement of youths in isolation in juvenile justice settings, except for emergencies, and then only for a maximum of a 4-hour period “Solitary confinement should never be used for punishment or disciplinary purposes, or for the protection of property,” states the resolution “The separation of youths from others must never be a substitute for adequate staffing numbers, staff training, and supervisory and/or administrative support ” The resolution passed 154-2, with 1 abstention. This resolution calls for implementing alternative, evidence-based strategies for managing behavior and promoting positive development It emphasizes the importance of mental health support for youth subjected to isolation The measure includes a recommendation that federal agencies and/or state youth justice authorities keep accurate track of and publicly report the frequency, prevalence, duration, conditions and rationales for various forms of individual confinement.

Secure Firearms Storage

The Council approved, by a vote of 157-6, a resolution aimed at promoting secure firearm storage practices This resolution underscores the critical role of psychologists and healthcare providers in preventing suicides by advocating for secure firearm storage and safety strategies The measure emphasizes the effectiveness of actions such as temporary removal of access to firearms during mental health crises, highlighting research indicating that such steps can prevent suicides by creating time and distance between individuals and lethal means The resolution also advocates for increased funding at federal, state, and local levels to support initiatives aimed at preventing suicides through secure firearms storage And it calls on psychologists, healthcare professionals, policymakers, and the public to support efforts to implement evidence-based strategies to prevent suicides and promote mental health and safety

Policy Statement on Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals

The Council passed, by a vote of 153-9, with 1 abstention, a policy statement affirming evidence-based care for transgender, gender diverse and nonbinary children, adolescents, and adults The policy affirms APA’s support for access to evidence-based clinical care for transgender, gender diverse and nonbinary children, adolescents, and adults It notes that recent legislative attempts to obstruct access to psychological and medical interventions for such individuals puts them at risk of depression, anxiety, and other negative mental health outcomes. The policy statement also addresses how misinformation can distort the characterization of gender dysphoria and gender-affirming care, leading to stigmatization, marginalization, and lack of access to psychological and medical care for this population It also highlights APA's support for insurance providers to include coverage that addresses the healthcare needs of this population

Approval of APA/APASI Strategic Plan

The APA/APASI strategic plan was approved by the Council by a vote of 145-5, with 6 abstentions This updated plan features revised language that enhances specificity, aligns with current

EDIstrategies,andhighlightstheimportanceofpartnerships.It replacesthepreviousplan,approvedinAugust2019,andfollows themandaterequiringCouncilapprovaleveryfiveyears

ParentswithDisabilities

Recognizingthebiasesandchallengesoftenencounteredby parentswithdisabilities,theCounciladoptedaresolutionto supportparentswithdisabilities Thepolicystatementcallsupon psychologyandpolicymakerstosupportincreasedpsychological research,intervention,advocacy,andpolicydevelopmentaimed atinformingandshapingdecisionsrelatedtoparentswith disabilities,andtoreducedisparitiesandbiasesfacedbythis population Theresolutionpassed158-1

CombatingMisinformationandPromotingPsychological ScienceLiteracy

TheCounciladoptedaresolutiononcombatingmisinformation andpromotingpsychologicalscienceliteracy.Theresolution recognizesthatmisinformationleadstomistrustandcanposea threattopublichealth.Itstatesthat“tofullyunderstandthe impactofmisinformation,itisnecessarytounderstandthe psychologicalfactorsthatdrivepeopletobelieveandshareit, theleversofmanipulationusedbyitscreators,andthenetwork effectsinducedbytoday’smediaandpoliticallandscapethat impactitsspread”ThepolicycommitsAPAtodisseminate psychologicalsciencetoaddressmisinformationandtopromote psychologicalscienceliteracy Itpassed151-3

RevisedGuidelinesforPsychologicalPracticewithOlder Adults

TheCouncilvoted153-0with4abstentionstoadoptrevised GuidelinesforPsychologicalPracticewithOlderAdults,withan expirationdateofDec 31,2034 Theseguidelinesfocusgreater attentiononthestrengthsandneedsofolderadults,andworkto developworkforcecompetencyinworkingwiththispopulation

Thisrevisionaddressestheincreaseduseoftechnologyand telehealthforthefirsttime

DiscussionofFutureMeetingOptions

TheCouncildiscussedwhethertoholdtheFebruarymeeting entirelyvirtuallyand/ortoremovethehybridoptionfrominpersonmeetings.Anonbindingstrawpollshowedthatneither optionwaspopularamongCouncilmembersandthatitwasclear fromthecommentarythatmostwishtocontinuetomeetinpersonandalsocontinuetohaveahybridmeetingoption available TheCouncilLeadershipTeamagreedtostudytheissue further.

DuesAdjustment

ThatCouncilapproveda$25reductionintheduesatyearfour throughsixoftheduesramp-up($149to$124)anda$27increase intheAPAbasememberduesrate($247to$274)

AddressbyDr MiriamDelphin-Rittman

Dr MiriamDelphin-Rittmon,administratorofSAMHSA,outlined HHSandSAMHSAprioritiesandmajorinitiatives--inparticular, progressandattentiontomentalhealthacrossdiverse populations,buildingtheworkforce,addressingsubstanceuse disorders,andsuicideprevention

AschairoftheCaucusofStates,TerritoriesandProvinces,Iam veryexcitedtoannouncethatinconjunctionwithDivision31,we willbeofferingtwoscholarshipsforstudentswhoarepresenting attheAPAConventionandhavealsodemonstratedinvolvement intheirState,TerritorialorProvencialAssociation.Iwillforward additionalinformationandtheapplicationprocessassoonasitis available.

IlookforwardtorepresentingNJPAatthenextCouncilof RepresentativesmeetinginAugust2024inSeattle,Washington

CallforBoardSlateNominations

Nominationsarecurrentlybeingsolicitedforpositionsonthe2025NJPAExecutiveBoard.AsstatedintheNJPAbylaws,allNJPAelections shallfollowthepoliciesandproceduressetforthbytheNominationsandLeadershipDevelopmentCommitteethatareapprovedbythe ExecutiveBoard Everyeffortwillbemadetosecureatleasttwonomineesforeveryofficeontheslate,andtwonomineesforeach member-at-largepositiontobefilled

President-ElectcandidatesmusthaveservedontheNJPAExecutiveBoardorinaleadershippositioninanaffiliateorganization,or chairedanNJPAcommittee,specialinterestgroup,taskforce,resourcegroup,orhadanactiveroleasanNJPAcommittee,specialinterest group,orresourcegroupmemberwithinthelastthreeyears

SecretarycandidatesmusthavefamiliaritywithfundamentaloperationsoftheNJPAExecutiveBoard;experienceassecretaryin otherorganizationsand/orcommitteeswillbehelpful;technologicalandorganizationskillsrequired Thecandidateshouldhave hadanactiveroleasanNJPAcommittee,specialinterestgroup,resourcegroup,oraffiliatewithinthelastfiveyears

Member-at-Large(Nominations)candidatesmustbeamemberingoodstandinginNJPAandhavehadanactiveroleinanNJPA committee,orotherNJPAgroupincludingNJPAGS,taskforce,specialinterestgroup,resourcegroup,oraffiliatewithinthelast year.

SubmitnominationsfortheaboveboardpositionsonlinebyJuly20,2024 Theformandmoreinformationcanbefoundhere (log-inrequired)

MemberatLarge(Affiliate)candidatesmustbeamemberingoodstandinginNJPAandhis/heraffiliateandhavehadanactive roleinanNJPAcommittee,orotherNJPAgroupincludingNJPAGS,taskforce,specialinterestgroup,resourcegroup,oraffiliate withinthelastyear InterestedmemberspleasecontactPhyllisBolling,AffiliateCaucusChairatdrpbolling@gmailcombyJuly20, 2024

Special Section: Geropsychology: Understanding and Helping Older Adults and their Families

A Continuing Education Article

The Scope and Effects of Ageism (1 CE)

Earn 1 CE credit when you read this article and successfully complete the post-test. Purchase this CE activity here.

ByDonaldFranklin,PhD

TheWorldHealthOrganization(2012)definesageismas “thestereotypes(howwethink),prejudice(howwe feel),anddiscrimination(howweact)towardsothers oroneselfbasedonage.”Theyreportthatchildren becomeawareoftheirculture’sagestereotypesand internalizethesestereotypestoguidetheirinteractions withpeopleofvaryingages Theyalsoreportthathalf oftheworld’spopulationisageistagainstolderpeople Ifweacceptthesefindings,thenageismislikelythe mostfar-reachingdiscriminatorybehaviorintheworld. Perhapstheproofofthisliesinalmostdailyconcerns voicedabouttheageofmajorpoliticalcandidates, withoutanydiscussionoftheprejudicialnatureof thosestatements Infact,thefocusonagebrought aboutbythecurrentpoliticalenvironmentispossibly increasingageismintheUnitedStates.

ThetermageismwasfirstusedbyButler(1969)in comparingstereotypesaboutagingtoracial stereotypes Nelson(2016)reportedthatnegative stereotypingaboutolderpeoplehasanegative influenceontheirmentalandphysicalhealth.The experienceofbeingminimalizedandseenasirrelevant resultsinmanyolderpeoplebecominglessinterested inhealthyengagement,withevidencethatthisleadsto longerrecoveryfromillness,reductioninlongevity, andanincreaseincardiovascularreactionstostress Conversely,whenolderpeoplerejectnegativeage stereotypesandseeagingasatimeforcontinued growth,withpositiveinvolvementandengagementin lifeactivitiesandsocialinteractions,theyexperience morepositivementalandphysicalhealthoutcomes

Themainproblemisthatageismisinstitutionalizedin Americansociety.Weliveinamostlyagesegregated society,whereyoungpeoplehavelittleinteractionwith

olderpeople.Thisleadstofurtheracceptanceofage stereotypes,asactuallifeexperiencesarenotavailable tocontradictthestereotypes.Anderson(2024)presents alistofagingstereotypesandcitesstatisticsdisproving thosestereotypes Therearemanystereotypesabout agingcitedbyAnderson Agingleadstodepressionand loneliness(studiescitemostelderlypeoplewithhigher happinessscoresthanmiddleagedadults).Aging diminishescognitivefunctioningandleadstodementia (olderadultsdoexhibitslowerreactiontimeandsome memoryissuesbut,only5%ofadultsover65develop dementia) Agingleadstoalackofproductivityanda declineincreativity(about24%ofseniorsareinvolved involunteerwork,somecontinuetoworkpart-timeor full-timeinpaidemployment,otherspursueartistic andothercreativeactivities,ortakeclassesatlocal collegesandcommunitycenters) Asistrueofnegative stereotypesusedinallformsofbigotry,thestereotypes aretrueforasmallpercentageofthegroup,aswellas beingtrueforapercentageofthemajoritygroup.

TheAmericanPsychologicalAssociation(Weir,2023, March1)hasidentifiedanumberofcontradictionsto agestereotypesandalsoidentifiedpotential consequencesresultingfromagediscrimination.Itis truethatageismcanleadtoolderadultsbeingpassed overforpromotions.Itisalsotruethatmany psychotherapistsprefertonottreatolderadults, assumealessfavorabletreatmentoutcome,andbelieve thatdepressionisanaturalpartofaging Ageismhas anotherdimensionthatextendsbeyondothertypesof discrimination.Weallareraisedinaculturethat promotesageism,buteventuallyweallbecomepartof thegroupsubjecttoageismandcanourselvesbelieve ageismstereotypeswhenweourselvesareolder When

olderadultsbelieveandacceptagingstereotypes,ithas anegativeimpactontheirownhealthandlongevity (Weir,2023,March1).Olderpeoplewhohave internalizednegativestereotypesaboutagingaremore likelytodevelopphysical,cognitiveandmentalhealth issuesasaresultoftheirnegativebeliefs Olderadults whohaveordevelopmorepositivebeliefsaboutaging tendtobeprotectedfromdevelopingdementiaand tendtoalsohavelowerfrequenciesofserioushealth problemsastheyage

Thesefindingscallforthedevelopmentand implementationofstrategiestoreversetheaging stereotypes,bothinolderadultsandinsociety Cognitivebehaviortherapycanbeeffectiveinhelping olderadultswithnegativeagingbeliefs Increasing intergenerationalcontactcanleadtolessageismin society.

Thereisalsoresearchexaminingtherelationship betweensubjectage(howwefeelversustheaging stereotype)onhealthandlongevity(Westerhofetal., 2023).Subjectiveageindicateshowpeopleperceive, interpret,andevaluatetheirownagingascomparedto culturalstereotypesaboutwhatagingandoldage mean Thereappeartobepsychologicalpathways linkingsubjectiveagetohealthindicators.Itisadaptive tomaintainapositiveperceptionofone’sownaging processwithinaculturethatoverlydevaluesoldage andolderadults But,weneedtomorefullyunderstand whysomepeopleareabletoresistacceptingcultural stereotypeswhileothersdonotorcannot Amore positiveself-imagecontributestowell-being,butnot justonapsychologicallevel.Olderadultswithamore positivesubjectiveagearemorelikelytoengagein positivebehaviors,suchasphysicalactivities Theyare alsomorelikelytobetaskorientedratherthan avoidancefocused Someresearchindicatesa connectionbetweenanegativesubjectiveageand cardiovascularstressresponsesaswell,butthisareais notyetwellresearched.Ultimately,apositive subjectiveageperceptionisconnectedtoamore positivesenseofwell-being,andthatappearstobe relatedtolongevity

Allenetal (2024)completedastudyontherelationship ofagingappearanceandexperiencesofaging The resultsindicatethatappearingrelativelyyoungerthan agepeerswasassociatedwithmorepositiveandless negativeexperiences.Appearingolderthanagepeers hadtheoppositeeffect.Therelevanceofthesefindings

isthatinasocietywithnegativestereotypesregarding age,lookingyoungerwillbeassociatedwithmore positivesocialinteractions.Morepositiveandless negativeexperiencesofagingwereassociatedwith bothphysicalandmentalhealth

Thefocusonappearancemayseemtrivialtosome,but itreflectsbotharefusaltoacceptsocialstereotypes aboutagingandadesireforpersonalcontrol (engagementinlife)overtheirrateofdeclineovertime Olderadultswhomaintaintheirappearancecontinue tobeengagedinlife,seeksocialrelationships,and continuetoworktowardinvolvementinlifewitha senseofpurpose.Thosefactorsarerelatedtoboth physicalandmentalhealththroughoutthelifespan.

Otherresearchalsoexaminedtheroleofmotivationon agingstereotypes Hertzogetal (2008)foundthat engagementincognitivelydemandingactivityis beneficialinpromotingcognitivehealthinolderadults. Theyfoundthatparticipatingintasksthatrequired highaccuracyincreasedengagement(effort) Older adultswhohadbeliefsconformingtoagingstereotypes exertedlesseffort Thiswaspresumablybecausethey believedtheywouldbeunsuccessful Whenthe participantsdidnotholdagingstereotypes,they producedgreatereffort.Seniorswhoacceptaging stereotypesextendlesseffortoncognitivetasks Pratt(2024)foundarelationshipbetweenholding essentialistbeliefsandcognitivefunctioning. Essentialistbeliefsaboutagingaredefinedasbeliefs thatagingisbiologicallydeterminedandinevitable, thusitisuselesstoattempttoinfluenceyourown agingprocess Acceptingnegativeculturalbeliefsabout agingcanhaveadetrimentaleffectonanolderperson’s senseofselfandidentity.Internalizingsociety’s negativeviewsaboutagingaffectsfeelingsofloneliness andhasanegativeeffectoncognitionandphysical health Prattalsoreportedthatolderadultswithoutany objectivecognitiveimpairmentexperiencedanxiety andfearaboutcognitivedecline.Whenolderpeople internalizenegativebeliefsaboutaging,thisresultsina self-fulfillingprophecy Olderpeoplewhorejectthe negativeculturalstereotypesaboutaging,andbelieve thatage-relatedchangesarenotinevitable,aremore likelytotakeactiontoslowtheprogressionofchanges astheygetolder.Acceptingthestereotypesabout declineinoldageresultsinpassiveacceptanceofthe inevitable Rejectionofthosebeliefsencouragesactions

thatwillslowtheagingprocess.Childrenbeginto developnegativestereotypesaboutolderpeopleata veryyoungage.Thedifferencebetweenageismand otherformsofbigotryisthatwealleventuallybecome partofthegroupthatisbeingnegativelystereotyped Internalizingnegativebeliefsaboutagingbecomesa mentalhealthriskfactorasyouage.Robertsonetal. (2016)alsofoundarelationshipbetweennegative perceptionsofagingandcognitivedecline.Becauseof globalnegativeattitudestowardaging,olderadultsare likelytoexperiencediscriminationinhealthcare, workplace,andsocialsituations Theyalsonotethat negativeperceptionsofolderadultsincludebeliefsthat theyareforgetful,grumpy,andphysicallyimpaired. Thisiscomparabletothesexiststereotypesthatall menareangryandaggressive,orthatallwomenare hysterical Thedifferenceisthatthereisan acknowledgedsocialcriticismagainstsexist stereotypes,butlittleornoneregardingageism stereotypes.Themoreimportantdifferenceisthatmen andwomenwhoholdsexistviewsoftheothersexwill not,overtime,becomepartofthegroupthey discriminateagainst But,allpeoplewhobelieve negativeageismstereotypeswilleventuallybecome olderadultsthemselves Thisleadstodislikeofoneself, andthatisamentalhealthriskfactor.Thepositiveor negativeperceptionsheldaboutagingstronglypredict psychologicalwell-beinginlaterlife Severalstudies havefoundthat“olderadultswithnegativeselfperceptionsofaginghavegreaterlevelsofdisability,ill health,worsephysicalfunction,andahigherriskof mortalityovertime.”Inthelongitudinalstudy conductedbyRobinson,King-Kallimanis,andKenny (2016)theauthorsreachedthefollowingconclusions: “Olderadultswithnegativeself-perceptionsofaging showdeclinesinverbalfluencyandself-ratedmemory overtimeindependentofsociodemographicfactors, physicalhealth,mentalhealth,andmedicationuse. Olderadultswithpositiveperceptionsofaging,namely feelingsofpositivecontrol,meanwhileexhibit improvementinverbalfluency”

AstudybyWeitzetal (2019)foundarelationship betweenopennessandnon-acceptanceofageism stereotypeswithsubjectiveage,orhowyoungorolda personfeels.Ayoungersubjectiveageisassociated withhigherself-esteem,cognitivefunctioning,wellbeing,health,andlongevity Thetwoseparatebeliefs areeitherthatnegativechangesrelatedtoagingare fixed,immutable,andinevitable,ortheyaremalleable

andmodifiable.Opennessisrelatedtobelievingthat thechangesduetoagingareflexible.Thereisa relationshipbetweenopennessandtheadoptionof counterstereotypeattitudesaboutaging Beingopen tomultiplepossibilitiesandyourabilitytoimpactyour ownfutureallowsyoutorejectageismstereotypes,and thisaffectshowyoungoroldyoufeel.

Anotherfactoraffectingagingisthedecisiontoretire, andhowyoutransitionintoretirement Researchon therelationshipofengagementacrossmultiplelife domainstoasuccessfultransitionintoretirement (Hammetal,2019)hasfoundthatcontinuingtobe engagedinimportantlifedomainsisneededfora successfultransition Perceivedcontrolreferstobeliefs peopleholdabouttheirabilitytoinfluencemajor eventsintheirlives.Inretirement,health,work,and relationshipsareessentialtopositiveadjustment.

Healthisessentialtoapositivetransitioninto retirement.Theindividualplanningretirementneeds toassesstheircurrenthealth,makecorrectionsto addresshealthproblems,andformulateaplanto maintainpositivehealthinretirement Somepeople haveaccesstonutritionalguidanceandexercise throughtheiremployer Ifthisistrue,theindividual needstomakearrangementstoreceivetheseservices outsideoftheworkenvironment.Motivationto accomplishthistaskreliesinabeliefthattheperson canmakedecisionstomaximizetheirhealthin retirement,andthatiscontrarytotheageism stereotypethatoldageleadstophysicalhealthdecline thatcannotbepredictedorcontrolled.

Formanypeople,theirworkdomainisintrinsicallytied totheirself-imageandsenseofpurpose Inretirement, peopleneedtoidentifyhowtomaintainasenseof purposeandidentityaftertheyleavetheiremployment setting.Thiscanbeaccomplishedthroughpart-time employment,volunteerwork,involvementwithsocial causesthatmatchtheperson’sgoalsandideals, involvementinnon-compensationactivitiesthathave personalmeaning(suchasartormusic),pursuing educationalgoals,oranyothermeaningfulactivitythat providesasenseofpurposeandbelonging.

Relationshipsalsochangeinretirement Outsideof closefamilyrelationships,manypeopleprimarily socializewithpeoplefromtheirworkenvironment Thiscanincludeexercisebuddieswhowork-outwith youatthecompanygym,thepeopleyouchooseto meetforlunch,andcasualconversationswithwork

friends while at work The easy access to these people at work makes maintaining these relationships simple, until you retire After retirement, you have to expend more effort to maintain these relationships, and your time schedules no longer coincide Continuing to benefit from your interactions within these life domains requires a belief that it is not only desirable, but essential to your post-retirement life satisfaction

In summary, this author has reviewed the essential elements of ageism and the impact of aging stereotypes on physical and mental health for older adults. We have also explored the inaccuracies of aging stereotypes, how these beliefs become a part of our world view, and the impact these beliefs can have on happiness, adjustment, and longevity. Counseling, particularly CBT, can be an effective tool in reversing the effects of ageism stereotypes But, to address the ageism stereotypes at a societal level will require a concerted educational program, coupled with the development of more opportunities for young and older people to be together socially, educationally, and in work environments

AbouttheAuthor

Dr Franklin has been licensed as a psychologist in New Jersey since 1987 and is a long-time member of the NJ Psychological Association He is a past-member and chair of the Forensic Committee, and a past-member of the NJPA Ethical Education and Resource Committee, He recently joined the Editorial Board of the NJ Psychologist. He works primarily as a forensic psychologist, including age discrimination cases. He is currently 72 years of age

References

Allen, J O, Moise, V, Solway, E, Cheney, M K, Larson, D J, Malani, P N, Singer, D, & Kullgren, J T (2024, February 29), How old do I look? Aging appearance and experience of aging Among US Adults Ages 50-80. Psychology and Aging. Advance online publication https://dxdoiorg/101037/pag0000800

Anderson, J (2024) Myths and stereotypes of aging, Cambrian Senior Living, https://www.cambrianseniorliving.com/myths-andstereotypes-of-aging/

Butler, R N (1969) Age-ism: Another form of bigotry The Gerontologist, 9, 243-246 https://doi.org/10.1093/geront/9.4 Part 1.243

Hamm, J M, Heckhausen, J, Shane, J, Infurna, F J & Lachman, M E (2019) Engagement with six major life domains during the transition to retirement. Stability or change for better or worse. Psychology and Aging, 34, 441456http://dxdoiorg/101037/pag0000343

Hertzog, C, Kramer, A F, Wilson, R S, & Lindenberger, U (2008), Enrichment effects on adult cognitive development Can the functional capacity of older adults be preserved and enhanced? Psychological Science in the Public Interest, 9, 165

Hess, T M, Growney, C M, & Lothary, A F (2018), Motivation moderates the impact of Aging Stereotypes on Effort Expenditure. Psychology and Aging, 14, 56-57.

