Geriatric Mental Health Disaster and Emergency Preparedness

338 Geriatric Mental Health Disaster and Emergency Preparedness
n What do I need to repair?
n Will I forgive?
n Was I good enough? Am I good enough?
All these questions are challenging and sometimes anxiety provoking
for anyone at any given time. Some of these questions are grounded in
false beliefs, irrational cognitions, and misperceptions about the self and
are best dealt with using a cognitive behavioral approach. Other questions
can be the focus of therapy, pastoral counseling, or spiritual direction relative
to the veteran’s stated preference. By clarifying which existential/spiritual
questions are most significant to the veteran, the provider is better
equipped to understand the impact of trauma upon the whole person.
Such understanding typically illuminates problematic patterns of behavior
and the persistence of irrational thinking confirming unhealthy guilt.
These elements often support avoidance and ambivalence in the treatment
process. How these questions relate to the veteran’s perceptions of
the current global crisis and threats of future acts of war or terrorism is crucial
to understanding where the veteran is on his or her own journey toward
healing and the integration of past combat trauma.
THE USE OF EVIDENCE-BASED PRACTICE (EBP)
WITH GERIATRIC COMBAT VETERANS
There are a variety of EBPs that have gained the attention and endorsement
of the VA and/or Department of Defense (DOD) for the treatment of
PTSD. Among these are cognitive processing therapy (Resick, et al., 2007),
prolonged exposure (Foa, Hembree, & Rothauma, 2007), and psychosocial
rehabilitation (Foa, Keane, & Friedman, 2000). These CBTs primarily
have been used successfully with the younger cohorts of veterans and to
date have not been adequately used and studied with WWII and Korean
combat veterans. CBT methods, however, whether applied to younger or
older combat veterans, require extensive therapist training. Untrained professionals
or paraprofessionals should not utilize them.
Psychosocial Rehabilitation Model (PRM)
One of the most successful EBPs that has been used with older veterans is
PRM. The model seeks to improve and enhance interpersonal relationships