Nelson, T D (2016) Promoting healthy aging by confronting ageism American Psychologist, 71, 276-282

Prati, G (2024, April 18) Changes in essentialist beliefs about cognitive aging predict changes in mental health Evidence from a 10-year longitudinal study Psychology and Aging https://dxdoiorg/101037/pag0000823

Robertson, D A, King-Kallimanis, B L & Kenny, R A (2016) Negative perceptions of aging predict longitudinal decline in cognitive function Psychology and Aging, 31, 71-81 https://dxdoiorg/101037/pag0000061

Weir, K (2023, March 1) Ageism is one of the last socially acceptable prejudices Psychologists are working to change that Monitor on Psychology, p 36 https://wwwapaorg/monitor/2023/03/cover-newconcept-of-aging

Weiss, D, Reitz, A K, & Yannick, S (2019) Is age more than a number? The role of openness and (non) essentialist beliefs about aging for how young or old people feel Psychology and Aging, 34, 729-737 http://dxdoiorg/101037/pag0000370

Westerhof, G J, Nehrkorm-Bailry, A M, Tseng, H Y, Brothers, A, Siebert, J S, Wurm, S, Wahl, H W, & Diehl, M (2023) Longitudinal effects of subjective aging on health and longevity: An updated meta-analysis Psychology and Aging, 38. 147-166.

World Health Organization (2021, March 19) Aging: Ageism https://wwwwhoint/news-room/questions-andanswers/item/ageing-ageism

Earn1CEcreditwhenyoureadthisarticleandsuccessfully completethepost-test. PurchasethisCEactivityhere.

Unlocking Hope: Advancements in Alzheimer’s Disease Testing and Treatment

ByEmilyBrislin,PsyD

According to the annual report by the US Census Bureau and the Chicago Health and Aging Project (CHAP), in 2024, approximately 6.9 million Americans age 65 and older are projected to be living with Alzheimer’s dementia. That equates to approximately 1 in 9 adults age 65 and up (Rajan et al. 2021). Alzheimer’s disease (AD) is a neurodegenerative condition that leads to cognitive decline and dementia. The major underlying pathology of AD is an accumulation of beta-amyloid (Aβ) plaques and neurofibrillary tangles of the protein tau, which leads to neuron death and damage to brain tissue Other changes include inflammation and atrophy of brain tissue According to the Alzheimer’s Association, recent research has demonstrated that these brain changes may occur as much as 20 years prior to the onset of symptoms (Alzheimer’s Disease Facts and Figures, 2024) As pharmaceutical treatments advance to modify the physiological progression of Alzheimer's disease, there is a significant push to create simpler tests for AD biomarkers (biological changes that indicate the presence or absence of a disease or the risk of developing a disease) allowing for earlier identification and intervention.

Assessment

Historically, diagnosing AD and its related dementia has often relied on ruling out other potential causes of cognitive decline (e.g., infection, vitamin deficiency, stroke/tumor/other brain lesion,

depression, vascular disease). Bloodwork and structural magnetic resonance imaging (MRI) of the brain could aid in making some of these determinations. Neuropsychological evaluation has also been used as a tool in the differential diagnosis of neurodegenerative disorders, such as dementia due to AD. This objective evaluation of brain-based behaviors provides a snapshot of cognitive functioning and specific information about the particular areas of cognitive decline (e.g., memory, visuospatial construction skills, word finding, executive functions), which can point to, or corroborate, diagnostic hypotheses

Neuropsychological testing can also aid in identifying any possible psychiatric conditions that may be part of the clinical picture or causing the reported cognitive changes However, over the past 20 years, advances in testing for biomarkers of AD have offered an opportunity to detect the presence or absence of beta-amyloid or tau pathology thereby enhancing diagnostic certainty when determining etiology

Current tests for AD biomarkers identify abnormal levels of beta-amyloid and tau in cerebrospinal fluid retrieved from a spinal tap or by positron emission tomography (PET) image, which can produce images showing where beta-amyloid and tau have accumulated in the brain. Specifically, FDG-PET (fluorodeoxyglucose positron emission tomography) scans can detect the accumulation of beta-amyloid

proteinplaquesandtauproteintanglesinthebrain (Vaquero&Kinahan,2015)

PETimagingwithspecificradiotracers,suchas florbetapir(Amyvid)orflortaucipir(Tauvid),allowsfor thevisualizationandquantificationofamyloidortau deposits(Villemagneetal,2018) However,theuseof PETscansandspinaltapsisverylimitedinroutine practiceasitisexpensive,nottypicallyreimbursedby insurance,andnotwidelyavailable.Thishasledtoa majorpushinthedevelopmentofreadilyaccessibleand accurate(sensitive/specific)bloodtestsforAlzheimer’s disease

Blood-basedbiomarkersholdthepotentialfor facilitatingearlierdetection,riskassessment,diagnosis, prognosis,andtreatmentmanagement.Severalseriesof bloodtestsarecurrentlybeingresearchedtoidentify thepresenceofbeta-amyloid,tau,andotherAD-related proteins Thetimelyidentificationofthephysiological changesandcognitivedeclineassociatedwithADisalso increasinglycriticalduetotheemergenceoftargeted therapiesguidedbybiomarkers.Thesetherapiesare believedtobemosteffectivewhenadministeredearlyin thediseaseprogression

PharmaceuticalIntervention

Gainsinpharmaceuticalresearchhaveledtothe developmentoftwoavailablemedicationsthatalterthe diseaseprogressionofAD,addingtothecurrentarsenal ofmedicationsthattemporarilymitigateADsymptoms Aducanumab(Aduhelm)representsasignificant breakthroughinthetreatmentofAlzheimer’spathology. Althoughitcarriedwithitsomesignificantrisks,itisthe firstmedication(intravenousinfusiontherapy)forearlystageAlzheimer’sdiseaseand/ormildcognitive impairment(MCI)thatdemonstratedthemitigationof cognitiveandfunctionaldeclinebytheremovalofbetaamyloidfromthebrain(Rahmanetal.,2023). Unfortunately,unrelatedtoadversesideeffectsor efficacy,thismedicationwillbediscontinuedbyits manufacturerthisyear Lecanemab(Leqembi)isthe secondtherapytodemonstratethatremovingbetaamyloidfromthebrainreducescognitiveandfunctional declineinpeoplelivingwithearlyAD(vanDycketal., 2023).Cholinesteraseinhibitorscontinuetobeatthe forefrontofsymptommanagementinindividualsliving

with Alzheimer’s disease and include the well-known brand names, including Aricept and Exelon, and are often used in the early to moderate stages of Alzheimer’s disease

Memantine (Namenda) is a glutamate regulator prescribed to improve memory, attention, reason, language, and the ability to perform simple tasks suitable for individuals with mid to late-stage Alzheimer’s disease

Psychological Consequences

While advances in testing and treatment are hopeful and exciting, revealing biomarker information may also carry negative consequences. What will it mean for individuals to know that there is a presence of Alzheimer’s pathology in their biological makeup that may one day lead to the development of dementia? It is reasonable to think that there may be associated stigma, questions regarding their capacity in the workforce, complications with health insurance, and individual feelings of grief, fear, anxiety, or depression Several studies have shed light on the significant stress, anxiety, and worry experienced by individuals shortly after the early detection of AD Existing literature indicates that individuals diagnosed with mild cognitive impairment (MCI) often grapple with social, psychological, and everyday challenges, which can precipitate feelings of depression or anxiety They express a specific desire for information regarding the underlying causes of the syndrome, potential disease progression, associated symptoms, social ramifications, and available treatment options (Banningh et al., 2008).

Management of Psychological Symptoms

Neuropsychiatric symptoms, such as anxiety and depression, are also common in the course of AD and may occur many years before the onset of significant cognitive symptoms (often leading to a chicken-egg debate of causation among the conditions). Clinical psychologists are well equipped to work with such individuals and implement psychotherapeutic interventions Psycho-oncology has been integral in cancer patient care for decades, encompassing clinical and psychosocial issue management, with evidence

supporting its effectiveness in reducing emotional burden and improving well-being This model could similarly aid in a comprehensive disease management approach for AD Interventions that encourage acceptance and adjustment have the potential to alleviate the psychological distress associated with a dementia diagnosis Meaning and problem-based approaches can also help reduce depressive symptoms Educating patients about good self-care skills, helping them to understand and acknowledge the illness (or possibility thereof), finding appropriate adaptations in daily routines, and decreasing isolation are all beneficial targets of treatment.

Summary

Significant advancements have been made in testing and treatment options for AD, offering hope for improved outcomes. With the development of biomarkers and more accessible diagnostic tools, early detection of AD has become increasingly feasible, enabling prompt intervention and potentially slowing or modifying the course of the disease However, the psychological symptoms accompanying AD, such as depression, anxiety, and feelings of despair, can significantly impact the well-being of individuals affected Psychology plays a crucial role in addressing these symptoms, offering therapeutic interventions to help individuals cope with the emotional challenges of AD diagnosis and progression Through counseling, support groups, and cognitive-behavioral techniques, mental health providers can enhance the quality of life for both patients and their caregivers, complementing medical treatments and fostering holistic care approaches for individuals living with AD.

About the Author

Emily Brislin, PsyD is a clinical neuropsychologist with a private practice in Sparta, NJ. She specializes in neuropsychological assessment and treatment of adults and geriatrics.

References

Alzheimer’s Association (2024) Alzheimer’s disease facts and figures [Ebook] Chicago Retrieved from https://www alz org/media/Documents/alzheimersfacts-and-figures pdf

Banningh, L J W , Vernooij-Dassen, M , Rikkert, M O , & Teunisse, J P (2008) Mild cognitive impairment: Coping with an uncertain label International Journal of Geriatric Psychiatry, 23, 148–154 https://doi org/10 1002/gps 1855

Rahman A, Hossen MA, Chowdhury MFI, Bari S, Tamanna N, Sultana SS, Haque SN, Al Masud A, Saif-Ur-Rahman KM. (2023) Aducanumab for the treatment of Alzheimer's disease: a systematic review. Psychogeriatrics, 23(3), 512-522.

Rajan, K. B., Weuve, J., Barnes, L. L., McAninch, E. A., Wilson, R. S., & Evans, D. A. (2021). Population estimate of people with clinical AD and mild cognitive impairment in the United States (2020-2060) Alzheimer’s & Dementia, 17(12), 1966-1975

Vaquero, J J & Kinahan, P (2015) Positron emission tomography: Current challenges and opportunities for technological advances in clinical and preclinical imaging systems Annual Review of Biomedical Engineering, 17(1), 385-414

van Dyck CH, Swanson CJ, Aisen P, Bateman RJ, Chen C, Gee M, Kanekiyo M, Li D, Reyderman L, Cohen S, Froelich L, Katayama S, Sabbagh M, Vellas B, Watson D, Dhadda S, Irizarry M, Kramer LD, Iwatsubo T. (2023). Lecanemab in Early Alzheimer's Disease. New England Journal of Medicine, 388(1), 9-21.

Villemagne, V.L., Dore, V. Burnham, S.C., Masters, C.L., & Rowe, C.C. (2018). Imaging tau and amyloid-β proteinopathies in Alzheimer disease and other conditions. Nature Reviews Neurology, 14(4), 225-236.

Understanding the Impact of Dementia on Family Dynamics

ByAuroraRegondala ByMichaelProcaccino

Dementiaisanorganicdiseaseofthebrainthatcauses aprogressiveandpersistentdeclineofcognitive functioning,specificallyinmemoryandabstract thinking AccordingtoAlzheimer’sDisease International(n.d.),over55millionpeopleworldwide havelivedwithdementiaasof2020,andsomeone developsdementiaeverythreeseconds Thenumberof peoplelivingwithdementiaisexpectedtodoubleevery 20years,reaching78millionby2030and139millionby 2050(Alzheimer’sDiseaseInternational,n.d.).

Symptomsofdementiamayincludememoryloss, difficultyperformingregulardailytasks,speech difficulties,disorientation,difficultyconcentrating, imbalancedmood,andfatigue.Significantchangesin thepatient’scognitivefunctioningoccurinthemiddle stagesofdementia(Podgorskietal,2009),often necessitatingcaregiverassistanceduetochangesin personalityandmemory.Assymptomsdevelop, limitationsbecomeincreasinglyapparent,family membersanticipatewhatistocome,andfamilyroles change

Dementiaisalsosometimestermeda“familydisease” ascaregiverstendtobeadultchildrenorspouses whosewellnessisaffected(Trujilloetal.,2016). Researchsupportsthatthequalityoffamily relationshipsbeforethedementiadiagnosisindicates whatcanbeexpectedforthequalityofthecaregiving experiencethatfollows(Podgorskietal.,2009).Many tensionsfrequentlyarisebetweenfamilymembersof dementiapatients,someofwhichexistedbeforethe dementiadiagnosisandothersthatoccurafterthe diagnosis(Smithetal.,2022).

Moreover,coordinatingacaregiverplanposes challengessuchasdeterminingaprimarycaregiver,

ByMarcelaFarfan,PsyD

increaseddiscordamongfamilymembersstemming fromthefamily’sinabilitytocopewiththediagnosis, differingopinionsofapproachestocaregivingstyle, andabreakdownincommunicationbetweenfamily members(Tatangeloetal.,2018).Familymembers’ differingabilitiestounderstandandacceptthedisease stronglyaffectfamilydynamics Asdementia progressesovertime,twopatternsoffamilydynamics becomeprominent:(a)onethatholdsthefamily togetherand(b)anotherthatbreaksthefamily relationships(Ohetal,2020)

Inmanyinstances,thedesignatedprimarycaregiverof adementiapatientfeelsthattheroleisenforcedon them(Tatangeloetal.,2017).Caregiversfordementia patientsmaybespouses,adultchildren,andother relativesofthedementiapatient Thefamilytypically designatestherelativeperceivedasthemostavailable, hasthemostfinancialresources,andlivesclosestto thepatient.Thisinvoluntarydesignationmaycause resentment,distress,andobligationtotheprimary caregiver Almostalladultcaregiversexpressan unequaldistributionintheeffortsandworkloadin caringforthepatient.Furthermore,Tatangeloand colleaguesreportedtheresultsoftheirstudieswhere adultcaregiverssharedthatoncetheprimarycaregiver rolewasestablished,otherfamilymemberswere complacentwiththedecisionanddidnotofferhelp andsupport (Tatangeloetal,2017)

RecentliteraturebyHurleyandcolleaguesindicates thatover50%ofcaregiversfordementiapatients reportedadverseimpactsontheirhealthduetotheir caregiverresponsibilities.Caregiverstendingto relativeswithdementiaexhibitedhigherratesof psychiatricillnessandsusceptibilitytophysical

ailments Recentresearchindicatesthatdementia caregiversoftenexperiencepsychologicalandfinancial distress,alongwithdiminishedcognitiveperformance (Hurleyetal.,2014).Researchalsoidentifieseffective waysfordementiacaregiverstomanagetheirmental healthsymptomsinlightoftherisingnumberof caregiverssufferingfromdepression.

TherapeuticInterventionsforDementiaCaregivers

Studiesshowthatmindfulness-basedapproacheslower ratesofdepression,anxiety,andstressindementia caregivers(Weismanetal.,2018).Mindfulness-Based CognitiveTherapyhelpspeoplewhosufferfrom depressionbecomemoreawareofhowtheirmindworks fromanon-judgmentalperspective.Mindfulness-based techniquesinvolvemindfulmeditation,allowing individualstoconcentrateonthepresentmoment If onenoticestheirminddrifting,theyareguidedonhow torefocusonthepresent.Fundamentally,mindfulness enhancesself-awarenessofemotionsandhelpsidentify momentsofburden Dementiacaregiverscanimprove theirmentalhealthbyenhancingtheirabilityto recognizetheirownemotionsandgroundingthemselves inthepresentmoment,thusalleviatingtheburdenthey mayfeel(Weismanetal,2018)

Inthisarticle,werecommendaneffectiveintervention that,whenimplementedwithamindfulness-based approach,canhelpreducedepressionamongdementia caregivers.Ourproposedinterventionisaneclectic approachthatintegratespsychoeducation,family counseling,andpsychotherapy Onesignificant consequenceofdementiacaregivingisthealterationin familydynamicsandthebreakdownofcommunication amongfamilymembers

Psychoeducationinvolveseducationalprogramsthatcan providetheprimarycaregiverandfamilyinformationto enhancetheirunderstandingofdementia Withadeeper comprehensionofthedisease,caregiverscancultivate skillstomanagechallengeseffectivelyandequipthe familywithcopingskills Oncethefamilygainsabetter understandingofdementia,thesubsequentstep involvesaddressingthebreakdownofcommunication resultingfromthedistressexperiencedbythefamily Researchsuggeststhatcommunicationtrainingand interventionsbetweenfamilycaregiversandother familymembersarenecessaryduetofamilytensions thatarisewhenassigningcaregiverresponsibilities (Smithetal.,2022).Familytherapyoffersanopportunity forfamiliesexperiencingchangesinfamilydynamicsto

getreferralsforpharmacologicalconsultationas needed,toaddresstheiranxiety,depressionandother formsofpsychologicaldistress,practiceeffective communication,andcollectivelyaddresstheir challenges

Conclusion

Dementiaismarkedbyacontinualandprogressive declineincognitivefunctions,notablyaffectingmemory andabstractthinking.Dementiaisoftenreferredtoasa “familydisease”duetoitsprofoundimpactnotonlyon thepatientbutalsoonthecaregiverandtheentire family.Theresponsibilityofprovidingcareforapatient withdementiamayleadtothecaregiverexperiencing stress,anxiety,andaprofoundsenseofbeing overwhelmed Caregivingandresponsibilitiesmayalso causeadriftbetweenfamilymembers,resultingina breakdownincommunicationandrelationships This articleaimstoraiseawarenessaboutthechallengesthat caregiversofdementiapatientsfaceandproposesa complementaryinterventiontobeimplementedin additiontoMindfulness-BasedCognitiveTherapy The goalistohelpcaregiverswiththeemotionaleffectsthat canarisewhencaringfordementiapatients.

AbouttheAuthors

AuroraRegondola,acertifiedBehavioralAssistantat HolistikTherapy,providesfamilieswithsupportin behavioralmanagementtotheyoungadultpopulation. ShewillbegraduatingwithaMasterofArtsinCounseling PsychologyinMay2024 Herresearchareafocuseson ChildandAdolescentPsychology.

MichaelProcaccino,acertifiedPeerRecoverySpecialistat SERVBehavioralHealthSystemInc,workswith individualsconfrontingsubstanceusedisorder.Hewill graduatethisMaywithhisMasterofArtsinCounseling Psychology Hehasdevelopedakeeninterestinthis researchopportunity,particularlyduetoaclientunder hiscarewhoisactivelytendingtoherelderlymother.

Dr MarcelaFarfan,alicensedprofessionalcounselorand psychologist,isaneducatoratFelicianUniversityand overseestheMaster'sinCounselingPsychologyprogram. Inthiscapacity,Dr.Farfaninstructsgraduate-level courses,suchaspracticumandinternship Herresearch areafocusesonMindfulnessanditsapplicationwithinthe Latinxcommunity.

ReferencesFurnishedUponRequest

Dementia: Lost and Found

ByCharlesDodgen,PhD

Is it possible to vanish in plain sight? In cases of dementing disorders, sadly, we learn that the answer is yes a person can be physically present and fully accounted for, yet still be absent The deterioration of the brain that characterizes Alzheimer’s disease forces us to consider challenging questions about the essence of personhood and the basis of relationships. When the usually tightly-knit mind and body become separated by illness, we must ponder whether our identity resides in our mind or body when the two are usually together. But that’s only the half of it; a person with dementia does not just cease to exist to us - we disappear from them - a scenario that can be hurtful to those associated with an individual with a dementing disorder. If we seem to have lost our presence in the mind of a loved one, then the foundation of our relationship can feel shattered and our motivation to be with them reduced or eliminated The termination of a relationship-based connection to a person with dementia is not necessarily the end of the story; a more value-driven commitment can provide purpose and meaning and can revitalize the link with them

Personal identity is more than skin deep; there is an essence which allows for the continuity of personal identity despite radical changes in ability and appearance, and which reminds us that our existence must include mind or spirit, in addition to body My work in a nursing home has made this point evident, as I discuss in my book, Simple Lessons for a Better Life: Unexpected Inspiration from Inside the Nursing Home (Dodgen, 2015). Nursing home residents may have lost organs and limbs, suffered sensory impairments (eg, losses of hearing or sight), and experienced disfigurement (e.g., from stroke or accidental injury), yet they remain easily recognizable to those who know them. But when the brain is

attacked by a dementing disorder, we see a loss of identity, even when their physical presentation remains largely undisturbed. These are complicated situations evoking intense emotional reactions and challenges, which do not allow for easy solutions: “For example, when do I mourn? If my grandmother is physically present, but her mind is absent, is she still here? Should I keep visiting once she fails to recognize me? Does it matter? What will people think of me if I stop coming? What will I think of myself?” (Dodgen, 2015, p. 150).

The case of Norman, a married, seventy-eight-yearold retired attorney, with whom I worked for about a year in the nursing home, illustrates this dilemma. Norman’s trajectory followed a classic course a slow deterioration of mental faculties, manifesting in diminishing abilities to communicate, to act with intention, and to regulate his feelings and behavior. By the time I stopped treatment with Norman, he had become a stranger to me Not only did Norman’s personality disappear before my eyes, but I ceased to exist in his eyes. Over the course of time, his identification of me devolved from, “Dr. Dodgen, the psychologist” to “Some kind of doctor, but I don’t remember your name” to “The guy who visits and asks questions” to no recall of ever having met me, and ultimately to an unknowing, vacant look when I greeted him Although we once shared an intimate relationship through discussion of his personal life in therapy, I eventually became indistinct and insignificant to him. To a professional treating a patient with a dementing disorder, this progression is understandable, expectable, and therefore tolerable For family members, the loss of specialness can be deeply hurtful. Imagine that you had engaged in a lengthy conversation with your father yesterday and he forgot every word of it when you spoke to him

today Considerhowmuchmorecrushingitwouldfeelif heforgotyournameorevenfailedtorememberwho youwere.Familymembershaveconfidedtomethatthis isapointatwhichitbecomessignificantlymoredifficult tomaintaincontactwiththepersonwithadvanced dementia Norman’sinabilitytobenefitfromthe treatmentmayhavenecessitatedmydiscontinuationof service,butwhataboutNorman’sfamilymembers?Did theyterminatetheirrelationshipwithhimaswell? His wifehadchosentovisithimdevotedlythroughthe entirecourseofhisillness;sherelatedtomethat althoughshewascertainherattendanceeventually meantlittletoNorman,itwasimportanttohertohonor hermarriagevows. Norman’swifeinitiallyactedto demonstrateherfaithfulnesstoherhusbandandlater wasmotivatedtoexpressherfidelitytohervalues(an actionwhichprovidedbenefitsofself-dignityandselfesteem thenaturalrewardsofbehavinginconcertwith highmoralstandards) Familymembersofotherswith dementiahavemadestatementssuchas,“Ikeepcoming becauseIpromisedmyfatherIwould;”“Becauseitisthe rightthingtodo;”“Everybodydeservestohave somebodytowatchoverthem;”“Iwouldvolunteer servicetostrangersatthehospital,whynottomy mother?”Theseexplanationsindicateadifferentkindof motivationthatrelateslesstotheactualrelationshipand moretomorality,ethics,andconscience.

Onceanindividual’smindiscompromisedbyillnessthey arelosttousandwetothem,ananguishingdoubleloss ofidentity Yet,byidentifyingimportantethical,moral, andspiritualvalueswecanstillfindpurpose,meaning, andsatisfactioninrelatingtothepersonwith Alzheimer’sdiseaseandotherdementingdisorders

ThisarticlewasoriginallypublishedonAlzheimer’s.netin 2015.

AbouttheAuthor

CharlesE Dodgen,PhD,isalicensedpsychologistwhohas maintainedavibrantprivatepracticeinCaldwell,NewJerseyfor over35years.Dr.Dodgenprovidesatrulycomprehensive spectrumofserviceswiththreeseparateareasoftreatmentfocus: childandadolescentproblems;substanceabuse(acrossallages); andgeriatricservices.

References

Dodgen,CE (2015) SimpleLessonsforaBetterLife:Unexpected InspirationfromInsidetheNursingHome PrometheusBooks

Dodgen,C (nd) Dementia:LostandFound https://wwwalzheimersnet/Home-Our-Blog

Member News

Mary Blakeslee, PhD has published her first children’s book- Isabella and the Pink Flamingos The book features Isabella who, while walking, meets up with some flamingos who help her solve the problem of who to invite to her party. She is delighted with their solution to her dilemma Mary originally wrote the story for her grandniece, who likes pink dresses and rainbows and shares Mary’s love of flamingos

Rosalind Dorlen, PsyD was chosen as one of 50 top contemporary artists to follow by ContemporaryArt net! ContemporaryArt Net has been dedicated to the service of contemporary art with a physical location in Chelsea, New York. Dr. Dorlen notes: "Despite my busy professional life as a clinical psychologist, my love for making art has never waned. I continue to paint and draw inspiration from my work as a psychologist My experience with matters of the mind has shaped my art techniques This has enabled me to use colors and materials to evoke feelings and moods that we often hide deep inside us. My primary goal in painting is to create something simple and serene, yet meaningful " To view Dr Dorlen’s collections, visit www.rdorlenartist.org.

Eileen Kennedy-Moore, PhD launched a podcast entitled Kids Ask Dr Friendtastic a FREE, weekly podcast for children (ages 5-13) about making and keeping friends Each 5-minute episode features an audio recording of a question about friendship from a kid plus a practical and thought-provoking answer With the epidemic of loneliness among adults, the mental health crisis among teens, and the painful divisiveness in our country and our world, it has never been more important to teach children to build strong and caring relationships You can find past episodes, plus easy-to-read transcripts and discussion questions, on https://DrFriendtastic.com/podcast or listen on your favorite podcast app *** Do you know a child who has a question for "Dr Friendtastic"? You can submit it here: https://DrFriendtastic com/submit

Disparities in Treatment Among Geriatric LGBTQ+ Individuals

ByMelanieFarfan

Accordingtoa2022reportbytheNationalCouncilonAging, thegeriatricpopulationisoneofthefastest-growing populationsinourcountry(TheNationalCouncilonAging, 2022) ThenumberofolderLGBTQ+individualsintheUnited Statesisspecificallysettodoublebytheyear2030(Johnson, 2018) “Increasingtheaccesstoqualitycareforanyolderadult isimportant,butduetomultiplebarriers,olderLGBTQ+adults arefivetimeslesslikelytoaccesshealthcareandsocial services”(Smithetal,2019) Also,inthepast,researchon agingLGBTQ+individualshasreceivedlittleattention,and “beforethe2000s,researchwaslimitedtoonlyafewnumbers ofsmallstudies”(Johnson,2018) Alongwiththeneglectof research,therehavebeendisparitiesintreatmentaswell.

ThedisparitiesinthetreatmentforgeriatricLGBTQ+include stigmatoreceivinghealthcare,lackofaccessibilityforproper services,lackoftrainingforthepersonnelthatworkswith geriatricLGBTQ+,bothinlong-termcarefacilitiesandmental healthsettings,andlackofcompetenceduetoabsenceof training(Smithetal,2019,p 198) Thestudiesthathavebeen conductedinthisareaandbringourattentiontothese disparitiescallforadditionalresearchandtrainingnecessary toadequatelypreparementalhealthpractitionersto effectivelyservetheelderlyLGBTQ+community

Health,economicstability,andsocialrelationshipsare essentialcomponentsofsuccessfulaging;“yettheseareareas inwhichmanyLGBTQ+eldersfacesubstantialbarriers, stemmingfromcurrentdiscrimination,aswellasthe accumulationofalifetimeoflegalandstructural discrimination,socialstigma,andisolation”(Movement AdvancementProject&SAGE,2017) Forexample,current literatureshowsthelegalandeconomicdiscrimination LGBTQ+eldersface,makingthemlesslikelytohaveenough financialresourcestocareforthemselvesortoacquire appropriatehealthcare(Johnson,2018).Medicalandmental healthprofessionalsshouldbeawareofthevariousbarriers geriatricLGBTQ+individualscanexperience LGBTQ+older adultsalsoaccountforhigherlevelsofdisabilityandpoor physicalhealth Thestigma,violence,anddiscriminationthat theLGBTQ+communityoftenfacesmaycontributetothe olderLGBTQ+individual’slesserlikelihoodofaccessinghealth andsocialservices

Inadditiontohavingdifficultyaccessinghealthandsocial services,olderLGBTQ+individualsalsoexperiencehealth disparities

ByAnnGuillory,EdD

Accordingto“TheEffectsofHealthCarePolicies:LGBTQAging Adults,”individualsoftheLGBTQ+communityexperiencea numberofhealthdisparitiesrelatedtophysicalhealthand wellness,sexuallytransmitteddiseases,mentalhealth,substance use,victimization,bullying,andhousinginsecurity(Zanetos& Skipper,2020) Duetothesefactors,manymembersofthe LGBTQ+communityoftenfearreachingoutforserviceswhichcan thengravelyaffecttheirhealth.Moreover,individualswhohave alreadyencountereddiscriminationorstigmamayfeel discouragedfromseekingtreatmentonceagain Therearealso chancesoffacingbiasesfromthehealthcareprovider,whichcan furthercontributetoalackofpropercarebythehelping professionalsforthepresentingpopulation.Forinstance,the resultsofacomprehensivesurveyoftheLGBTQ+community highlightedexperiencesofdiscriminationresultingin“littleorno confidencethatmedicalpersonnelwouldtreatthemwithdignity andrespectasLGBTQ+individualsinoldage”(MetLife MatureMarketInstitute,2006,p 14)

WhenexploringthedifficultiesfacedbygeriatricLGBTQ+ individuals,itisimportanttouseanintersectionalapproachthat takesintoconsiderationfactorssuchassocioeconomicstatus, race,andethnicitywhichmayimpactanindividual’sexperienceof discriminationandhealthdisparities LGBTQ+olderadults experiencesimilardisparitiesandhealthinequitiesasother populationsofolderadultswhomaybedisadvantageddueto racialandethnicbackground,incomestatus,andeducationlevel (Emlet,2016) Mentalhealthprofessionalswhoareinterestedin addressingandmeetingtheneedsofLGBTQ+olderadultsshould considerworkingwithanintersectionalapproach;“notonlywillit leveragethispopulation’sconsiderablestrengthsandresiliencies, butthisapproachalsowillfuelnewopportunitiesforsocialand policyprogressbycreatingsharedagendasandcollaborative actionfoundedontheintersectingneedsofdiverseelder communities”(Adams,2016,p 100)

Inadditiontoencounteringdiscriminationbyhealthproviders,the healthcareneedsoftheagingLGBTQ+populationareoften adverselyaffectedduetoalackofpropertrainingonthepartof personnelwhoworkwiththispopulation Forexample,“many educationalandclinicalsettingsdonotoffertraininginwaysto provideoptimalcaretotheagingLGBTQ+population,creatinga gapinhealthcareservices”(Selixetal.,2020,p.349).Recognizing thatthesefactorscanhaveanegativeimpactonthehealthcare needsoftheagingLGBTQ+communityhighlightsanecessityfor greaterindividualizedandspecifictreatmentforolderLGBTQ+ individuals

InordertoincreasetheaccessandqualityofcareforLGBTQ+ elders,thereisaneedforthoughtfulandcompetentproviders ThesamesurveyofLGBTQ+individuals’experiencesinlongtermcaresettings,bySmithandcolleaguespublishedin2019, calledattentiontodiscriminationfromfellowresidentsand mistreatmentbystaffmembersagainstLGBTQ+residents. “Only22%ofrespondentsreportedfeelingtheycouldbe forthcomingwithfacilitystaffregardingtheirsexualorientation orgenderidentity,and43%experiencedabusebecauseof havingsharedtheirsexualorientationorgenderidentity”(Smith etal.,2019,p.199).

Smithetal (2019)furtherexaminedtheexperienceofmental healthproviderswithLGBTQ+olderadultsinlong-termcare settingsandtheperceivedbarrierstoqualitycareforthe population.Thisstudyfoundthat22%ofprovidersreportedno formalLGBTQ+coursework,20%reportednoCEhours,and 11%reportednoself-studyhours Theresultsofthisstudyassist inidentifyingcertainareasofneededimprovementinthecare ofLGBTQ+eldersinlong-termcaresettings,aswellasinareas ofstafftraining Theseareasincludeincreasingexperiencewith LGBTQ+olderadults,specifictrainingregardingLGBTQ+relatedhealthissues,reducingstigma,andcreatingLGBTQ+specificevidence-basedpracticesthatareefficientinlong-term caresettings

Summary

TheexistingliteraturehascometoshowthatgeriatricLGBTQ+ individualshaveoftenfaceddiscrimination,stigma,andbiases whenseekingoutmentalorphysicalhealthcare.Experiencing thesedisparitiescanbedetrimentaltothephysicaland emotionalhealthofgeriatricLGBTQ+individuals Facingstigma, biases,ordiscriminationcanoftenhavelong-termeffectsonan individual’smentalhealth Afterexperiencingsuchprejudices,it isjustifiablethatanindividualwouldlacktrustinthepersonnel whoworkwiththem Negativepastexperiencescanhold geriatricLGBTQ+individualsbackfromreachingforcareand couldcauseunfavorableeffectsontheirhealthandqualityof life Also,alackofcompetenceontheproviders’partcan perpetuatethecontinuationofinequalitiesanddisparitiesin treatmentforthisgroupofindividuals.Itisimportantfor providerswhoworkwithLGBTQ+olderadultstobeawareof thebarriersthispopulationmayface.Manytimes,older LGBTQ+individualswhohavefacedprejudiceandunfaircare previouslymaybehesitanttoworkwithnewproviders Providersmayusemanystrategiestoembracemembersofthe LGBTQ+communityintheirpractice Forinstance,“better patientoutcomesmaybeachievedinthecareoftheLGBTQ+ communityifproviderslearntheterminologies,understand healthcarerisks,andmaintainawealthofknowledgeinthecare ofLGBTQ+clients”(Bass&Nagy,2023).Inaddition,providers thatopenlyacknowledgeandempathizewiththeneedsof LGBTQ+olderadultscancreateamorewelcoming environment,encouragingthemtoseekoutmentalandhealth careservices

Finally,ensuringthatmentalhealthcareprofessionalsreceive andmaintainadequatetraininginworkingwithgeriatric LGBTQ+adultsisacrucialstepinassuringcompetentcarefor LGBTQ+olderadults “Professionalsengagedinproviding competentandsuitablecareservicestoolderindividualsshould activelypursuetrainingprogramsthatexpresslyaddresstopics relatedtoagingandLGBTQIA+issues”(Pereira&Banerjee, 2021) Thismayhelpprofessionalsenhancetheirabilities, improvetheirservices,andactivelycontributetothesuccessful agingofolderLGBTQ+individuals LGBTQ+olderadultsshould beabletofeelconfidentthattheywillreceivehigh-qualitycare whenevertheyreachoutforassistance.Providingpersonnel

withappropriatetraining,havingcoursesthatareLGBTQ+ specific,andcontinuingone’seducationinthissubjectcan provideamorepositivehealthcareexperienceforgeriatric LGBTQ+individuals.

AbouttheAuthors

MelanieFarfanisadoctoralstudentinFelicianUniversity’s counselingpsychologyprogram Sheisparticularlyinterestedin studyingtopicsrelatedtothegeriatricpopulationandtheLatinx community

Dr.AnnVerrettGuillory,EdDisafull-timeprofessorof counselingpsychologyatFelicianUniversityofNewJersey Dr Guillory’sdoctorateisinAppliedHumanDevelopmentwitha specializationinAdultDevelopmentandAgingaswellasa MastersinGerontologyfromTeachersCollegeofColumbia University InadditionsheearnedaBachelorofScienceand MastersinGuidanceandCounselingfromLoyolaUniversityNew Orleans

References

Adams,M.(2016).AnIntersectionalApproachtoServicesandCare forLGBTElders JournaloftheAmericanSocietyonAging,40(2) https://wwwlgbtagingcenterorg/resources/pdfs/S21 Gene 40 2 Ad ams 94-100pdf

BassB,NagyH CulturalCompetenceintheCareofLGBTQ Patients [Updated2023Nov13] In:StatPearls[Internet] Treasure Island(FL):StatPearlsPublishing;2024Jan-.Availablefrom: https://wwwncbinlmnihgov/books/NBK563176/

EmletC A (2016) Social,Economic,andHealthDisparitiesAmong LGBTOlderAdults Generations(SanFrancisco,Calif),40(2),16–22

Johnson,K (2018,May29) SpecialIssuesinLGBTQGeriatric Psychiatry PsychiatricTimes https://wwwpsychiatrictimescom/view/special-issues-lgbtqgeriatric-psychiatry

MetlifeMatureMarketInstitute®2,&TheLesbianandGayAgingIssues NetworkoftheAmericanSocietyonAging (2010).Outandaging:TheMetLifestudyoflesbianandgaybaby boomers.JournalofGLBTFamilyStudies,6(1),40–57.

MovementAdvancementProject&SAGE (2017) Understanding IssuesFacingLGBTOlderAdults[Slides] LgbtmapOrg https://wwwlgbtmaporg/file/understanding-issues-facing-lgbtolder-adultspdf

Pereira,H,&Banerjee,D (2021) SuccessfulAgingAmongOlder LGBTQIA+People:FutureResearchandImplications Frontiersin psychiatry,12,756649 https://doiorg/103389/fpsyt2021756649

Selix,N W,Cotler,K,&Behnke,L (2020) ClinicalCarefortheAging LGBTPopulation TheJournalforNursePractitioners,16(5),349–354 https://doiorg/101016/jnurpra202002005

Smith,R W,Altman,J K,Meeks,S,&Hinrichs,K L M (2019) Mental healthcareforLGBTolderadultsinlong-termcaresettings: Competency,training,andbarriersformentalhealthproviders.Clinical Gerontologist:TheJournalofAgingandMentalHealth,42(2),198–203 https://doi-orgfelicianidmoclcorg/101080/0731711520181485197

TheNationalCouncilonAging (2022,December12) FactsonOlder Americans TheNationalCouncilonAging https://www.ncoa.org/article/get-the-facts-on-older-americans Zanetos,J M,&Skipper,A W (2020) TheEffectsofHealthCarePolicies: LGBTQAgingAdults JournalofGerontologicalNursing,46(3),9–13 https://doiorg/103928/00989134-20200203-02

Aging with Pride: Understanding and Healing Baby Boomer LGBTQ+ Mental Health Through Contemporary Psychotherapeutic Interventions

ByCristianXavierMorillo

Today, the majority of the elderly LGBTQ+ community is from the Baby Boomer generation, which was born between 1946 and 1964 As of 2024, these individuals are roughly between 60 to 78 years of age (Fry, 2020) In general, LGBTQ+ Baby Boomers are more likely to experience negative mental health outcomes in comparison to their heterosexual counterparts (Liu & Reczek, 2021)

Baby Boomers, regardless of gender or orientation, have also witnessed several significant adverse life events that may have compounded their mental health and outlook on life. One significant adverse life event that Baby Boomers experienced included growing up during the Cold War Research suggests that children who grew up in the United States during and after the Cold War were more likely to develop mental health conditions such as anxiety, depression, and posttraumatic stress disorder (PTSD) (Okello et al., 2014). In addition, Boomers also lived through the Vietnam War and the Watergate Scandal, both events which potentially instilled a sense of disillusionment and distrust in government entities (Robinson, 1974; Jones, 2020)

LGBTQ+ Baby Boomers face unique intersectionality that stems from the struggles faced by members of gender and/or sexual minority groups while also tolerating obstacles that their generation afflicted them with Some examples of unique struggles that LGBTQ+ Boomers have faced are the pathologization of queer people (APA, 1952), hate crimes and violence, history of police brutality and criminalization (Legal Defense Fund, 2023), living within a society that did not, and in some cases still does not, grant LGBTQ+ people recognition or rights, having to live double lives

ByAnnGuillory,EdD

for the sake of safety, and living through the Acquired Immunodeficiency Syndrome (AIDS) epidemic (Bietsch, 2022)

The Diagnostic and Statistical Manual of Mental Disorders (DSM), editions I - III-R, which were published between 1952 and 1987, introduced terminology such as “homosexuality,” which was described as a “Sociopathic Personality Disturbance” (APA, 1952) In addition, the DSM-III introduced the diagnosis of “gender identity disorder,” which labeled and pathologized the trans community (APA, 1980; APA, 1987).

While efforts were made to amend historical ignorance of LGBTQ+ identities, the damage had already been done to the reputations of queer people and this contributed to a national antipathy for this community. This animosity was further exacerbated by the acquired immunodeficiency syndrome (AIDS) epidemic of the early 1980s, which targeted gay and bisexual men as a scapegoat for the spread of HIV/AIDS amongst the general population in the United States (Bietsch, 2022)

The narratives that the LGBTQ+ Baby Boomers may have internalized because of medical, social, or secular discriminatory practices could have had profound negative effects on the self-concept of said individuals Not to mention, a history of police brutality and criminalization of LGBTQ+ persons also existed explicitly before the 1950s, which took the form of prosecution, arrest, or imprisonment, for example (Wiley, 2023) Some LGBTQ+ Baby Boomers combated police brutality against queer people at the Stonewall Riots, which started the Gay Rights Movement

(Brittanica, 2024).

Past research shows that LGBT older adults are likely to experience constructs such as social isolation by fellow elders in contrast to chosen families, in which they are more likely to have sturdier social connections (Kuyper & Fokkema, 2010). Social isolation is associated with instances of poor nutrition, poverty, hospitalization, premature mortality, and postponed care-seeking (Sederer, 2006) To add, poor nutrition has been linked to an increase in depressive symptoms, which may be a risk factor for suicidal tendencies that may or may not eventually lead to attempts resulting in premature mortality (Selvaraj et al., 2022). Factors that historically were seen as exacerbating the seclusion of LGBT elders included that they have been statistically more likely to live alone and feel unwelcome in healthcare/community settings (Sederer, 2006) These statistics are worsened by the fact that LGBT elders are found to be “four times less likely to have adult children to help them and are far more fearful of discrimination from healthcare workers” (Krehely, 2009). To make matters even worse, research also indicates an increased likelihood of substance use disorders in LGBTQ+ baby boomers in comparison to other generations (Quinn & Mowbray, 2018)

Psychological challenges may impact LGBTQ+ elders deeply, yet there are psychotherapeutic approaches that could effectively mitigate these issues Group therapy emerges as a key intervention, creating bonds among isolated individuals in need of a support network It also offers LGBTQ+ Baby Boomers a collective space to work through their traumas and draw insights from peers with similar experiences, fostering a sense of community and establishing trust in healthcare providers when properly managed (Cerezo, et al , 2014) Furthermore, LGBTQ+ affirmative therapy stands out for its targeted approach to combat homophobia, transphobia, social stigma, and the unique adversities faced by the LGBTQ+ community. In addition, LGBTQ+ affirmative therapy also seeks to identify dysphoric states such as internalized homophobia or denial and teach coping skills in the forms of selfexploration of identity and radical acceptance for example This approach encourages self-discovery and the acceptance of one’s sexuality and gender, especially for those grappling with internalized negative feelings (Pachankis, et al., 2022).

Narrative therapy provides an avenue for individuals to voice their life stories and reassess their past with a new understanding, recognizing their strengths and weaknesses to overcome feelings of helplessness (Poole et al., 2009). Additionally, SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) Recovery groups,

focusingonLGBTQ+elderswithsubstanceuse disorders,offerstructuredsupporttoachievesobriety andfosterconnections,byclearlyoutliningrecovery goalsandstrategies(McGeoughetal.,2022).Cognitive BehavioralTherapy(CBT)addressesanxiety, depression,PTSD,andsubstanceabusebycorrecting harmfulthoughtpatternsandbehaviors,and promotinghealthiercopingmechanisms(Satterfield& Crabb,2010).Additionally,whilemanyseniorsare physicallyimpaired,theuseoftelehealthservicesmay helptoprovideaccesstomentalhealthservicesfor immobilizedindividualsorthosewhoare geographicallyincapableofaccessingaffirmativecare (Waad,2019).

Ultimately,whileanyoneoftheapproacheslisted abovemaybebeneficialtothepsychologicalhealthof anLGBTQ+BabyBoomersufferingfrommentalhealth issues,itisalsoimportanttoconsiderthata combinationofanyofthosemodalities(multimodal therapy)maybejustaseffective,ifnotmoreso,fora givenindividual.Itisimportanttounderstandthelevel ofknowledgethatclientsmaypossess.Inthecasethat aclientisuninformedoruneducatedabout psychotherapeuticconceptssuchasmindfulness,or traumaforinstance,treatmentmayalsorequirethe inclusionofelementsofpsychoeducationtobetter facilitatetheirtreatmentgoals.

Finally,tobesuccessfulinprovidingthebestpractices forLGBTQ+BabyBoomersrequiresclinicianstoshow adaptabilitytousingnewtherapeuticmodalitiesand focusingonthestrengthandresilienceofthese individuals,whileshowingempathyandpatiencewith apopulationthathasahistoryfilledwith discriminationandrejection.

AbouttheAuthors

CristianXavierMorilloisadoctoralstudentincounseling psychologyatFelicianUniversity Hisinterestsareintreating andconductingresearchintomarginalizedcommunities, includingBIPOC,neurodivergent,andLGBTQ+populations

AnnVerrettGuillory,EdDisafull-timeprofessorofcounseling psychologyatFelicianUniversityofNewJersey Dr Guillory’s doctorateisinAppliedHumanDevelopmentwitha specializationinAdultDevelopmentandAgingaswellasa MastersinGerontologyfromTeachersCollegeofColumbia University Inaddition,sheearnedaBachelorofScienceand MastersinGuidanceandCounselingfromLoyolaUniversity NewOrleans.

ReferencesFurnishedUponRequest

Cognitive Decline in the Aging Population and the Importance of Audiological Assessment and Treatment

By,TalinMedzadourianAraian

Aging, an inherent and widespread phenomenon, unfolds like a tapestry woven with threads of experiences, emotions, and adaptations Yet, the diminishing hues of cognitive functioning within this tapestry can elicit a myriad of feelings From occasional forgetfulness accompanying advancing years to more profound challenges of memory loss and diminished cognitive capacities, aging and cognitive decline influence an individual's quality of life and affect caregivers and loved ones Baby Boomers, defined as adults born between 1946 and 1964, constitute the largest population segment in the United States and are either at, or approaching, retirement age. With a burgeoning elderly demographic, the well-being and health outcomes of the aging population are crucial for sustaining a high quality of life

Research has shown that cognitive impairment affects an individual's functional capacity in daily life and personal relations, leading to a loss of independence and autonomy, ultimately resulting in a decline in life quality for the elderly (Chaves et al, 2015) In a large study evaluating the association of late-life depression with mild cognitive impairment and dementia, Richard et al (2013) found dementia patients to be depressed twice as often as those without dementia Initiating the process of prevention or support in healthy cognitive aging could commence with enlightening aging adults about cognitive decline and its associated contributing factors.

Practitioners can play a vital role in the assessment, education, referral process, and recommendations with the aging population to help mitigate or prevent unnecessary cognitive decline. For example, individuals who decrease their engagement in cognitive activities over time compared to their initial self-reported baseline levels face a higher risk of cognitive decline Alternatively, those who increase their cognitive activity from baseline tend to exhibit increased cognitive performance (Mitchell et al, 2012) In addition to engaging in physical exercise and activity, engaging in mentally stimulating activities, and cognitive exercises has been shown to improve cognitive functioning in both cognitively healthy and mildly cognitively impaired

By,MahaYounes,PhD

populations (Gheysen et al, 2018)

Additionally, research has revealed the impact of other risk factors, some of which are not typically associated with cognitive decline in the general public, such as hearing loss in older adults, which can lead to further cognitive decline, if not adequately treated. Hearing loss could increase loneliness and depression in the geriatric population, along with the prospect of social isolation (Babajanian & Gurgel, 2022) While at first, research highlighted the impact of factors such as hearing loss and common chronic conditions on older adults' health-related quality of life (Simpson et al, 2015), a robust connection between cognitive decline and hearing loss was identified, strengthening the need for attention, especially considering the prevalence of hearing loss among the aging population Further, hearing loss has been identified as a risk factor for cognitive decline among older adults, underscoring the importance of addressing hearing loss in this demographic not just for quality of life, but also for brain health (Gao et al, 2020)

Studies that support the association between hearing loss and cognitive decline have found a higher incidence of dementia observed in older adults with hearing loss (Wei et al., 2018; Liu & Lee, 2019). In addition, a systematic review of epidemiological studies affirms that hearing loss serves as an independent risk factor for the development of dementia (Thomson et al, 2017) In a recently published study, Anwar et al. (2022) state that hearing loss has a linear relationship with dementia due to the strong link between intensive hearing loss and severe dementia. The risk of dementia increases multiple times with the incremental severity associated with hearing loss. Anwar et al. (2002) further state that age-related hearing loss negatively affects overall cognitive performance and raises the risk of dementia. While the mechanism of these effects is not fully understood, it seems to affect the vascular system in the brain and may exacerbate vascular brain anomalies, which usually lead to vascular dementia and Alzheimer's (Anwar et al, 2002)

Stahl (2017) delved into potential mechanisms that link hearing loss and cognitive decline and stated that

explanations are seen in overarching theories. The cascade hypothesis theory, for example, emphasizes that auditory deprivation in hearing loss affects cognition directly through the impoverished sensory input and indirectly through decreased socialization (Stahl, 2017). Consequently, social isolation, poor communication, and depressive states cause cognitive decline. Another possible explanation is cognitive load theory, which hypothesizes poorer cognitive functioning due to hearing impairment, contributing to excessive cognitive load on the brain (Stahl, 2017). Excessive cognitive load is taxing on brain structures and, therefore, leads to more neurodegeneration. As a result, cognitive reserve depletion leads to cognitive impairment (Stahl, 2017).

Martini et al (2015) also looked into potential theories to explain the substantial link between hearing loss and cognitive decline, emphasizing that these theories could overlap and be influenced by an individual's general clinical condition Martini and colleagues proposed that these theories proposed by the scientific community are not mutually exclusive, and although some predisposing conditions, such as age, are not modifiable, they indicate that the cognitive effects of hearing loss can be modified with appropriate treatment The authors further emphasized that the aging brain does not inevitably mean cognitive decline, and sensory impairments often experienced by the aging population should not be perceived as inescapable; in other words, healthy aging is possible Martini et al (2015), for example, emphasized that procedures that were once only recommended for younger patients, such as copular implants, have increasingly clear therapeutic benefits on the aging brain

In a longitudinal retrospective study, Bucholc et al (2020) sought to understand how the utilization of hearing aids impacts the transition from mild cognitive impairment to dementia as well as the advancement of dementia in individuals Results from their analysis indicated a more gradual progression from mild cognitive impairment to dementia among individuals who utilized hearing aids. These findings further support that the effective treatment and

identificationofhearingimpairmentmayreducethe cumulativeincidenceofdementia

Albersetal (2015)statedthathearinglossprecedesthe onsetofcognitivedeclinebyseveralyears,furthersolidifying thelinkassociatedwithincreasedriskofcognitivedecline, dementia,andhearingloss Whileevidencefromstudies indicatesthathearinglossoftencomesbeforecognitive decline,itremainsuncertainwhethertheimpairmentin hearingservesasanearlyindicationofdementiaorifit representsariskfactorthatcanbemodified.(Peracino& Pecorelli,2016;Linetal,2011;Gatesetal,2002) Further, hearinglossisnowconsideredamodifiableriskfactor associatedwithpreventingcognitivedecline(Babajanian& Gurgel,2022) Addressinghearinglossthroughinterventions, suchashearingaids,maybecrucialinpotentiallymitigating cognitivedeclineandreducingtheriskofdementia(Amieva etal.,2015).Hearingrehabilitationtechniques,including hearingamplification,middleearsurgery,orcochlear implantation,havethepotentialtobothhelpslowdownand evenpreventcognitivedeclineinindividualswithhearing loss(Babajanian&Gurgel,2022)

Whetherconsideringitforyourself,afriend,oralovedone, orevenplanningforyourfutureself,recognizingthe significanceofallthefactorsthatcanenhancetheoverall qualityoflifeandmitigatetheeffectsofcognitivedeclineis pivotal Asmentalhealthpractitioners,withproper assessment,referralswhennecessary,andeducatingour patientsorclients,wecanplayavitalroleinmitigating cognitivedeclineandpossiblyincreasingtheaging population'squalityoflife.Giventheprofoundconnections betweenhearinglossandcognitivedecline,notablyobserved indementiacases,adoptingaproactivestancetowards routinehearingevaluationandaudiologicalassessment becomesimperative Byaddressinghearinglossinolder adultsanddisseminatingknowledge,wecanplayavitalrole inpotentiallyalleviatingcognitiveimpairmentandaverting theonsetofcognitivedecline

AbouttheAuthors

TalinMedzadourianAraianisa2nd-yeardoctoralstudentin counselingpsychologyatFelicianUniversity Fueledbyapassion forsocialjustice,Taliniscommittedtotheresearchand understandingoftheuniquechallengesfacedbymarginalized communities Heracademicjourneyembodiesablendof compassion,scholarship,andaferventdrivetomakea meaningfulimpactonthosewhoneeditmost.Hercurrent researchincludesintimatepartnerviolencesurvivorsandpostseparationabuse

MahaYounes,PhDisalicensedpsychologistinNewJersey,who teachesintheCounselingPsychologyPsyDprogramatFelician University,andworksatMindfulAssessmentsandPsychological Services,LLC.specializingintheassessmentofolderadults.

ReferencesFurnishedUponRequest

Preventing Dementia in Older Adulthood:

Is It Possible?

ByMahaYounes,PhD

“You have dementia.” At the beginning of my career as a neuropsychologist, having to say those words during a feedback session after a cognitive evaluation was one of the most painful professional experiences. There was nothing I could offer to patients and families other than empathy and support, as well as practical suggestions about end-of-life planning and establishing daily routines. Recent research on aging, cognition, and dementia, though, has changed the landscape of the field and there are findings that offer a lot more to patients than just empathy; they offer concrete recommendations that can enhance cognition, or at least minimize cognitive decline over time.

While research was originally focused on the concept of “cognitive reserve” (Stern, 2009), the idea that our brains are primarily reinforced against the effects of aging and dementia by innate intelligence and educational experiences, research is now focused on a myriad of factors that seem to be protective The National Academy of Neuropsychology has recently released a paper in which they discuss four key lifestyle factors that science has shown to have implications for brain and cognitive health: 1) physical activity and exercise, 2) social engagement, 3) cognitively stimulating activity, and 4) diet (specifically Mediterranean-style diets) (J J Randolph et al , 2024) In addition, the paper also discusses how sleep and stress are implicated as modifiable factors that contribute to our ability to retain our cognitive functions as we age

Physical Activity and Exercise

Physical activity has long been touted as important for cardiovascular health (Shiroma & Lee, 2010) Research then found associations between a person’s level of exercise in midlife to a reduced risk of neurodegenerative disease as far as two decades later (Spartano et al , 2016), indicating that physical activity was just as important for brain health Even more interesting was the research showing that, in addition to having better functional outcomes in later adulthood, people who exercised in their middle adulthood actually showed greater integrity of the white matter tracts in the brain and had thicker primary motor and somatosensory

cortices (Tarumi et al., 2021). Therefore, it seems that the amount of exercise during one’s earlier and middle adulthood years has a direct effect on the preservation of brain networks. While some of this effect seems to be from reducing cerebrovascular risk, which can contribute to small vessel disease that leads to dementia, there is also evidence from animal studies suggesting physical activity may actually facilitate neuroplasticity (Ahlskog et al., 2011), the ability of the brain to form and reorganize synaptic connections.

Some of the most exciting research on this topic, though, has to do with how the brain can actually grow and retain new neurons in response to exercise. It was once believed that the brain stopped making neurons at or shortly after birth Since the 1960s, however, research has slowly been demonstrating the fallacy of this earlier belief More recent research has shown that the brain can produce new neurons throughout life, and in fact, some brain regions may make thousands of new neurons a day, but most tend to die within just weeks (Shors, 2014) Physical exercise may be one way to actually increase the number of neurons in key areas of the brain, such as the hippocampus, which is responsible for memory

One of the most compelling studies conducted had older adults, who had been inactive, walk for 40 minutes per session, 3 days per week, for a year (Erickson et al , 2011) After the first few weeks of walking at any rate, they were asked to walk at a moderate rate (defined as 60-75% of their maximum heart rate) for the remainder of the study After the year, during which the study was conducted was over, they compared this group to a control group that was prescribed stretching and toning exercises The results showed increased hippocampal volume and improvement in spatial memory in the group of seniors who had engaged in moderate-intensity exercise regularly In contrast, there was a loss of hippocampal volume in the control group, presumably the “typical” decline associated with “normal” aging. Interestingly, even within this control group, those older adults who had higher fitness levels prior to this study had less hippocampal volume loss than those who did not. The results of this research supported findings by previous

research suggesting that physical activity is protective and may even augment cognitive functioning regardless of when it begins

Social Engagement

Human beings are social creatures At no time in our history did this become so apparent as it was during the COVID-19 pandemic when the world was on lockdown The effects of that prolonged period of isolation have been discussed regarding its impact on mental health and mood both within the general population (Kupcova et al., 2023) and within the older adult population, specifically (Lau et al., 2023). While lack of social engagement can cause cognitive issues indirectly because of its detrimental effects on mental health (Bauermeister & Bunce, 2015) and physical health (Yang et al., 2016), lack of social engagement can also have a more direct detrimental effect on cognition (Prommas et al., 2023).

Just as lack of social interaction can have a negative effect on cognition, increasing the frequency of social interaction and the size of our social network, including our sense of social support, can positively impact our cognitive functioning as we age While this positive impact may be partly due to the indirect effects of improved mental health (Kawachi & Berkman, 2001) and improved physical health (Cohen & Janicki-Deverts, 2009), it also has a direct effect on our cognition, especially as we age, because social interactions give the brain a workout Social interaction involves paying close attention, comprehending language, interpretation of body language, and recollection of recent or distant experiences for context Then the brain needs to process all of this information and formulate a response within an appropriate timeframe (J Randolph, 2020) In fact, research suggests that the effect of social activity on cognitive functioning can be found even after controlling for factors such as mental health, physical health, cognitive activity, and physical activity (James et al , 2011) Just as with physical activity, the effects from social engagement, even those much earlier in life, are related to the preservation of cognitive functioning as we age But, it is never too late to take advantage of this benefit; starting to socialize later in life has been linked to a reduction in cognitive decline in older adults (Park et al , 2017)

Cognitively Stimulating Activity

When thinking about ways of preserving cognitive functioning, cognitive stimulating activities may be the most obvious. In the past, some of these activities were contained within the concept of “cognitive reserve” and included advanced educational pursuits and cognitively stimulating jobs; these activities were found to be associated with less cognitive decline with time (Scarmeas & Stern, 2003). However, research has shown that educational and occupational activities are not the only way to be cognitively stimulated. Studies indicate that engaging in challenging leisure activities can also reduce the risk of developing

dementia (Yates et al , 2016) and that engaging in such activities can moderate the influence of education on dementia risk (Lachman et al , 2010)

People often wonder about what types of activities, frequency of activities, and level of difficulty are needed to reap the benefits Reading, in particular, seems to be very powerful in reducing the risk of dementia (Lopes et al , 2012), but computer-based activities, playing games, and crafting activities (such as knitting or quilting) also have all been found to reduce dementia risk (Geda et al., 2011). Ultimately, anything that requires cognitive effort seems to be beneficial. As a rule of thumb, a task should be challenging, but achievable: having a task be too challenging will lead to frustration, and having it be too simple will not result in the “cognitive work” needed for the effect. The research supports the colloquialism of “use it or lose it.” To see the most significant impact on functioning, studies indicate that one must engage in a cognitively challenging task at least one hour a day (Hughes et al., 2010).

Diet

The importance of a healthy diet, along with images of food pyramids, is drilled into our minds from elementary school However, we are rarely taught about how nutrition directly affects the brain Research in the past two decades has shown that there are both neuroprotective and neurorestorative mechanisms related to our intake of certain nutrients, such as antioxidant micronutrients (like vitamins C and E) and antiinflammatory macronutrients (like omega-3 polyunsaturated fatty acids) (Whalley et al , 2004) As a result, a diet was developed that provides individuals with guidelines on the best foods to eat and to avoid in order to reduce the risk of developing dementia called the MIND diet (MediterraneanDASH diet intervention for neurodegenerative delay) (Morris et al , 2015) Since its introduction in 2015, many studies have evaluated the effectiveness of the MIND diet and have frequently found it to be superior to other diets in improving cognitive functioning in older adults, though it may not have an equal impact on all aspects of cognition (Kheirouri & Alizadeh, 2022; Berendsen et al , 2018) In fact, some studies have shown this diet to slow cognitive decline by as much as 7 5 years (Balakrishnan, 2022) Though some controversy about its effectiveness exists, following the MIND diet can have a positive and significant impact on health and mortality, more generally (Corley, 2022), so it is a healthy choice to make Further, it is not a formal diet but rather a set of guidelines, making it easy to introduce gradually; even making little changes can make a big difference in health.

Sleep

In our busy, hectic world, people often undervalue the importance of a good night’s sleep; as a result, there is a high prevalence of individuals in our society who get insufficient sleep (defined as less than 6 hours per night). Studies have linked poor sleep to many medical diseases including

rcardiovascular disease and diabetes, as well as an increased incidence of accidents and injuries, stress, pain, and mortality (Grandner, 2022) But the effects of lack of sleep on cognition are more than just from being fatigued Sleep is the primary time when the brain’s glymphatic system, the neuronal equivalent of a “janitorial crew”, can flush out the neuronal waste that is produced during the day by our brain’s activities (Jessen et al , 2015) One of those waste products is called beta-amyloid (Xie et al , 2013) and it contributes to Alzheimer’s disease when it accumulates, causing brain plaques and inflammation; so the less sleep one gets, the more the buildup of beta-amyloid (Sprecher et al., 2017).

Research suggests that individuals should routinely get 7-8 hours of sleep (Grandner et al., 2010); sleeping less than this amount for even a couple of days has been found to negatively impact cognitive performance (Van Dongen et al., 2003), and ultimately, chronic poor sleep is related to a higher risk of developing cognitive impairment (Bubu et al., 2017). Paradoxically, too much sleep is also not a good thing (Léger et al., 2014). Regularly sleeping more than 10 hours per night can have a negative impact on cognition, as well, though the mechanism is not as well-understood (Ma et al , 2020); it is possible that this relationship is mediated by psychiatric issues, such as depression (Léger et al , 2014)

Stress

To a certain extent, stress is unavoidable in life and some stress may actually be helpful, increasing motivation especially when it is perceived as goal-related and manageable (Travis et al , 2020) However, when we talk about the negative effects of stress, we are usually talking about the “other” kind of stress; those perceived as unmanageable This type of stress directly affects our brain and can cause a disconnect between the amygdala, the brain’s threat warning system, and other parts of the brain including parts of the frontal lobe and hippocampus (Jovanovic et al , 2011) These effects can limit our ability to use our working memory, remember information, problemsolve, and regulate our emotions In addition, during these high-stress times, the amygdala activates a fight-or-flight type of response with a release of stress hormones (such as adrenaline and cortisol), which can also affect cognition (Franz et al , 2011)

Chronic stress has been linked to damage in specific brain areas, such as the hippocampus and parts of the frontal lobe (Papagni et al., 2011), because of the toxic effects of cortisol (Lupien et al., 2018). Mindfulness and meditation strategies are some of the most effective means of managing stress; they have also been found to have a positive impact on brain structure (Fox et al., 2014), but any self-care strategies can be

helpful (Perera & Agboola, 2019). Exercise has also been touted as a stress-management strategy (Churchill et al , 2022) that also improves mood, in general (Yao et al , 2021); therefore, exercise gives double the brain-promoting effect by increasing your physical activity and reducing your stress!

Conclusions

Forgetting is a part of life We are never going to remember every moment of our lives or every detail, but the kind of cognitive decline that we were once told to accept as a “natural” part of aging, or which is more severe and debilitating, might not have to happen Research into “SuperAgers,” older adults who cognitively function at the level of individuals up to 30 years younger, indicates that it is possible to age very well (Sun et al , 2016); it also may provide additional insights into those factors which affect our cognitive performance as we age We are continuing to expand our knowledge of just how much of what we do throughout our lives can set us up for a healthier future Even if you have not had the best habits thus far in your life, it is not too late to start Changes that you make today can significantly improve your tomorrow

Resources

If you are interested in learning more about the research in this area and/or interested in more specific guidance about how to implement them, there are several books written by respected practitioners in this field. Here are a few:

1) The Brain Health Book: Using the Power of Neuroscience to Improve Your Life, by John Randolph, PhD

2) High-Octane Brain: 5 Science-Based Steps to Sharpen Your Memory and Reduce Your Risk of Alzheimer’s, by Michelle Braun, PhD

3) Keep Your Wits About You, by Vonetta M Dotson, PhD

About the Author

Maha Younes, PhD is a licensed psychologist in New Jersey, who teaches in the Counseling Psychology PsyD program at Felician University, and works at Mindful Assessments and Psychological Services, LLC specializing in the assessment of older adults

References Furnished Upon Request

Prolonged Grief Disorder in Older Adults: Implications for Clinicians

ByRalphDell’Aquila,EdD

Overview

Whilegriefmaybeexperiencedasauniversalemotionaland physiologicalreactiontolifeeventsinvolvingthelossofloved ones,itcanpresentdifferentlyforpeoplebasedonmany circumstances Animportantquestionforpsychologiststo ascertainishowpeopleadjusttogrief/loss Aspeopleage,they aremorelikelytoexperiencedifferentlosseswithinthemselves (disability/healthconcerns)andwithinthecontextof relationships Loss,coupledwithshiftingaccesstoinformal support(unpaidhelpfromfamily/friends/neighbors),could signalmorevulnerabilityforolderindividualswithregardto prolongedgriefdisorder(PGD) AccordingtotheDiagnosticand StatisticalManualofMentalDisorders5TR,PGDis characterizedbyalonging/yearningforthepersonwhohas diedandafocusonthefinaldaysofthedeceased(DSM-5-TR, 2022) Comtesseetal (2024)foundthatolderpeoplearemore vulnerabletoPGD.

Todate,ourunderstandingofthefactorsintermsofhowgrief ismanagedincludesthefollowing:typeofloss,thetimingofthe loss(eg,expectedorsudden),predisposedpersonalityofthe olderadult,cognitivemindset/appraisal,cultural considerations,copingmechanisms/resources,priorloss, mentalhealthcomorbidity,andsocialsupport(perceivedand instrumental).WhiletheDSM5TR(2022)andInternational ClassificationforDiseasesandRelatedHealthProblems-11(ICD11,2018)havesomedifferencesintermsofsymptomduration(12 monthsand6monthsrespectively),thecommondenominators areayearningforthedeceasedandpreoccupationwiththe eventsleadinguptothepassingofthelovedone(Duffy&Wild, 2023).

Inameta-analysisdonebyLundroffetal (2017)involvingloss afterthedeathoflovedonesfromnon-violentsources,itwas foundthat98%ofstudyparticipantsexperiencedsymptoms consistentwithPGD Incontrast,Comtesseetal (2024) conductedameta-analysisinvolving20,247participantsfrom 16countries;theyfoundanoverallprevalenceof13%with respecttoPGDsymptompresentation Thisnumberis complicatedbyothermentalhealthdiagnosesthatcanrunin tandemwithprolongedgriefdisorder(Duffy&Wild,2023; Szuhanyetal,2021) Circumstancesofthedeathcanalso

playaroleintermsofthemanifestationofPGD Inthisregard, thechallengingsituationsinvolvingthedeathofayoung person,achild,ordeathbyatragedysuchasadrugoverdose cometomind(Thielemanetal,2023) Theremayalsobe multiplesourcesofgriefandlossthatcanspanyears

Oneotherwaytoexplainhowsomepeoplemanagetheirgrief moreeffectivelyliesincognitiveappraisal.Lazarusand Folkman(1984)definedcognitiveappraisalasthewayinwhich peopleperceiveandcopewithstressors Expectancy violationsrepresentthecontrastbetweenindividual perceptionandthespecificevent;theimplicationsinvolve attendingtotheperson’sperceptionoftheworldis compromised(Riefetal,2022) Inameta-analysisof65 studies,EismaandStroebe(2021)foundthatruminationand avoidancecontributedtowardsPGD Relatedtoexpectancy violationsandcognitiveappraisalistheconceptofmeaningmaking(howpeopleconstructmeaningintheirperspective andwithintheworld)

Park(2022)spokeofmeaning-makingbaseduponsituational meaning,whichinvolveshowpeopleratetheirexperience,and globalmeaning,whichiscomposedofanindividual’s fundamentalvaluesandoverallworldviews Neimeyer(2020) hasalsodoneconsiderableresearchintermsofmeaning reconstructionandhowthishelpspeoplewhoaregrievingto chartanewlifecoursewithoutforgettingtheirpast These strategieshaveimplicationsforprovidersastheyassistthose withPGDandapplyhelpfulconceptstowardmoreadaptive coping Whenitcomestogrief,theassessmentofhowpeople seethemselvesandtheworldaroundthemtiesindirectlywith healingandadjustment.

Abasicunderstandingoftheseconceptscanhelp psychologiststocraftinnovativestrategiestohelpthosewho havePGD Forexample,findingoutthelevelofmotivationand howtheclientperceiveshealingtheirgriefisanimportant aspectofthetherapy.Whatevertheoreticalperspectivethatis usedtohelpothersmanagetheirgrief,compassion,and flexibilityarekey Inaddition,theassessmentofpersonal resourcesofindividualsandculturalconsiderationsshouldbe considered

Whilegriefisrelativelyuniversal,thewayinwhichitis experiencedmaynotbeandthisisbecausetherearemany variablesthatcanaffecthowpeoplecopewithgrief Itisimportant forpsychologiststoassessriskfactorsforPGDandrecognizethat theremaybemorethanonesourceofgrief(eg spouse,multiple friends,personaldisability)thatneedtobeaddressedwithinthe contextofcounseling.Perceptionsandexpectationsplayan importantroleinhealingbutcanalsobeanimpediment(seeEisma &Stroebe,2021) Cultural,spiritual,andreligious-relatedrituals andremembrancescanprovidegrounding(Lee,Gibbonsand Bottomley,2022) Lastly,thereconciliationbetweenone’spastlife withinthecontextofthedeceasedandtheemerginglifeaheadcan alsobuffertheeffectsofgriefandloss.

AbouttheAuthor

Forthepast20years,RalphD Dell’Aquila,EdDhasbeenaSr EAP CounselorforNJTransit’sEmployeeAssistanceProgram.Healso worksinprivatepractice Dr Dell’Aquilaisalicensedpsychologist andprofessionalcounselorinWashington,DCandNewJersey

References

AmericanPsychiatricAssociation (2022)Diagnosticandstatisticalmanualof mentaldisordersfiftheditiontextrevision(DSM5TR) Washington,DC: AmericanPsychiatricAssociation

Comtesse,H,Smid,GE,Rummel,A,Spreeuwenberg,P,Lundorff,M & Duckers,ML (2024)Cross-nationalanalysisoftheprevalenceofprolonged griefdisorder.JournalofAffectiveDisorders,350,359365https://doiorg/101016/jjad202401094

Duffy,M,&Wild,J (2023) Livingwithloss:acognitiveapproachtoprolonged griefincorporatingcomplicated,enduringandtraumaticgrief Behavioural andCognitivePsychotherapy,51(6),645-658 https://doiorg/101017/S135246822000674

Eisma,M,&Stroebe,MS (2021) Emotionregulatorystrategiesincomplicated grief:Asystematicreview BehaviorTherapy,52(1),434-249 https://doiorg/101016/jbeth202004004

Lazarus,S R,&Folkman,S (1984) StressAppraisalandCopingSpringer PublishingCompany:NewYork

Lee,SA,Gibbons,JA &Bottomley,JS (2022) SpiritualityInfluencesEmotion RegulationDuringGriefTalk:TheModeratingRoleofProlongedGrief Symptomatology.JReligHealth61,4923–4933. https://doi.org/10.1007/s10943-021-01450-z

Neimeyer,R A (2020) What’snewinmeaningreconstruction?:Advancing grieftheoryandpractice GriefMatters,23(1),4–9 https://searchinformitorg/doi/103316/informit439384113866066

Park,CL (2022) Meaningmakingfollowingtrauma FrontiersinPsychology, 13,1-4 https://doi103389/fpsyg2022844891

Rief,W,Sperl,M F J,Braun-Koch,K,Khosrowtaj,Z,Kirchner,L,Schäfer,L, Schwarting,R.K.W.,Teige-Mocigemba,S.,&Panitz,C.(2022).Using expectationviolationmodelstoimprovetheoutcomeofpsychological treatments ClinicalPsychologyReview,98,1–18 https://doiorg/101016/jcpr2022102212

Szuhany,KL,Malgaroli,M,Miron,CD,&Simon,NM (2021)Prolongedgrief disorder:Course,diagnosis,assessmentandtreatment Focus:Thejournalof lifelonglearninginpsychiatry,19(2):161-172. https://doiorg/101176/appifocus20200052

Thieleman,K,Cacciatore,J,&Frances,A (2023) Ratesofprolongedgrief disorder:Consideringrelationshiptothepersonwhodiedandcauseofdeath JournalofAffectiveDisorders,339,832-837

https://doiorg/101016/jjad202307094

Therapeutic Considerations of Grief Experiences in Older Adults

ByLauraK.Palmer,PhD

ByAdrianaB.Dunn,PhD

An inherent challenge of living a long life is experiencing loss

ByJessicaTorgovnik,MA

For older adults it is not uncommon to lose many of the most important people in their lives (parents, siblings, spouses, friends, often even children) One study found that over 70% of older adults experience bereavement in a 2.5 year period (Shear et al , 2013) These losses can be overwhelming because of the frequency with which they are experienced and because of the impact on a shrinking social support network Such losses are often associated with increased isolation, loneliness, and depression (Colvin & Ceide, 2021)

Several terms define aspects of mourning Bereavement is the state of loss, while grief is the emotional and physiological reaction to it Acute grief is the immediate, intense response; integrated grief follows as the adaptive process, allowing for resumed coping Complicated grief represents an extended acute grief phase that hinders adjustment (Shear et al , 2013) With over 25 years of experience in a Continuing Care Retirement Community (CCRC) with median resident age of 87, we've observed that the complexity of grief in older adults extends beyond current classifications They endure multiple, overlapping losses including the deaths of loved ones, declines in health and function, and the loss of careers, homes, possessions, hobbies, pets, driving privileges, and life purpose. For instance, an 82-year-old who recently lost her husband and daughter faced additional upheaval by relocating, leaving behind her home and friends, and then losing two new friends to illness. Such a cascade of losses can lead to bereavement overload, where the grieving process is interrupted before one loss can be processed, compounding their distress

Older adults aslo often endure significant anticipatory grief due to their own or their loved ones' declining health, particularly with conditions like Alzheimer's, Parkinson's, and other dementias (Rogalla, 2018). These losses, unlike the death of family or friends, lack recognition and community support Kenneth Doka Ph.D. introduced the concept of "disenfranchised grief" for such unacknowledged and unsupported losses (Doka, 2002).

With the aging population set to increase, there's a pressing need for improved grief models and interventions tailored to older individuals. The term "older adult" is too broad, masking the unique characteristics of different age groups within the 60-110+ year range Current treatment models for those in their eighties, nineties, and beyond are scarce Brown and Lowis's

ByAlyssaWestdyk

(2003) study on Joan Erikson's (Erikson, 1997) ninth stage of psychosocial development provides some theoretical direction for psychotherapy among the oldest age groups, but research on effective grief therapies for these populations remains notably insufficient.

Colvin and Ceide (2021) recommend specialized psychotherapies for Prolonged Grief Disorder (PGD) in older adults, including group therapy, Cognitive Behavioral Therapy, Meaning Centered Grief Therapy, Interpersonal Psychotherapy, Complicated Grief Treatment, and Life Review Therapy Recognizing and differentiating PGD from normal grief is crucial for appropriate therapy selection and implementation Screening for PGD must consider coexisting physical, cognitive, and environmental factors for accurate diagnosis and treatment (Colvin & Ceide, 2021) Pérez et al (2018) identified that individuals with PGD exhibit reduced cognitive function compared to those with normal grief, underscoring the importance of understanding grief's impact on cognition to enhance intervention effectiveness. Evaluating grief history, loss processing, and resilience is also vital for distinguishing between typical grief and PGD.

We've adopted a comprehensive approach to assist octogenarians (80-89 years), nonagenarians (90-99 years), and centenarians (100 years +) experiencing complex grief, offering services that aim to normalize help-seeking for grief and mental health issues. Our interventions including psychoeducation, and both individual and group therapy Therapy focuses on evaluating the individual's history of loss, coping strategies, and cultural perspectives on death and aging It encompasses educating about the grief process, helping clients navigate the disorientation of multiple losses, and fostering a sense of personal agency and purpose For those who have lost a life partner after decades of shared identity, the shift from "we" to "me" is profound Individuals who've never lived alone face the daunting task of forging independence at an advanced age, a stark contrast to the youthful journey of self-discovery. Individual therapy offers a confidential environment to express a range of emotions, from anxiety and despair to guilt and even relief.

Our introduction of grief support groups and individual therapy, tailored to the diverse and overlapping grief experiences of older individuals, has yielded positive outcomes These groups foster an understanding of loss's

commonality and normalize various grief reactions. We've also established specific support groups for those with Parkinson's, caregivers, pet owners, and general discussion groups Group methods are effective in mitigating grief and enhancing coping, particularly as isolation, which can exacerbate grief, is common among older adults (Rogalla, 2018). Facilitating group environments is crucial for older adults to promote dialogue, connection, and the mobilization of personal and communal resources

In summary, the grief experienced by older adults, compounded by losses of independence, health, and identity, requires a nuanced approach that includes understanding disenfranchised grief and PGD to safeguard their emotional and cognitive well-being. Personalized support systems, combining support groups with specialized psychotherapies, are essential to alleviate bereavement overload and build resilience in this demographic

About the Authors

Laura K Palmer PhD, MSCP, ABPP is a board certified psychologist with over 35 years’ experience in clinical work, research, consulting, and training in psychology and neuropsychology across the lifespan

Adriana B. Dunn, PhD, LMFT is a licensed psychologist and Marriage and Family Therapist specializing in assessment and treatment of individuals, couples and families across the lifespan and in the training of graduate students

Jessica Torgovnik, MA is a graduate of Fordham University’s Master’s Program in Mental Health Counseling She has 6 years’ experience working with older adults and developing programs in mindfulness, grief support, and animal assisted therapy.

Alyssa Wesdyk, BA has her Bachelor of Arts in Psychology from New York University. She has been an intern working with geriatric populations for the past two years

References Furnished Upon Request

LIFETIME ACHIEVEMENT AWARDS

The NJPA Lifetime Achievement Award, the Association’s highest honor, recognizes exceptional leadership in the form of enduring and exemplary contributions to NJPA, over a sustained period of time, which collectively, has significantly enhanced the Association’s ability to positively impact the lives and careers of its membership, as well as advancing the field of psychology in New Jersey, and beyond. It is suggested that the candidates be at least 65 years of age, however remarkable life circumstances will be taken into consideration for those candidates under 65 years of age

PSYCHOLOGIST OF THE YEAR

Recognize and nominate a fellow member who has made an outstanding contribution to the profession of psychology through demonstrated excellence in practice, research, or teaching Recipients will be selected by the Nominations Committee and Psychologist of the Year Subcommittee based upon how well they meet the criteria of the award.

JANE SELZER MEMBERSHIP RECOGNITION AWARD

Ms Jane Selzer was a long time employee of NJPA and passionately involved with NJPA membership She retired in 2015 To acknowledge her long standing service to NJPA, and in an effort to publicly acknowledge and recognize those members who contribute so much to NJPA in so many diverse ways, the NJPA Membership Committee renamed this established award after her to recognize members who add value to NJPA every day

CITIZEN OF THE YEAR

Awarded to a non-psychologist who has made significant contributions to the ideals of mental health or social welfare. Recipients will be selected by the NJPA Executive Board based upon how well they meet the criteria of the award

STANLEY MOLDAWSKY MENTOR AWARD

Recognizes a member who exhibits exceptional leadership over a sustained period of time, in the form of enduring and exemplary contributions to mentoring new psychologists and/or graduate students

Please take the time to think of someone you admire and/or appreciate that you wish to nominate

The deadline for submissions is June 28, 2024. Read more about the awards here.

How Do You Know When It Is Dementia?

ByDaphnaRoth,PhD

Losingkeys,forgettingappointments,andword-finding difficulties-theseexperiencesarecommonenough Butwhen isittimetoworrythatthesetypesofmemoryproblemsarethe signofsomethingmoreseriousinourpatientsandfamily members?

Allpeopleexperiencedeclinesintheirmemoryandintheir abilitytoretrievethecorrectwordastheyage However, decliningmemorycanalsobethebeginningofdementia Whatisdementia?

Dementiaisaclassofdiseasesinvolvingchemicalandstructural changesinthebrainthatcausesymptomssuchasintellectual declineandsocialdysfunction Thesedeficitscanbecome severeenoughtointerferewithdailyfunctioning Themost commondementiaisAlzheimer’sdisease,althoughthereare manyothers,eachwithitsownsymptomprofile.Asperthe DSM-5-TR(AmericanPsychiatricAssociation,2022),adiagnosis ofdementia(alsoknownasmajorneurocognitivedisorder) requires:

1)adeclineincognitivefunctioninginoneormoreareasof cognitivefunctioning–attention,memory,language, perceptual-motor(includesbothvisuospatialandmotorskills), and/orjudgmentandplanning(alsoknownasexecutive functioning) a baseduponpatientand/orinformantinformation,and b.aneuropsychologicalevaluation

2)thecognitivedeclineinterfereswitheverydayfunctioning 3)thecognitivedeclineisnotduetodelirium

4)thecognitivedeclineisnotduetoanotherdisorder

Mildneurocognitivedisorder(alsoknownasmildcognitive impairment)requiresamodestdeclineofoneormoreofthe abovementionedcognitivedomainsthatdoesnotinterferewith dailyfunctioning Thedeclineisnotduetodeliriumoranother disorder Approximately10to15percentofindividualswithmild neurocognitivedisorderprogresstodementia(MCI,2022).

Personalitychangescanalsooccurwithsometypesof dementia,buttheyarenotincludedinthediagnosticcriteria

Whiletheearlystagesofdementiamayseemlikeordinary forgetfulnessatfirst,overtime,dementiasufferersdeclineinall areasoffunctioninguntiltheyarenolongerabletocarefor themselves.Theadvancedstagesofdementiaarecharacterized byincreasingphysical,aswellascognitive,disability

TypesofDementia

Thereareanumberofdifferenttypesofdementiaseachwitha uniquesymptomprofile. Apartiallistincludes:

Alzheimer’sdiseaseisthemostcommonandusually beginswithmemoryandlanguagedysfunction

Vasculardementiaistheresultofdamagetothe arteriessupplyingyourbrainorheart Symptomsmayappear suddenlyorgraduallyandaredependentuponthelocationof thedamage

Fronto-temporaldementiaaffectsthefrontaland temporallobesofthebrainandoftenfirstmanifestsas changesinpersonality,lackofinhibition,andpoordecisionmaking.

Lewybodydementiahassimilarsymptomsto Alzheimer’sdiseasebutwithalternatingperiodsofclear thinkingandconfusion Hallucinationsarealsoacommon symptomofthistypeofdementia.

Therearealsodementiasassociatedwithdiseasessuchas Huntington’sandParkinson’s,amongothers RiskFactorsofDementia

Whataretheriskfactorsassociatedwithdementia?

Thenumberoneriskfactorisage.Mostcasesofdementia occurinpeopleovertheageof65 AstheAmericanpopulation ages,moreindividualswilldevelopdementia Astudy publishedin2022foundthat10%ofindividualsoverage65 havedementia Byage,approximately3%ofindividualsfrom ages65-69havedementia,risingto35%forindividualsintheir 90s Anadditional22%havemildcognitiveimpairment Genderandraceareadditionalriskfactors;womenand minoritiesaremorelikelytohavedementia However, educationallevelmitigatesdementiariskasitisnegatively correlatedwithdementia.

Althoughestimatesvary,therearenowbetween5.8millionto 69millionindividualsintheUnitedStateswithAlzheimer’s diseaseandotherdementias(Alzheimer’sAssociation,2023; Alzheimer’sAssociation,n.d.;Manlyetal.,2022;Matthewset al,2019;MCI,2022)

Physicalhealthcanalsoinfluencethelikelihoodofdeveloping dementia Individualswithuncontrolledhighbloodpressure

andstrokehistorymaydevelopvasculardementia Likewise,thosewithatherosclerosis,diabetes,smokers,andalcoholusedisorder allhaveanincreasedlikelihoodofdevelopingdementia(Agrawal&Agrawal,2022;Dolanetal,2010;HopkinsMedicine,2013;Kotonet al.,2022;Petersetal.,2008;Rao&Topiwala,2020).

Physicalhealthcanalsoinfluencethelikelihoodofdevelopingdementia Individualswithuncontrolledhighbloodpressureandstroke historymaydevelopvasculardementia.Likewise,thosewithatherosclerosis,diabetes,smokers,andalcoholusedisorderallhavean increasedlikelihoodofdevelopingdementia(Agrawal&Agrawal,2022;Dolanetal,2010;HopkinsMedicine,2013;Kotonetal,2022; Petersetal,2008;Rao&Topiwala,2020)

Althoughmostcasesofdementiaoccurinindividualsovertheageof65,dementiacanoccur,inrarecases,inyoungerpeopleaswell Thesecasesof“early-onset”dementiausuallyhaveageneticcomponentandthusruninfamilies.Butgenesarenotthesolecauseof dementia InheritingtheapolipoproteinE*4(APOE4)geneputsyouathigherriskforAlzheimer’sdisease However,evenpeoplewho haveinheritedacopyoftheAPOE4frombothparentsarenotguaranteedtodevelopdementia(buttheydohaveahigherchanceof gettingAlzheimer’sdiseasethanthegeneralpopulation)(Yamakazi,2019).

Testingfordementia

Acomprehensiveassessmentfordementiabeginswithtakingamedicalhistory,aphysicalexam,andoftenanexambyaneurologist, aswell.Physicians,neurologists,andmentalhealthprofessionalswilloftenrecommendaneuropsychologicalevaluationofcognitive functioning,particularlyifthereisacomplicatedpsychologicalhistory Theseexaminationsconsistofteststhatmeasurean individual’smemory,attentionandconcentration,languageability,visuospatialskills,motorskills,andexecutivefunctions Psychologicalfactorsarealsoevaluatedastheycannegativelyaffectdailyfunctioning.Atypicalneuropsychologicalevaluationtakes4 to8hours,oftenadministeredovermorethanoneday Dependinguponthesuspectedcauseofthedementia,brainscanssuchas computerizedtomographyscans(CTscans)andmagneticresonanceimaging(MRI),andalumbarpuncturemayberecommendedas well.

Treatmentfordementia

Althoughrelativelyuncommon,sometypesofdementiaarereversible(Bello&Schultz,2011) Forexample,thecognitiveabilitiesof individualswithmeningitisimproveoncetheinfectionhascleared Forthemorecommontypesofdementia,likeAlzheimer’sdisease, thereiscurrentlynocure However,therearemedicationsthatcanslowtherateofcognitivedeclineaswellasmedicationsthatcan alleviatecertainsymptoms Forexample,withincreaseddisorientation,manypatientsbecome,understandably,agitated Agitation canbetreatedwithbothmedicationandbehavioraltechniquestokeepthepatientsafe,comfortable,calm,andcontent.

Caregivers

Lastly,caregivingforindividualswithdementiacanbeverystressful.Caregiversneedtotakecareofthemselves.Whileresearchhas shownthatcaregiversbenefitfromsocialsupport,isolationandestrangementarecommon Depressionandanxietyisestimatedto occurinupto60percentofthispopulationandmayworsenovertime(Harrisetal,2020) Psychologistscanhelpaddressissuesof loneliness,caregiverburden,andgrief.Psychoeducationaswellaspsychotherapycanimprovecaregivers’lives.Effectivemodalities includecognitivebehavioraltherapyandacceptanceandcommitmenttherapy Researchonmindfulnessbasedtherapyismixed (Chengetal,2019;Shoesmithetal,2020) Telehealthpsychotherapyhasalsobeenshowntobeeffective(Shoesmithetal,2020) In addition,caregiversoftenbenefitfromperiodsofrespitecareandcontactwithotherswhoarefacingsimilarissues(beitthrough grouptherapyorothersupportiveservices)

MemoryProblemsThatAreNotConsistentWithNormalAging:

Confusionaboutthetimeandplace

Forgettinghowtodotasksofdailyliving(basichygiene,writingchecks,etc)

Frequentlygettinglostwhiledriving

Troublelearningnewinformationorthings

Frequentlyrepeatingphrasesorstories

Significantdifficultywithfindingtherightwordwhenspeakingorwriting

AbouttheAuthor

DaphnaRoth,PhDisalicensedpsychologist,whoinprivatepracticeatComprehensiveNeuropsychologicalEvaluationsinTeaneck,New Jersey Shespecializesindiagnosticneuropsychologicalevaluationsofadults(ages16andup)

ReferencesFurnishedUponRequest

Foundation Awards: Call for Award Submissions

NJPA Foundation Board of Trustees

President: Matt Hagovsky, PhD

Secretary: Toby Kaufman, PhD

Treasurer: Ann Stainton, PhD

Board Trustee: Eileen Kohutis, PhD

Board Trustee: Jonathan Wall, PsyD

Liaison: Amy Chapman

AfundamentalcomponentofourFoundation’smissionistosupportthetrainingofgraduatestudents Onewaywe meetthisgoalisbyprovidingfundingforstudent-initiatedresearchandprojectsaddressingpsychologicalissuesthat havesignificantimpactoncommunityhealth.Throughthegenerosityofindividualcontributions,weareabletooffer fourawardsandscholarshipsforinnovativefamily,school,andcommunityprojects.

ApplicantRequirements:

NJPAGSstudentmemberAND1.

EnrolledinaNewJerseyuniversityorcollegemaster'sordoctorallevelpsychologyprogramOR 2 PsychologyinternataNewJerseyfacility 3

Deadlineforsubmissions:June30,2024

GraduateStudentInitiatedResearchAwards:

(NEWAWARD)RayHanburyMemorialResearchAward

ThisnewFoundationAwardisinservicetothelegacyofDr RaymondHanbury,whowasnotonlyadistinguished psychologistandNJPAmember,butalsoa9/11crisisresponderandhealerafter:disaster,crisis,traumaandaccident Thisisinhonortohisserviceandcontributions ThisfocusesonareasofresearchrelatedtoDr Hanbury'sclinicaland researchinterestssuchasclimatechange,naturallyoccurringdisastersandcrisisintervention.

TheJohnM.LagosAwardforResearchintoCausesand/orTreatmentofSocialProblems

Awardedforthestudyofcausesand/ortreatmentofsocialproblems.Somepossibletopicsincludeschoolissues, workproblems,healthissues,andaggression.

TheNJPAFoundationScholarshipforResearchonDiversityIssues

Awardedtoagraduatestudentinpsychologywhoadvancesthefollowinggoals:(a)promotescientificunderstanding oftheroleofdiversityinpsychology;(b)fosterthedevelopmentofsensitivemodelsfordeliveryofpsychological servicestodiversepopulations Somepossibletopicsincludeissuesrelatedtoculturalorethnicissues,socioeconomic issues,genderissues,orworkwithunderservedpopulations.

TheDr.ZelligBachAwardfortheStudyoftheFamily

Awardedforthestudyofbehaviorrelatedtodivorce,teenagepregnancy,adoption,singleparentswithdependent children,interpersonalabuse,substanceabuse,custody,dualcareers,childcare,etc.

TheWinifredStarbuckScottAward

Awardedtoagraduatestudentinschoolpsychologyforcompletingadistinguishedproject,usuallyduringinternship.

Celebrating Our Longstanding Members! Thank You For

50+ Years

Janet Altman, PhD

Micheal Andronico, PhD

Barbara Barrett, EdD

Joseph Braun, PhD

Natalie Brown, PhD

Daniel Diamant, PhD

Richard Formica, PhD

Michael Gerson, PhD

Alan Gordon, EdD

Lawrence Hall, PhD

Susan Herman, PhD

William Herron, PhD

Russell Holstein, PhD

Sharon Perrotta, PsyD

Mark Reuter, PhD

Louis Richmond, PhD

Stanley Teitelbaum, PhD

40+ Years

Howard Adelman, PhD

Amy Altenhaus, PhD

Barbara Alter, PhD

Kim Arthur, PhD

Charles Bachus, PhD

Amy Becker-Mattes, PhD

Sheila Bender, PhD

Mary Blakeslee, PhD

Gordon Boals, PhD

Gary Borer, PhD

Isabel Brachfeld, EdD

Richard Brewster, PsyD

Merrilea Brunell, PhD

Michele Buchbauer, PhD

John Caliso, PhD

Monica Carsky, PhD

Mark Cetta, PhD

Gary Chanowitz, PhD

Marvin Chartoff, EdD

Karen Cohen, PsyD

Michael Colis, PhD

Roger Colonna, EdD

Ralph Constantino, PhD

Richard Dauber, PhD

Joseph DeMeyer, PhD

John H. Diepold, Jr., PhD

Charles Dodgen, PhD

Rosalind Dorlen, PsyD

Steven Dranoff, PhD

John Duryee, PhD

Frank Dyer, PhD

Susan Esquilin, PhD

Sean Evers, PhD

Your Continued Support!

40+ Years (cont.)

Kerry Farrell, EdD

Stephen Feldman, PhD

Dennis Finger, EdD

Donald Franklin, PhD

Eliot Garson, PhD

Marc Geller, PsyD

Leslie Gilbert, PhD

Ronald Gironda, PhD

Elizabeth Goldberg, PhD

Wayne Goldman, PhD

Bryan Granelli, PhD

Jeffrey Greenberg, PhD

Ricardo Grippaldi, EdD

Richard Guild, EdD

Emile Gurstelle, PhD

Mathias Hagovsky, PhD

Doris Hiatt, PhD

Barbara Holstein, EdD

Maureen Hudak, PsyD

Alfred Hurley, PhD

Michael Kahn, PhD

Sharon Kamm, PsyD

Charles Katz, PhD

Judy Kaufman, PhD

Toby Kaufman, PhD

Alex Kehayan, EdD

Stanley Keyles, PsyD

Kenneth Kressel, PhD

Martin Krupnick, PsyD

Barbara Kurlansik, PsyD

Ellen Lacy, PsyD

Phyllis Lakin, PhD

Sandra Lee, PhD

Kenneth Leight, PhD

Roman Lemega, PhD

Ilana Lev-El, PsyD

Ruth Lijtmaer, PhD

Edward J. Linehan, PhD

Bonnie Lipeles, PsyD

Neal Litinger, PhD

Mark Lowenthal, PsyD

Geraldine Lucignano, PhD

Cornelius Mahoney, PhD

Howard Mangel, EdD

Charles Mark, PsyD

Bonnie Markham, PhD, PsyD

Maria Masciandaro, PsyD

John McInerney, PhD

Nancy McWilliams, PhD

Leslie Meltzer, PhD

Samuel Menahem, PhD

Edward Merski, PsyD

40+Years(cont.)

StanleyMesser,PhD

MarshallMintz,PsyD

BarryMitchell,PsyD

NicholasMolinaro,EdD

LynnMollick,PhD

RuthMollod,PhD

SharonRyanMontgomery, PsyD

JoanGlassMorgan,PsyD

RosemarieMoser,PhD

SusanNeigher,PhD

MargaretNichols,PhD

RobertPasahow,PhD

StephaniePatten,PhD

FrancescaPeckman,PsyD

PilarPerez-Ortega,PsyD

JeffreyPusar,PsyD

MicheleRabinowitz,PsyD

HowardRappaport,PsyD

JerylRempell,PhD

JohnRosado,PsyD

LoriRosenberg,PsyD

BartRossi,PhD

MicheleRubin,EdD

MichaelSakowitz,PhD

CaroleSalvador,PsyD

GeorgeSanders,PhD

CarmelaSansone,PhD

KomalSaraf,PhD

ElissaSavrin,PhD

DorothySaynisch,PhD

LouisSchlesinger,PhD

JaySchmulowitz,PhD

KennethSchneider,PhD

PaulSchottland,PhD

DorisSchueler,PhD

HeleneSchwartzbach,EdD

InaraSegal,PhD

LauraShack-Finger,EdD

TamaraShulman,PhD

EleanorSiegel,PhD

DavidSiegman,PsyD

RonaldSilikovitz,PhD

HowardSilverman,PhD

TamaraSofair-Fisch,PhD

AndreaLynnSollitto,EdD

StanleySpergel,PsyD

MiltonSpett,PhD

BarbaraStarr,EdD

NinaThomas,PhD

George Tierney, PhD

Anothony Todaro, PhD

Janine Tremblay, PhD

William Walsh, PhD

Cathy West, PhD

Philip Witt, PhD

James Wulach, PhD, JD

Michael Zampardi, PhD

Joesph Zielinkski, PhD

Michael Zito, PhD

30+ Years

Philip Accaria, PhD

Amy Aho, PhD

Rhonda Allen, PhD

Carolyn Alper, PsyD

Toni Ann Amabile, PhD

Jeffrey Axelbank, PsyD

Frances Baker, PhD

Bruce Banford, PsyD

Thomas Barrett, PhD

Elinor Bashe, PsyD

Theodore Batlas, PsyD

30+ Years (cont.)

Lauren Becker, PhD

Elaine Belz, PhD

Roderick Bennett, PhD

Rhea Bensman, PsyD

Janet Berson, PhD

Jeffrey Bessey, PhD

Alison Block, PhD

Carol Blum, PsyD

Barbara Byrd, PhD

Diane Cabush, PsyD

Melanie Callender, PhD

Vic Carlson, PsyD

Michelle Chabbott, EdD

Dana Chavkin, PsyD

Lorraine Chiavetta, PsyD

Paul Ciampi, PhD

John Clabby, PhD

Carol Clark, PhD

Judy Clyman, PhD

Sidney Cohen, PhD

Barry Cohen, PhD

Louise Conley, PhD

John Corbisiero, PhD

Joseph Coyne, PhD

Stephanie Coyne, PhD

Deborah Dawson, PsyD

John DeLuca, PhD

Laura DeMarzo, EdD

Deborah Diament, PhD

We Celebrate Our Longstanding Members!

30+ Years (cont.)

David Diament, PhD

Tara Donnelly, PhD

Richard Drew, PhD

Linda Earley, PsyD

Laura Eisdorfer, PsyD

Allan Eisenberg, PhD

B. Sue Epstein, PhD

Robert Evans, PhD

Sylvia Fask, PhD

Sandra Feldman, PhD

Janie Feldman, PsyD

Ellen Fenster-Kuehl, PhD

Ellen Fink, PsyD

Deborah Fisch, PsyD

Irene Fisher, EdD

Resa Fogel, PhD

William Frankenstein, PhD

Kenneth Freundlich, PhD

Cynthia Friedman, PhD

Mark Friedman, PhD

Thomas Frio, PhD

Cheryl Futterman, PhD

Daniel Gallagher, PhD

James Garofallou, PhD

Kenneth Gates, PsyD

Jill Gentile, PhD

Jane Glassman, PhD

Linda Glazer, PsyD

Susan Goff, PhD

Santa Gregory, PhD

Susan Grossbard, PsyD

Ronald Gruen, EdD

Hadassah Gurfein, PhD

Kathryn Hall, PhD

Angela Hall, PsyD

Jeffrey Harrison, PhD

Steven Hartman, PhD

Christina Hathaway, PsyD

Frances Hecker, PhD

John Hennessy, PhD

Susan Herschman, PsyD

Eric Herschman, PsyD

Bernard Hershenberg, PhD

Nancy Hicks, PsyD

Linda Hochman, PhD

Laurine Hollyer, PhD

Kenneth Hoyne, PhD

Ellen Hulme, EdD

Jane Jacobus, PhD

Shashi Jain, PhD

Kathleen Janocko, PhD

Alison Johnson, PsyD

30+ Years (cont.)

Thomas Johnson, EdD

Denise Johnson, PhD

Barbara Jortner, PsyD

Arthur Joseph, EdD

Heidi Kaduson, PhD

Alan Kagel, EdD

Jeffrey Kahn, PhD

George Kapalka, PhD

Paula Kaplan-Reiss, PhD

Thomas Kavanagh, PsyD

Eileen Kennedy-Moore PhD

MaryAnn Kezmarsky, PhD

Myra Klein, EdD

Diane Klein, PhD

Kenneth Kline, PhD

Laura Kogan, PsyD

Eileen Kohutis, PhD

Elissa Koplik, PhD

James Korman, PsyD

Steven Korner, PhD

Robert Kornhaber, PhD

Peter Krakoff, PhD

David Krauss, PhD

Marcia Laky, PhD

Robin Lang, PsyD

Elizabeth Langell, PhD

Mary Larsen, EdD

Isabel Lerman, PhD

Marsha Lesowitz, PhD

Renee Levin, PhD

Linda Levy, PhD

Barbara Lino, PhD

Viviana Litovsky, PhD

Deborah Lubetkin, PsyD

Marilyn Lyga, PhD, ABPP

Stanley Mandel, EdD

Margery Manheim, PhD

Susan Marx, PsyD

Debra Mashberg, PhD

Jim Mastrich, EdD

Kenneth Mathisen, PhD

Dennis McCarthy, PhD

Frank McElroy, PhD

Robert McGrath, PhD

Kenneth McNiel, PhD

Bea Landman Mittman, PhD

Rachel Modiano, PsyD

Lucinda Monica, PsyD

Leila Moore, EdD

Gregory Moore, PsyD

Marsha Morris, PhD

Sandra L. Morrow, PhD

30+Years(cont.)

PhilipMorse,PhD

CynthiaMulligan,PsyD

CandiceNattland,PsyD

SallieNorquist,PhD

MichaelNover,PhD

RoseOosting,PhD

SpyrosOrfanos,PhD

SusanOrshan,PsyD

JamesOwen,PsyD

DavidPanzer,PsyD

ArminePapazian,PhD

ClaudiaPascale,PhD

MarcyPasternak,PhD

JordanPauker,PsyD

CraigPearl,PsyD

CarynPhillips,PhD

AngePuig,PhD

CynthiaRadnitz,PhD

EmiliRambus,PsyD

JonathanRapaport,PhD

RichRapkin,PsyD

JohnRathauser,PhD

GinaRayfield,PhD

NancyRazza,PhD

AnnReese,PhD,PsyD

StevenReillyEdS

AnnaMarieResnikoff,PhD

DavidRiley,PhD

BarbaraRosenberg,PhD

JoellynRoss,PhD

PeggyRothbaum,PhD

DebraSalzman,PhD

DanielSchievella,PhD

GailSchrimmer,PhD

RonaldSchroeder,PhD

RichardSchwarts,PsyD

EllenSchwartz,PhD

JeffreySegal,PsyD

DennisShaning,PhD

WilliamShinefield,PsyD

JeffreySinger,PhD

JudithSpringer,BA

AliceStClaire,PsyD

RobertStaffin,PsyD

MichaelStango,Phd

MaryellenStanisci,PhD

PatriciaSteen,PhD

RobertSteer,EdD

LoisSteinberg,PhD

JakobSteinberg,PhD

2Ben Susswein, PhD

David Szmak, PsyD

Laura Tahir, PhD

Beverlee Tegeder, PsyD

Patricia Tistan, PhD

Daniel Tomasulo, PhD

Leslie Tuttle, PsyD

Gerard Vaccarella, PhD

Peggy Van Raalte, PsyD

David Velder, PhD

Varvara Von Klemperer, EdD

Deborah Wagner, PhD

Richard Waldron, PhD

Virginia Walters, PsyD

Seth Warren, PhD

Beth Watchman, PhD

Daniel Watter, EdD

Allen Weg, EdD

Frank Weiss, PhD

Aaron Welt, PhD

Norbert Wetzel, ThD

Amie Wolf, PhD

Guy Woodruff, PhD

David Yammer, PhD

Sandra Yarock, PsyD

Julie Zakreski, PhD

Richard Zakreski, PhD

Grace Zambelli, PhD

Alan Zwerdling, PhD

25+ Years

Ruth Ahrens, EdD

Derek Aita, PsyD

Marta Aizenman, PhD

Susan Albert, PsyD

Rika Alper, PhD

Julie Alter, PhD

Mary Altonji, PhD

Shari Becker, PhD, JD

Leslie Becker-Phelps, PhD

Pauline Bergstein, PhD

Radha Bhatia, PhD

Rosa Bianco, PsyD

Mona Birk, PhD

Monica Blum, PhD

Dorothy A Borresen, MSN, PhD

Charles Buchbauer, PhD

Donna Cangelosi, PsyD

Rosemarie Cataldo, PhD

Avivah Dahbany, PhD

Michelle Daniel, PsyD

Daniel DaSilva, PhD

Lise Deguire, PsyD

We Celebrate Our Longstanding Members!

25+ Years (cont.)

Mary Ann DeRosa, PhD

Tammy Dorff, PsyD

Shapar Farzad, PhD

Guity Fazelpoor, PsyD

Joan Fiorello, PhD

Mark Flescher, PhD

Sharon Freedman, PhD

Kevin Fried, PhD

Antonia Fried, PsyD

Lorraine Gahles-Kildow, PhD

Marlon Gieser, PhD

Jacqueline Gilbert, PsyD

David Goldberg, PhD

Lydia Golub, PhD

David Gomberg, PhD

Dustin Gordon, PhD

Rhonda Greenberg, PsyD

Diane Handlin, PhD

Dale Hartman, PhD

Aynn Hartman, PhD

Donna Hitchcock, PhD

Susan Huslage, MSW, PhD

Lisa Jacobs, PhD

Nancy Just, PhD

Tamar Kahane, PsyD

Jonathan Karp, PhD

Elena Kazakina, PhD

Richard Kessler, PhD

Linda Klempner, PhD

Chris Kotsen, PsyD

Stephen Kuwent, PsyD

Dennis La Scala, PhD

John LoConte, PhD

Elaine Lukenda, PsyD

Lisa Lyons, PhD

Heather MacLeod, EdD

Steven Master, PhD

Carol McCrea, PhD

Carol McCrea, PhD

Brendan McLoughlin, PhD

Gail McVey, PsyD

Lisa McWhinnie, PhD

David Mednick, PsyD

Lauren Meisels, PhD

Karen Mengden, PhD

Alexis Menken, PhD, PMH-C

Caridad Moreno, PhD

Daniel Moss, PhD

Morgan Murray, PhD

Ronald Newman, PhD

25+ Years (cont.)

Cynthia Orosy, PhD

Michael Osit, EdD

Behnaz Pakizegi, PhD

Susan Parente, PsyD

Nora Alarifi Pharaon, EdD

Lori Pine, PsyD

Katherine Placek, PhD

Adam Price, PhD

Sharon Rauschenberger, PhD

David Raush, PhD

Dolores Reilly, PsyD

Katherine Rhoades, PhD

Denise Ricciardi, PsyD

Paul Rockwood, PhD

Debra Roelke, PhD

Noreen Romano, PhD

Francine Rosenberg, PsyD

Gianine Rosenblum, PhD

Diane Schaupp, PhD

Margot Schwartz, PsyD

Laura Segal, PsyD

Michael Selbst, PhD BCBA-D

Nancie Senet, PhD

Arline Shaffer, PhD

Terri Sinclare, PhD

Frank Sileo, PhD

Mark Singer, EdD

Vincent Stranges, PhD

Nanette Sudler, PhD

Steven Sussman, PhD

Donna Teti, PhD

Tamsen Thorpe, PhD

Lana Tiersky, PhD

Kenneth Vaughan, PsyD

Allison Widerman, PsyD

Ida Welsh, PhD

Allan Westreich, PhD

Megan Willis, PhD

Alison Winston, PhD

Miriam Sherr Wolosh, PhD

Jeannine Zoppi, PhD

20+ Years

Mitch Abrams, PsyD

Wendy Bedenko, PsyD

David Berkovitz, PhD

Phyllis Bolling, PhD

Lily Bollinger, PsyD

Thomas Boyle, PhD

Cynthia Bratman, PsyD

20+ Years (cont.)

Loretto Brickfield, PhD

Rhona Brown, PhD

Suzanne Buchanan, PsyD

Dina Cagliostro, BA

LaTeisha Callender, PhD

Drew Cangelosi, PhD

Lucille Carr-Kaffashan, PhD

Linda Centeno, PhD

Rosemarie Ciccarello, PhD

Robin Cooper-Fleming, PsyD

Joseph Davidow, EdD

Doreen DiDomenico, PhD

Nancy Distel, PhD

Chistopher Doran, PhD

Irene Erckert, PhD

Lucille Esralew, PhD

Marnie Fegan, PsyD

Pamela Foley, PhD

Barbara Fox, PhD

Vered Frumer, PsyD

David Gelber, PhD

Beata Sylvia Geyer, PhD

Marc Gironda, PsyD

Clair Goldberg, PsyD

Rachel Golum, PsyD

Jay Gordon, PhD

Jamie Gordon-Karp, PsyD

Lisa Granato, PsyD

Janice Hainsworth, PhD

Tamar Hammer, PsyD

Jennifer Hanych, PhD

Josephine Hines, PhD

Sean Hiscox, PhD

Christine Hudson, PhD

Jonathan Huston-Wong, PsyD

Elena Jeffries, PhD

Masami, Junod, PhD

Eliisa Kaplan, PhD

Deborah Kaplan, PsyD

Michele Kinderman, PhD

Eric Kirschner, PhD

Joel Kleinman, PhD

Thomas Kot, PhD

Deidre Kramer, PhD

Karen Landsman, PhD

Danielle Lavelle, PhD

Stuart Leeds, PsyD

Deborah Liner, PhD

John Macri, PhD

Daniel Mahoney, EdD

20+ Years (cont.)

Vanessa Marcantuono, PhD

Nicole Martell, PsyD

Jennifer McDermut, PhD

Greer Melidonis, PsyD

Wilda Mesias, PhD

Emilia Muglia, PsyD

Cheryl Notari, PhD

Jennifer Oglesby, PhD

Allison Dorlen Pastor, PhD

Annamaria Pruscino, PhD

Ann Rasmussen, PsyD

Ellen Reicher, PhD

Melissa Rivera Marano, PsyD

Laura Rosen, PhD

Nansie Ross, PsyD

Elissa Rozov, PhD

Gina Rudolph, PsyD

Nicole Safonte-Strumolo, PhD

Sue Schonberg, PhD

Tina Sherry, PsyD

Nancy Sidhu, PhD

Leonard Sitrin, PhD

Susan Skolnick, PhD

Shawn Marie Sobkowski, EdD

Craig Springer, PhD

Cheryl Sterling, PhD

Deana Stevens, PsyD

Patricia Sudol, PsyD

Linda Tamm, PsyD

Anthony Tasso, PhD

Peter Thomas, PhD

Barbara Tocco, EdD

Elizabeth Vergoz, PhD

James Walker Jr., EdD

Johnathan Wall, PsyD

Melissa Warman, PhD

Kim Weiss, PhD

Nancy Ziebert, PhD

Thank You to Our 2024 Sustaining Members!

ByadvancingyourlevelofmembershiptoSustainingMembershipstatus,youhavegenerouslydemonstratedyouradditionalsupport ofyourprofessionalassociation.Wethankyouforyourcommitmentanddedicationtoyourorganization!

Mitch Abrams, PsyD

Rhonda Allen, PhD

Amy Altenhaus, PhD

Kim Arthur, PhD

Christopher Barker, PhD

Kyle Barr IV, PsyD

Louis Barretti, PhD

Elinor Bashe, PsyD

Leslie Becker-Phelps, PhD

Roderick Bennett, PhD

Vanessa Bing, PhD

Monica Blum, PhD

Alice Bontempo, PsyD

Randy Bressler, PsyD

Richard Brewster, PsyD

Sidney Cohen, PhD

Deniz Colak, PhD

John Corbisiero, PhD

Briana Cox, PsyD

Joseph Coyne, PhD

Stephanie Coyne, PhD

Deborah Dawson, PsyD

Joseph DeMeyer, PhD

Peter DeNigris, PsyD

Ingrid Diaz, PsyD

Rosalind Dorlen, PsyD

Linda Earley, PsyD

Daniel Edelman, PsyD

Rachael Fite, PhD

Resa Fogel, PhD

Pamela Foley, PhD

Thomas Frio, PhD

Daniel Gallagher, PhD

Tim Gambino, PsyD

David Gelber, PhD

Lauren Gerardi, PhD

Leslie Gilbert, PhD

Marc Gironda, PsyD

Ronald Gironda, PhD

Elizabeth Goldberg, PhD

Susan Grossbard, PsyD

Hadassah Gurfein, PhD

Mathias Hagovsky, PhD

Cynthia Hanes, PsyD

Steven Hartman, PhD

John Hennessy, PhD

Susan Herman, PhD

Susan Herschman. PsyD

Ann Houston, PhD

Christine Hudson, PhD

Lisa Jacobs, PhD

Nancy Just, PhD

Toby Kaufman, PhD

Thomas Kavanagh, PsyD

Richard Kessler, PhD

David Krauss, PhD

Roman Lemega, PhD

Ilana Lev-El, PsyD

Neal Litinger, PhD

John LoConte, PhD

Mark Lowenthal, PsyD

Konstantin Lukin, PhD

Marilyn Lyga, PhD

Bonnie Markham, PhD, PsyD

Donald Marks, PsyD

Nicole Martell, PsyD

Kathleen McNulty, PhD

David Mednick, PsyD

Alexandra Miller Clark, PsyD

Ruth Mollod, PhD

Marsha Morris, PhD

Sandra Morrow, PhD

Morgan Murray, PhD

Susan Neigher, PhD

Daniel Noll, PhD

Cheryl Notari, PhD

Craig Pearl, PsyD

Francesca Peckman, PsyD

Lysandra Perez-Strumolo, PhD

Brittni Poster, PhD

Rich Rapkin, PsyD

Ellen Reicher, PhD

AnnaMarie Resnikoff, PhD

Barbara Rosenberg, PhD

Lori Rosenberg, PsyD

Eileen Russell, PhD

Nicole Safonte-Strumolo, PhD

Carole Salvador, PsyD

Luciene Sant’Anna Takagi, PsyD

Jayne Schachter, PhD

Doris Schueler, PhD

Charlena Sears, PsyD

Nancie Senet, PhD

Eileen Senior, PsyD

Arline Shaffer, PhD

William Shinefield, PsyD

Nancy Sidhu, PhD

Ronald Silikovitz, PhD

William Skelton, PsyD

Marjorie Slass, PsyD

Robert Staffin, PsyD

Jakob Steinberg, PhD

Deana Stevens, PhD

Vincent Stranges, PhD

Ben Susswein, PhD

Anthony Tasso, PhD

Tamsen Thorpe, PhD

Johnathan Wall, PsyD

Virginia Walters, PsyD

Beth Watchman, PhD

Allen Weg, EdD

Aaron Welt, PhD

James Wulach, PhD, JD

Michael Zito, PhD

Book Review: Attia, P. (2023). Outlive: The Science and Art of Longevity. New York, NY: Harmony Books.

ReviewedbyAnthonyTasso,PhD ProfessorandDeputyDirectorSchoolofPsychology&Counseling FairleighDickinsonUniversity

Themarketisfloodedwithhealthandwellnessinformation Blogs,books,podcasts,andothermediapromotinghealthy lifestylesarereadilyavailabletoanyoneinterestedinlearning more Thereisnodearthofself-proclaimed“experts”extolling theirpersonalpathwaytotheFountainofYouth“generously” sharingtheirblueprintsforlongevitytoanyonewillingtolisten (orpay).Indeed,suchindividualsfrequentlylaudtheir proclamationsasdisentanglingtheGordianKnotofaging, regardlessoftheireducation,training,experience,orscientific supportfortheirrecommendations

Theproblemisthatmuchoftheextantinformationhasnotbeen properlyvetted Alltoooftenthe“data,”andthosedisseminating saidinformation,aredrivenbysavvymarketing,financial motivations,orfromso-calledinfluencerswithnolegitimate credentials(possiblyotherthanlookinggood).Allthiscanleave eventhemostdiscerningconsumerconfused,overwhelmed,and potentiallyonthewrongroadtolivingthehealthiestlifepossible

Outlive:TheScienceandArtofLongevity(2023,HarmonyBooks) isanerudite,tempered,andempiricallygroundedbookthat addresseshowtoliveahealthylife Physicianandpublic personalityPeterAttiareliesonawealthoflaboratory-basedand appliedscientificfindingsinconcertwithpersonalandanecdotal experienceswithpatientstoprovideacomprehensivepathway tobestaddressthebroaddomainsofhealthandwellness–all aimedatlivingnotonlyaslongaspossiblebut–more importantly–aswellaspossible

Attiaopenswithabriefoverviewofthehistoryofmedicine, beginningwithHippocratesandtheearliestobservational medicalmethodstothemorecontemporary(andsomewhat myopic)medicalapproachoftreatingdiagnoseddiseases.This sectionthenseguestothepremiseofOutlive:prevention Attia highlightsthesomewhatobviousalthoughalmostanathematic conceptinmodernmedicineofhowaconcertedfocuson preventionofillnessanddiseaseismostdesirousforhealthy

living Specifically,hecontendsthatapreventativeethosleadsto agreaterchancetoavoid,ratherthanmerelytreat,illnesses ThisisthepremiseofOutliveandundergirdstheentiretext

Howlongwelive,ourlifespanisperhapsthemosttangibleand commonlyacceptedmarkerofhealth However,Attiaquestions thequalitativevalueoflifespanasthesingularcriterionfora healthylife Specifically,whatifourfinalyearsarewroughtwith illness,fragility,and/oremotionalandcognitivelimitations?For thisreason,Attiaemphasizeswhathecallshealthspan,whichis definedastheabsenceofdiseaseanddisability Assuch,Outlive anointshealthspanastheprimarymetricfordetermininghealth andwellness

Outliveofferssubstantiveproceduralinformationtoaddressthe salientdomainsgermanetohealthspan Specifically,Attiaplumbs theareasofcardiovascularity,strength,nutrition,sleep,and mentalhealth Attiafirstdelvesintocardiovascularhealthby parsingZone2fromVO2-maxtraining,withtheformer consistingofalongerduration,steadypacewhilethelatter cardiovasculartrainingmethodreliesonshortdurationwith burstsofnear-maximumoutput Attiaunderscorestheneedfor bothandthoroughlyexplainsthevaluesofeach Thesection deftlyelucidatesthegranularelementsofcardiovascularityatlarge,alongwiththepracticalelementsofincorporating cardiovasculartrainingintoaworkoutprotocol

Strengthandresistancetraining,acommonlymisunderstood topicoutsideoftheworldofathletics,isimperativefor healthspan Outlivehighlightsthenecessityofmusclegrowth andmaintenance,irrespectiveofone’sage,engagement(orlack thereof)withsports,orbaselineheathstatus Underscoringthe notionthatdecreasedstrengthisassociatedwithincreased mortality,theauthoralsohighlightstheconceptsofgrip strengthandstability–lessobviousphysicalmeasuresthatare highlyrelevanttohealthandlongevityaswellasday-to-day qualityoflife AsAttiaparsestheelementsofstrengthand stability,heimpressesuponreadersthatallformsofexercise

arefacilitativeofhealthspan.Inotherwords,thereisnothingwe candothatismoreimportantthanexercise

Perhapsnodomainofhealthandwellnessismoresaddledwith confusion,turfwars,proselytizing,anddejectionthannutrition Fromtheoriesonwhattoeat(eg,Atkins,paleo,keto,veganism) towhentoeat(eg,multiplesmallmealsdaily,intermittent fasting,prolongedfasting),thetopicofnutritionisoverwhelming. Attiamakesnospuriousclaimsofnutritionalsimplicity,and,in fact,statesthatnutritionalbiochemistryistheareaaboutwhich weknowtheleast Theauthoraimstoclarifythismurkyareaof healthbyassessingwhetherapersonisa)under-orovernourished,b)under-orover-muscled,andc)metabolically healthyornot Theauthorclosesthissectionwiththe perspectivethat,basedontheextantevidence,pooreating habitsmaybemoredetrimentaltohealththanexemplaryeating habitsarefacilitativeofhealth

Outlivealsoexplainstheimportanceofsleep Longunderstood byeventhemostcasuallyawareadolescentthatunproductive sleepisassociatedwithsubparphysicalityandemotionality,the multifacetedsignificanceofsleepiscomingintosharperfocus withagrowingempiricaldatabase Attiatapsintoevidencethat demonstratessleep’sdirectimpactoncardiovascularityand neurocogntion,thusunderscoringthebreadthanddepthof sleep’simpactonouroverallwellness.Thissectioncloseswitha briefchecklistofnotablewaystoimprovecompromisedsleep (eg,eliminatealcoholconsumption,maintainacoolroom,and avoidanceofeatingtooclosetobedtime).

Althoughnoaspectofhumanfunctioningissingularly constitutionalorpsychological(note:Descartes’mind-body bifurcationisnowrelegatedtotherealmofhistorical interest), themajorityofOutlive,thusfar,hasprimarilytargetedthe materialbody However,Attiaclosesthebookwithadiscussion oftheindispensabilityofemotionalhealth.Headdressesthis topicbyleaningonempiricalevidencealongwithanadmirable reflectiononhisownexperienceswithhispsychologicaland relationalstruggles.Inanexpressionofrawvulnerability,Attia reportshow,despitehislifelongcomprehensivepersonal biomedicalhealthprotocols,hisfailuretoprioritizehis socioemotionalitystymiedhisabilitytoachievewellness He closesthischapterwiththetake-homemessagethattrue healthspanisnotpossiblewithoutpsychologicalhealth Itisraretoproclaimthatabookshouldbeconsidereda“must have,”however,IaminclinedtodosowithOutlive This comprehensive,readablebookoutlinesthemanywayswecan livethebestlifepossible.Attia’slucidwritingallowsthereaderto apprehendoft-complexbiomedicalprocesses.Farfrom hyperbolic,Attia’sapproachissoundlytemperedand methodological Heimpartsproceduralinformationborneoutof laboratory-basedhumanandnonhumanresearchalongwithrich clinicalwisdomtoprovidethereaderwithtoolstolivethe healthiestlifepossible

Thoseofusimmersedintheworldofmentalhealthpracticeare fullyawarethatapsychotherapybooknotanchoredina foundationaltheoryisessentiallyuseless,asacollectionof“how to”techniqueswithoutatheoreticalunderpinningfallsshortof

anythingmeaningful.Inotherwords,goodpsychotherapybooks donottellushowtodotherapybutratherfacilitatemeaningful thinkingaboutourpatientsandexpandthewayinwhichweare abletoworkwiththoseinourconsultingrooms

Outlivebeautifullyparallelsthisthesis Attia’sbookisgroundedin theconceptofprevention,fromwhichappliedinformationis extrapolated.Outliveisnota“howto”bookorsomevariationofa whitepaper Itisfarricherthanthat Attia’sclearandconcise gemofabookprovidesasolidfoundationalongwithmeaningful waystothinkaboutandexpandonhowtoimproveandadvance ourhealthandwellness.Noeasyfeatbutmasterfullydone.

Thereasonsforreviewingsuchabookforapsychologyjournal aremany Oneisthat,aspsychologists,weare,attheveryleast, awareoftheneedforselfcareandwellness Outliveprovidesus withmaybethemostusefulmanualtodate Anotherreasonis thatjustaspsychologistsareawareoftheneedfor–and,at times,deficiencyof–medicalpractitioners’appreciationofthe significanceofpsychologicalfactors,weneedtoavoidsimilar professionalblindspotsinourapprehensionofpatients’possible biomedicallimitations.Inotherwords,psychologistsneedto fullyappreciateourpatients’physicalandemotionalwellness Therefore,Outliveis,Iargue,immenselybeneficialfor psychologistsonbothpersonalandprofessionallevels.

IfeelcompelledtoidentifyOutlive’slimitations,or,whatmight bemoreaccurate,myfrustrationswiththisbook.Firstand foremost,Attiafailstodisabusetheinevitabilityofdeath Therefore,thoseconsideringreadingthisbookhopingitisa mortalityantidotewillbedeadwrong(punintended) Furthermore,onewillquicklylearnthatthepathwaysto healthspanarefarfromsimple,passive,oreasy Evidentacross thepagesofthisbookisthatthereisnopanaceapillforillnesses orjumping-jackelixirforlongevity Inotherwords,thisbook makesitclearthattooutlive,youmustoutwork.Relatedlyvexing maybetherealizationthatyourcurrenthealthandwellness protocol,nomatterhoweffectiveyouthoughtittobe,is insufficient.(Onapersonallevel,therewereseveraltimeswhen readingOutlivethatIconsideredthrowingthebookina woodchipper,butrefrainedfromdoingsobecausea)Idon’thave awoodchipper,andb)suchragecanresultinvarious psychobiologicalsequelae.Thus,ifyouarewillingtoworkhard, Outliveisabookforyou)

Outlivebeautifullybalancesdensebiochemicaldataand processeswithouttoodeepofadivethatmaystrayfrom practicalapplication Farfromofferinganalgorithmicblueprint, AttiadoeswhatIimagineanypsychologistwouldwant:he providesrichinformationasameanstobetterthinkaboutone’s personalwellbeingandhowtobestapplysuchdata Assuch, Outliveismorethanaworthwhilereadforyourpersonaland professionalwell-beingasitprovidesthetoolstoliveaswellas possibleforaslongaspossible

AbouttheReviewer: AnthonyF Tasso,PhDisaprofessorofpsychologyandDeputy DirectoroftheSchoolofPsychology&Counseling,Fairleigh DickinsonUniversity Healsohasapsychotherapypracticein Whippany,MorrisCounty,NJ.

988 – The Number that Saves Lives

ByMaryJeanWeston,LCSW

NewJersey988StateLeadattheNJDepartmentofHumanServices, DivisionofMentalHealthandAddictionServices

NOTE: This article talks about suicidal thoughts and feelings, so please consider this before reading any further

A Crisis of Mental Health Crises

According to the Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report for 2021 (as reported on the American Foundation for Suicide Prevention (AFSP) website)1, suicide was the 11th leading cause of death in the US in 2021 (the last year for which we have complete data). That same year, 48,183 Americans died by suicide and there were an estimated 1.7 million suicide attempts. And since the end of 2021, stressors including the pandemic, the economy, climate change and political developments, as well as many personal challenges, have continued to bring difficult times to many people

Suicide Prevention

Those in the helping professions know that some individuals are in a very dark place They struggle to find any light or hope for their future Ending their lives Dying Being dead This is their solution to the crises, the pain, the exhaustion, the anger, the fear, the isolation, the hopelessness, the loneliness… Being dead is their solution to the complete despair they are facing

For those who have not been down this road, it may be hard to imagine just how deep and dark this place can be. It’s the reason that we learn in our professional training that it’s okay to ask someone if they are thinking of killing themselves For those who are not contemplating suicide, it seems like a strange question It is often answered by, “No!” followed by some additional comment that indicates this is not a path they would be likely to choose. However, those who are in a dark corridor often find this a helpful question

as it opens the door to a conversation few people are willing to have with them

988 - A Step Towards a Transformed Crisis Care System in America

In 2020, the Federal Communications Commission (FCC) designated 9-8-8 as the new 3-digit dialing code to connect individuals to the pre-existing National Suicide Prevention Lifeline (NSPL). Previously, the NSPL offered an 800 number to call, but the FCC required all US states and territories to transition to this easy-to-remember, 3-digit number by July 16, 2022. On this date, in New Jersey and across the country, the 988 Suicide & Crisis Lifeline was established, and 988 became the new number to call or text for suicidal, mental health and substance use crises Help is also available by chat at https://988lifeline org/chat/

When people contact 988, they are connected to trained crisis counselors who provide free, confidential support and resources based on the need(s) presented New Jersey currently has five 988 Lifeline centers that respond when people in crisis reach out Anyone in the United States or its territories can contact 988 for themselves or for someone else, and services are available 24 hours a day, every day of the year.

New Jersey

According to 2021 data from the Centers for Disease Control and Prevention (CDC), New Jersey had the lowest suicide mortality rate per capita in the United States. While this may appear to be good news, New Jersey residents continue to die by suicide, and we believe that every life lost is one too many. Nevertheless, these statistics reflect the robust crisis

and acute care continuum available in New Jersey. Mental health and substance use resources for New Jersey residents include the 988 Lifeline, ReachNJ (substance use treatment referral), NJ 211 (social and community services referral), behavioral health clinics, community support services, screening, partial care, respite homes, wellness centers, hospitals and other community programs.

To expand the crisis and acute care continuum of services and complete the 988 system, the NJ Department of Human Services’ Division of Mental Health and Addiction Services (DMHAS) will fund two additional community crisis programs One is a statewide system of Mobile Crisis Outreach Response Teams (MCORTs) for situations requiring an in-person, behavioral health response in the community When this program is operational, which is anticipated in the next few months, MCORTs will be dispatched without law enforcement whenever it is deemed safe to do so They will meet with individuals in person, help them deescalate their crisis and access needed resources to support them in the community. Until the Mobile Crisis Outreach Response Team system is in place, existing community services are available to help people who contact 988. However, once these MCORTs are activated, they will work with and complement current crisis response services. In addition, Crisis Receiving Stabilization Centers (CRSCs) will be located throughout the state. The CRSCs will offer community-based services in a facility designed to meet immediate needs of people experiencing a mental health or substance use crisis, and will provide referrals to other community programs Both MCORTs and CRSCs will be available 24 hours a day, every day of the year

Mental Health Professionals and Suicide Prevention

Mental health professionals, including psychologists, play a crucial role in preventing suicide across our state and throughout the United States Helping professionals comprise much of the workforce that provides so many of the crucial services offered throughout the crisis care continuum. And psychologists are already involved in the 988 system answering calls, texts and chats, or serving in other capacities at New Jersey’s Lifeline centers. Information about employment opportunities with 988 is available at Careers : Lifeline (988lifeline.org).

This is a moment to reflect on where we are as professionals in addressing this critical public health concern. One recommendation would be to learn QPR (Question. Persuade. Refer.). This evidence-based suicide prevention training teaches participants to recognize the warning signs of suicide and then question, persuade, and refer people at risk for suicide to helpful resources. In 2 hours, you can learn to save a life. The New Jersey DMHAS Disaster and Terrorism Branch offers this training for free to the public and privately to organizations If you are interested in attending or hosting a training for your organization or joining the mailing list to receive the public training calendar, please email DMHAS DTBtraining@dhs nj gov These trainings are funded and made possible by a Substance Abuse and Mental Health Services Administration’s (SAMHSA) Mental Health Awareness Training grant

Finally, I encourage you to take a few minutes and learn more about suicide prevention and 988. Frequently Asked Questions about the 988 system are available at 988 Frequently Asked Questions | SAMHSA. For national information, go to 988 Suicide & Crisis Lifeline | SAMHSA. For information about 988 in New Jersey, go to Department of Human Services | 988 Suicide & Crisis Lifeline (state.nj.us). And if you have questions about 988, please email 988Questions@dhs.nj.gov.

If you or someone you know is experiencing suicidal thoughts, a mental health crisis, substance use crisis or any kind of emotional distress, you can call or text 988, or chat at https://988lifeline.org/chat/ for free, confidential support.

Planning and Measuring Effectiveness of Psychotherapy

ByLidiaD.Abrams,PhD Chair,NJPAEthicsEducationandResourceCommittee

We are ethically bound to help and do no harm to our clients, and responsible for upholding our clients' best interests as they put their trust in us. We are to use evidence-based treatments and make sure that we are working within the boundaries of our competence and abilities (APA Ethical Principles Code of Conduct 2 01) With these conditions met, every client is unique and there are no guarantees that our specific approach will lead to desired outcomes It is good practice, and in our clients’ best interest that we periodically assess their functioning and progress toward their desired goals

One way of gathering information about our effectiveness is to ask for client feedback Some recommend doing so at the end of every session, maybe using a session rating scale (structured feedback), or having a feedback conversation aimed at finding out what the client found useful and what was not wellreceived (Duncan et al, 2003, Lambert et al, 2005). This process can yield useful information, help the client stay in treatment and help strengthen the alliance. There is research showing that systematic client feedback improves treatment outcome (e g , Bovendeerd et al, 2022, Janse et al, 2020), and also some showing that routine clinical feedback is not helpful with all clients (deJong et al, 2018) Solstad et al (2021) recommend that clinical feedback systems should be used in ways that are flexible, meaningful to clients, and sensitive to individual needs and preferences

Obtaining client feedback should only be a component of treatment assessment and planning. After all, the client may not know what will ultimately be helpful to them, or they may resist aspects of therapy which challenge them. As the professionals, and we are responsible for guiding the treatment. It has been

recommended that we do so by engaging in “reflective practice.” Dewey (1993) was among the first to describe the value of using reflective thinking, involving identifying a problem, clarifying its essence, generating hypotheses, comparing them to each other and testing our hypothesis by imaginative action Several variations on his model have been since developed There is of course value in approaching our work with our clients with self-awareness, critical and reflective thinking However, Lilienfeld and Basterfield (2002) find that there is little support for the usefulness of reflective practice techniques in and of themselves They note that self-reflection by itself only involves accessing information already available to us, and as per Dunning (2011), we do not know what we do not know. Further, our way of looking at available information is just that, our way of looking at the information. It can be skewed due to implicit biases we all have, such as confirmation bias, fundamental attribution bias, hindsight, overconfidence, and others. We may hold on to these biases even when we understand what they are, because of the bias blind spot – we just don’t recognize our own implicit biases (Pronin et al, 2004)

Obtaining a baseline measurement of our clients’ functioning and periodically measuring progress gives us objective data to help guide our clinical work For most clients, brief tests like the PHQ-9, GAD-7, BDI-2 or BAI can give us some useful information about their condition and level of distress There are many other useful brief tests, some specifically developed to monitor treatment progress (see Psychiatry.org - DSM5-TR Online Assessment Measures). More comprehensive psychological testing such as the MMPI, PAI or MCMI might be helpful for complex cases. Alternatively or additionally, we may create our

own measure of the frequency of the thoughts, feelings and behaviors our client would like to increase or decrease The same tests and measures can be readministered periodically and the results compared to the initial measure Meta-analyses find that routinely tracking client outcome leads to less deterioration and increased positive outcome for clients (e g Lambert et al, 2003) Whether progress is found to have occurred or not, outcome measurement is useful; perhaps the client has decreased symptomatology but has not been aware of this progress, and this would be encouraging information. If the data shows lack of progress, a frank discussion with the client about how improvement could be achieved may lead to more effort, more compliance with behavioral homework by the client, or a different approach by the psychologist

The New Jersey Administrative Code Title 13 Law and Public Safety Chapter 42 Board of Psychological Examiners tells us in subchapter 10 10 that “Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service ” Continued treatment that is not working, when a different type of treatment might do better, is of course not in our client’s best interest. While sometimes it is obvious to client and therapist that the treatment is not leading to desired results, this is not always the case. The psychologist may be doing their best to be helpful, and feeling hopeful about eventual results, even though there is no actual progress. And, as long as the therapist endorses further sessions, the client has reason to believe that the sessions are warranted

The therapeutic relationship, important as it is to successful treatment, is only a means to an end The strength of this relationship may sometimes carry psychotherapy beyond its usefulness A long-term therapeutic relationship may even become a dysfunctional relationship, harmful to both For example, the client may deteriorate, engaging in increasingly pathological or harmful behaviors in order to get attention and concern from the psychologist and to ensure that the sessions continue. They may even become abusive to the psychologist, and the psychologist might feel that it is their duty to persevere in a long-term therapeutic relationship gone awry.

Using some empirical measures of progress and setting clear treatment goals can help avoid unhealthy turns

Individualized treatment plans are a formal way of setting goals based on the initial assessment, planning treatment and measuring progress Treatment plans help both psychologist and client stay on task, using each session to make some progress towards the client’s goals of treatment As treatment plans are meant to be created by psychologist and client together, they serve as an extended consent by the client, in which they not only consent to treatment in general, but agree repeatedly in the course of treatment to work in specific ways towards the mutually agreed-upon goals.

Some workplaces require that formal treatment plans are created for each client and reviewed at set time intervals Psychologists in private practice are not obligated to do so, but treatment plans are becoming part of what is considered good practice Insurance companies, in particular Medicare, are looking for treatment goals and some measure of progress Kelly (2023) https://www courtemancheassocs com/behavioral-health-treatment-plans/ reviews CMS requirements for treatment plans, and Dustman (2023) https://www.aapc.com/blog/88200meet-documentation-requirements-for-psychotherapyservices/ further discusses treatment planning being part of required documentation and bearing on medical necessity determinations.

Treatment plans build on our initial assessment of the client's condition and set a path towards improvement. They help us identify long term goals for the client, the clinical interventions we plan to use, and the intermediate, measurable, short-term objectives for the clients to achieve They are usually meant to be reviewed every 12 sessions or so, at which point the initial assessments can be re-administered, or the client’s progress can be assessed based on a behavioral definition of their functional deficits Progress is measured and new objectives are set for the client, with proposed timeframes for completion. When the client has made sufficient progress, termination is discussed with the client. If not enough progress is being made, different approaches, including referring to a higher level of care or different type of treatment are considered.

Mostorallelectronichealthrecordsprogramscontain templatesfortreatmentplans.Theycanalsosuggest pre-definedoptionsforinterventionsforcertain problems Therearealsomanualsfortreatment planning ArthurJongsma,Jr (2021)forexampleeditsa seriesoftreatmentplannersforadults,children, adolescents,couplesandothercategoriesofclients.The manytreatmentplansincludedaddressmostcommon presentingproblemsandsuggestavarietyofobjectives andinterventionsbasedonevidencebased psychologicaltreatments Artificialintelligence programssuchasChatGPT-4 (https://chat.openai.com/)cancreatesurprisingly comprehensiveandrelevanttreatmentplansinseconds, basedonourdescriptionoftheclient.Ofcourseone shouldcriticallyreviewthese,buttheyareusefulasa springboardfortreatmentideasandconceptualization Assessinginitialfunctioning,settinggoalsfortreatment andperiodicallymeasuringprogressdoesnothaveto takealongtimeandstillallowsustoconducttherapyin ourusualways,whilealsokeepingusandourclientson therighttrack Whetherornotwecreateformal treatmentplans,itisbestpracticeto haveclearcut goalsfortreatment,toperiodicallyassessclient progresstowardsthesegoals,andtomakeclinical decisionsbasedonourassessmentsofourclients’ progress.

AbouttheAuthor

Dr LidiaAbramsisalicensedpsychologistwithaprivate practiceinClifton.SheisalsoexecutivedirectorofResolve CommunityCounselingCenterinScotchPlains Sheprovides counselingandforensicevaluationsforfamilycourtandothers.

References

Bovendeerd,B.,DeJong,K.,DeGroot,E.,Moerbeek,M.&De Keijser,J (2022)Enhancingtheeffectofpsychotherapythrough systematicclientfeedbackinoutpatientmentalhealthcare:A clusterrandomizedtrial,PsychotherapyResearch,32:6,710722,DOI:10.1080/10503307.2021.2015637

deJong,K,Segaar,J,Ingenhoven,T,vanBusschbach,J,& Timman,R (2018) Adverseeffectsofoutcomemonitoring feedbackinpatientswithpersonalitydisorders:Arandomized controlledtrialindaytreatmentandinpatientsettings Journal ofPersonalityDisorders,32,393–413 https://doiorg/101521/pedi 2017 31 297

Dewey,J (1933) Howwethink:Arestatementoftherelationof reflectivethinkingtotheeducativeprocess(2nded) New York:HealthandCompany

Dunning,D (2011) TheDunning-Krugereffect:Onbeing ignorantofone'sownignorance.InJ.M.Olson,&M.P.Zanna (Eds),Advancesinexperimentalsocialpsychology,vol 44(pp 247–296) NewYork:AcademicPress

Dustman,R (2023) MeetDocumentationRequirementsfor PsychotherapyServices. AAPC.Retrievedfrom https://wwwaapccom/blog/88200-meet-documentationrequirements-for-psychotherapy-services/January3,2023

Janse,P.D.,deJong,K.,Veerkamp,C.,vanDijk,M.K., Hutschemaekers,G J M,&Verbraak,M J P M (2020) The effectoffeedback-informedcognitivebehavioraltherapyon treatmentoutcome:Arandomizedcontrolledtrial Journalof ConsultingandClinicalPsychology,88(9),818–828. https://doi.org/10.1037/ccp0000549

JongsmaJr,A E,Peterson,L M,&Bruce,T J (2021) The completeadultpsychotherapytreatmentplanner.JohnWiley& Sons.

Kazantzis,N,Whittington,C,&Dattilio,F (2010) Metaanalysisofhomeworkeffectsincognitiveandbehavioral therapy:Areplicationandextension ClinicalPsychology: ScienceandPractice,17(2),144–156 https://doiorg/101111/j1468-2850201001204x

Kelly,A (2023) Behavioralhealthtreatmentplans Courtemanche&Associates Retrievedfrom https://wwwcourtemanche-assocscom/behavioral-healthtreatment-plans/onJanuary3,2024

Lambert,M.J.,Harmon,C.,Slade,K.,Whipple,J.L.,&Hawkins, E J (2005) Providingfeedbacktopsychotherapistsontheir patients’progress:Clinicalresultsandpracticesuggestions JournalofClinicalPsychology,61,165–174

Lambert,M.J.,Whipple,J.L.,Hawkins,E.J.,Vermeersch,D.A., Nielsen,S L,&Smart,D W (2003) Isittimeforcliniciansto routinelytrackpatientoutcome?Ametaanalysis Clinical Psychology:Science&Practice,10,288–301

Lilienfeld,S O,&Basterfield,C (2020) Reflectivepracticein clinicalpsychology:Reflectionsfrombasicpsychological science ClinicalPsychology:ScienceandPractice,27(4), Article12352.https://doi.org/10.1111/cpsp.12352

Pronin,E.,Gilovich,T.&Ross,L.(2004).Objectivityintheeyeof thebeholder:Divergentperceptionsofbiasinselfversusothers PsychologicalReview,111(3),781-799 https://doi.org/10.1037/0033-295X.111.3.781

Solstad,S M,Kleiven,G S,Castonguay,L G&Moltu,C (2021) Clinicaldilemmasofroutineoutcomemonitoringandclinical feedback:Aqualitativestudyofpatientexperiences, PsychotherapyResearch,31:2,200-210,DOI: 10.1080/10503307.2020.1788741

What’s New (Old?) in Special EducationDetermination of Eligibility for Special Education in New Jersey: Integrating Best Practices, Federal Regulations, and State Code (Part 11)

ByStevenKorner,PhD

Ipreviouslywrote(Korner,2016)aboutthelackofcongruence betweenthefederalregulations(IDEA,2004)andtheNewJersey SpecialEducationAdministrativecode(NJSA,14,title6A),andhow thedifferentdefinitionsofaspecificlearningdisability(SLD)that emanatedfromtheselegislativeeffortshaveinfluenced practitionersinimplementingthebusinessofevaluatingand makingdecisionsabouteligibilityandremedialserviceswith studentsbeingthevictimsoftheirdifferences Despitelegislative effortsforthepastsevenyearsmeanttobridgethegapbetween thefederalandstatedefinitionsbyfourprofessionalassociations (ie,theNJPsychologicalAssociation,theNJAssociationofSchool Psychologists,theNJAssociationofLearningConsultants,andthe LearningDisabilityAssociationofNJ),disputesstillrageaboutthe basicdefinitionofaSLD,thenatureofwhichdrivesdecisions aboutassessment,interventions,andeligibilityforspecial educationservices.

Thepurposeofthispaper(Part11),istobrieflyreviewthestateof thefield,and,inthefaceofwhateverobstacleshavethusfar preventedthepassageoflegislationthatreflectstheinfusionof thelatestscienceintheregulations,toproposeadifferenttact:to revisittheexistinglanguageinthefederalandstatecodestoseeif itprovidessupportforusingthefederalthirdoptioninNew Jersey,bringingitinlinewithatleast35otherstates(Maki& Adams,2018)andwithitsomebestpracticeoptions,especiallythe useofassessmentmethods(ie,PatternofStrengthand Weaknesses[PSW]andcasestudy/mixedmethod)thatmeasure basicpsychologicalprocessesasstipulatedinthefederal definitionofaSLD

Background

AsIwroteearlier(Korner,2016),“Thelimitationsofthemost frequentlyusedassessmentmodel,thatis,theAbility[Achievement]Discrepancymodel(AAD),havebeenwidely documented(Hale&Fiorello,2004;Hale,Kauffman,Naglieri,and Kavale,2006;Flanagan,Fiorello,Ortiz,2010;Dixon,Eusebio,

Turton,Wright,andHale,2011;Hale,Fiorello,Kavanaugh, Holdknack,andAloe,2007;Haleet.Al.,2010),andmore recentlyreaffirmed(Allen,2021;SchneiderandKaufmann, 2017) TheNationalAssociationofSchoolPsychologists (Gresham&Vellutino,2010)declaredthefollowingovera decadeago:“Relyinguponanability–achievement discrepancyasthesolemeansofidentifyingchildrenwith specificlearningdisabilitiesisatoddswithscientificresearch andwithbestpractice.”

Totakethisastepfurther,WillisandDumont(2002),liken AADtothe“MarkPenalty”(i.e.,“**Mark4:25:"Forhethat hath,tohimshallbegiven:andthathathnot,fromhimshall betakeneventhatwhichhehath" Theycontinueby explaining: “TheMarkPenaltyisincurredwhenastudent's disability(e.g.,visualimpairment,hearingloss,orlearning disabilitybasicprocessdisorder)isallowedtodepressnot onlymeasuresofacademicachievement,butalsoestimatesof thestudent'sintelligencesothatthemisguidedexamineror benightedteamconcludesthatthereisnosignificant differencebetweenthestudent'sacademicachievementand thelevelofachievementthatwouldbepredictedfromthe student'sscoreontheintelligencetest.”Asaresult,they concluded:“Thesamedisabilityisdepressingboththe student’sactualachievementandtheerroneousestimateof thestudent’sintellectualability”

Yet,thisapproachisoneoftwosetinstoneintheNJcode, and,theonemostwidelyusedbyChildStudyTeams(CST) acrossthestatedespitetheadmonitioninboththestateand federalcodesagainstusingonemethodasthesolemeansof diagnosingaSLD Infact,asdefinedby§3008(c)(10)that districts:“Mustnotrequiretheuseofseverediscrepancy betweenintellectualabilityand achievementfordetermining whetherachildhasaspecificlearningdisabilityasdefinedin §3008(c)(10)”

Thecontinueduseofamodeofassessmentinthefaceof overwhelmingevidenceinthefieldtothecontraryrecallsthe kindofrationaleimplicitinthefollowingstory:Ayounggirl askedhermotherhowcomeshecutstheroastbeefinhalf beforeplacingitintheoven.Hermotherreplied,“Becausethat isthewaymymotherdidit”Stillcuriousaboutthispractice, theyounggirlqueriedhergrandmother,“Howcomeyoucut theroastbeefinhalfbeforeplacingitintheoven?” Her grandmotherthoughtforamoment,andthenreplied,“Because wehadsuchasmalloventhatwastheonlywayitwouldfit”

Similarly,CST’salloverthestatecontinuetouseAADbecause itisinthecode Yet,withincreasingfrequency,andhelped alongbytherecentpassageofNJSenateBill2256which,in concertwithaparallelAssemblybill4266couldbringthethird optiontoNJwhilesunsettingAAD,moreandmoreCST membersarevoicingtheirdissatisfactionwiththeneedtouse anarbitrarycutscore(ie,15standarddeviations)tomake servicesavailabletostudentswhodesperatelyneedthem. Muchoftheirdiscontentstemsfromthelargepopulationof studentswhoeitherdonotmakethecutofforwhoarelow abilityperformingcongruenttothatability,leaving professionalsscurryingforwaystogetaroundthecodeto providethestillneededsupports Thegrowingdisaffection withAADalsocomesfromtheincreasedtrainingandeducation ofCST’swhorealizethatthismethodofferslimitedinformation aboutthecognitiveprocessingdeficitswhichareattheheart oftheaccepteddefinitionofaSLD,andabouthowto remediatethem Inahumorous,and,atthesametime,serious commentaryonCST’sattemptstogetaroundAAD,Gottlieb, Alter,Gottlieb,andWisher(1994)wrote:“ thediscrepancythat shouldbestudiedmostintensivelyisbetweenthedefinitionof learningdisabilitymandatedbyregulationandthedefinition employedonaday-to-daybasisinurbanschools(p.455).”

Consequently,CSTslookedtowardtheothercriterion(N.J.A.C. 6A:14-34(h)6),“aspecificlearningdisabilitymayalsobe determinedbyutilizingaresponsetoscientificallybased interventionsmethodology,”thatformsthebasisforthe ResponsetoIntervention(RTI)approachtodeterminingthe presenceofaSLD However,RTI,too,provedtohave significantflaws:“UseofRTIwithoutmeasuresofabilityor cognitiveprocessingultimatelydisregardsthedefinitionofSLD anddistortstheconstructinthesamewayaptitudeachievementdiscrepancymodelsdid RTIonlydocumentsone partofthedefinitionofSLD:lowachievement Nothinginthe regulationseversuggestedthatthediscrepancybetween abilityandachievementwastobethesoledeterminantinthe identificationofanSLD Itwasneverintendedtodefinethe entireconstructofSLDortobeusedasthesolecriterionfor placementdecisions(Ofiesh,2006inCamp-McCoy,2012,p. 31)”

ThepracticeofautomaticallydeclaringstudentsSLDafter failingRTIinterventionhasbeenharshlycriticized:“Weobject tothepracticeoflabelingchildrenwhofailtorespondto interventionaslearningdisabledonthegroundsthatnotall childrensoidentifiedwillhavecognitiveprocessingdeficits (Schneider&Kaufmann,2017,p 11)”“Therecanbelittle

confidenceintheSLDstatusofstudentsidentifiedthrough RTIbecauseSLDdeterminationisessentiallybyfiat: nonresponsiveipsofactoSLD(Kavale&Flanagan,2007,p 143)”

Similarly,theNationalCenterforLearningDisabilities(2023) declaredthefollowing:“AlthoughRTIdataprovidevaluable information,inisolationtheyarenotequivalenttoa comprehensiveevaluation DatafromanRTIprocessshould bepartoftheanalysis,synthesis,andrecommendationsused forevaluation,identification,eligibility,andprogramplanning. RTIdataaloneareinsufficientfordeterminingastudent’s eligibilityforidentificationofalearningdisability”Asaresult oftheproblemswithAADandRTI,practitionersarestuck: “ThereisnowaytodetermineifachildhasaSLDbasedon theability-achievementdiscrepancy,andthereisnowayto determineifachildhasaSLDbasedonthenon-responseto intervention So,whatisaresponsiblepractitionertodo? (Hale&Hicks,2013).”

TheComplexityofSLDIdentification

Thefirststepinresolvingthisdilemmaistoacceptthe challengesinherentindiagnosingaSLD:“Theprimaryreason isSLDsinvolveacomplexsetofinteractingvariables includingbiology,genetics,development,qualityofteaching, curriculumdemands,stateandlocalpolicy(Cottrell&Barrett, 2016),cognition,language,socialcompetence,academic behavior,co-morbiddisorders(ie,ADHD),family’s educationalhistory,andothersourcesofdata Consequently, anymethodwhichpurportstobethemostaccuratearguably over-simplifiestheconstruct(Schulz&Stephens-Pisecco, 2019)”

WhilesomestakeholdersguardAADandchoosetosupport its’continuationbecauseityieldsanumberwhichtheyfeelis moretrustworthythanallowingpractitionerstousetheir clinicaljudgementincombiningandanalyzingmultiple sourcesofdata,Schneider&Kaufman(2017)recognizedthe problemsinherentindichotomizingcontinuousdatavia arbitrarythresholds:“Nomatterwherewesetourcutscore thresholds,largenumbersofchildrenwithbarelydifferent scoreswillbeonoppositesidesofadecisionpoint Dichotomizationresultsintreatingdiagnosticnear-misses andegregiousdiagnosticblundersasmistakesofequal magnitude….Respectingthecontinuousnatureoflearning disabilityrequiresashifttoakindofthinkingwehumansfind tobequitedifficult:probabilisticreasoningwithcontinuous variables.Thequestionisnotwhetheralearningdisabilityis present,yesorno Thequestionisthedegreetowhichan academicskillisbeingdepressedbyweaknessesinoneor morecognitiveabilities”

Thisfocusonunderstandingprocessingskillsratherthanan overallmeasureofintelligence(ie,FSIQ)inthecontextof SLDidentificationwasechoedinarecentpaperbyMcGrew, Schneider,Decker,&Bulut(2023)whoconductedanetwork analysisofCHCintelligencemeasures,andconcluded: “ResultssupporttheprimarybroadabilitiesfromtheCattell–Horn–Carroll(CHC)theory ”

BreakingtheLegislativeLogjam

SomestakeholdersinNJhaveeithershownlittleaffectionfororaresimplyengagedinblockingtheadditionofthefederalthird optiontothespecialeducationcodebecausetheyopposedroppingAADanddonotseethepotentialforathirdoptionapproach,the PatternofStrengthsandWeaknesses(PSW)orcasestudies,toimprovenotonlyourunderstandingofstudents’cognitiveabilities, butalsotoguidethewaytowardmoreeffectiveinterventionsmeanttotargetthosedeficientabilities Somereportedthatitwill bringchaostothecurrentCSTsystemorfeelthatPSWwilljustreplaceAADwithlittledifferenceresulting Somefeelsecureinthe “number”(ie,resultsofthediscrepancyformula)theAADmethodyieldsandfeelthatanythingshortofthis(ie,practitionersusing theirclinicaljudgmentaboutalltheavailabledata)willresultinadisproportionatenumberofstudentsbeingclassified.Shanock, Flanagan,Alfonso,andMcHale-Small(2021)speaktothisworryandthecostsdistrictswillincurbypointingoutthatonedayof trainingandthepurchaseofsoftwarecosting$65willallowCST’stoimplementthisapproach Moreover,thehigherdegreeof precisionityieldsregardingtheexclusionofstudentswhoarenotSLDwillreducecurrentcosts.SomepreferRTIbecausethis approachhasnouniversalguidelines,allowingdistrictstodefinequestionsaboutwhenstudentsarebroughttotheRTIcommittee, whatinterventionsmaybeused,howlongprogressmonitoringshouldcontinue,whathappenstostudentswhofailinterventions, etc,(McBride,Dumont,andWillis,2011),thus,controllingwhoisdeterminedtobeSLDandwhoisnotSLD

Duringhis2015reviewofmy2016article,IhadapersonalcommunicationwithRonDumont,PhD,aformerpsychologyprofessorat FairleighDickinsonUniversityandanexpertinpsychologicalassessment,whoexpressedtheopinionthatthe“permission”touse PSWwasimplicitintheexistingcodelanguage.Consideringthecurrentlegislativelogjam,Irevisitedthecodesindetail,andIfound thefollowingsupportsforusingPSWorotheralternativemethods,and,ingeneral,formethodsthatare“comprehensive”(ie, definedasinvestigatingthestudent’scognitiveprocessingprofile):

WhereDoWeGofromHere?

IntheabsenceofalegislativefixfortheflawedAADandRTIcriteriacurrentlyinthespecialeducationcode,thereappearstobe justificationfortheapplicationofthirdoptionmethodslikePSWandcasestudyunderthefollowingconditions:

1 Committingtousemorethanonesinglemethodasthesolecriterionfordeterminingeligibility;

2.Conductingevaluationsthataresufficientlycomprehensive,thelatterdefinedastheevaluationofthepresenceofdeficitsinbasic psychologicalprocessesasstatedinthedefinitionofaSLD;

3 Consideringmethods(ie,PSW,casestudy)thatincludetheevaluationofpsychologicalprocesses;

4 Placinggreaterconfidenceintheclinicaljudgmentofpractitionerswhomustcombinenormativeandfunctionaldataintheir analyseswhileatthesametimebringingtobeartheirclinicalexperienceandintuition,affirmingthefactthatevaluatingstudentsis bothpartscienceandart;and

5 ProvidingtrainingforCST’sinthealternativemethodslikePSWorcasestudiesastheytransitionfromAADandfromRTI approachesthatdonotmeetthestatutoryrequirementsofthelaw.

ReferencesFurnishedUponRequest

AbouttheAuthor

Dr KorneriscurrentlyspearheadinganinitiativetorevisethespecialeducationcodeinNewJerseybyaddingthefederallyapproved thirdoptionwithcollaborationbetweentheNewJerseyPsychologicalAssociation,theNewJerseyAssociationofSchoolPsychologists,the NewJerseyAssociationofLearningConsultants,andtheLearningDisabilityAssociationofNewJerseywhereheisamemberofthe advisoryboard Dr Kornerwasawardedthe2018SamKirkAwardforEducatoroftheYearfromtheLearningDisabilityAssociationof Americaforhisneuropsychologicalmodelofassessment Dr Kornercurrentlymaintainsaprivatepracticespecializinginpsychotherapy forchildren,adolescents,adults,andfamiliesaswellasneuropsychologicalevaluations.

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