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The clinical need to address stress and depression in Latino dementia caregivers (CGs) combined with low health literacy and less accurate knowledge of dementia motivated the development of a pictorial tool [called a fotonovela (FN)] to teach (a) coping skills for caregiver (CG) stress; (b) self-assessment of depression; and (c) encourage improved utilization of available resources. To test the effectiveness of the FN, 110 of 147 Latino CGs, who were randomly assigned to the Fotonovela Condition (FNC) or the Usual Information Condition (UIC), were included in the final analyses. Self-report measures were given at baseline and post intervention. Results showed that FNC CGs demonstrated significantly greater reductions in level of depressive symptoms than UIC CGs. A significant decrease in level of stress due to memory and behavioral problems exhibited by their loved ones was similar in both groups. The FNC CGs reported that the FN was more helpful and that they referred to it more often than the UIC CGs did with regard to the informational materials they were provided about dementia. In conclusion, a culturally tailored FN can be an effective tool for Latino CGs given their high unmet needs for assistance and various barriers in accessing resources.

Previous research has identified three distinct factors that make up the Texas Revised Inventory of Grief-Present (TRIG-Present) scale, which tap into grief-related thoughts, emotional response, and nonacceptance regarding a loss. In the present study, the authors sought to identify which of these core grief experiences in the early aftermath of loss are predictive of subsequent intensified grieving. Information was collected from 169 conjugally bereaved older adults at 2- and 12-months following the loss of their spouse. Using a cross-lagged panel design, early experiences of nonacceptance were found to significantly predict more intense grief experiences later on; whereas grief-related thoughts and emotional response were not strongly related to grief at 12-months postloss, after accounting for synchronous (cross-sectional) and autoregressive (stability in the same factor over time) associations. These findings suggest that practitioners working with bereaved clients should pay close attention to early expressions of nonacceptance. (Contains 1 table and 2 figures.)

It has long been assumed that one of the reasons clients maintain improvement after psychotherapy is that they learn skills during the course of therapy and continue to apply them once therapy has ended. While research on homework completion and psychotherapy outcome provides support for this assumption, there has been no direct examination of "afterwork," the use of skills learned in therapy after therapy has ended, or how those posttherapy skills differ across different theoretical approaches. The purpose of this study is to test a skills hypothesis of long-term psychotherapeutic benefit in a sample of 90 older adults who have completed psychotherapy for depression. Helpfulness of the techniques learned in therapy was negatively associated with depressive symptoms up to 2 years after treatment. The number of techniques used was positively correlated with depressive symptoms within 6 months of treatment once helpfulness was controlled, indicating that skills learned in therapy are used when symptoms return. There were also between-group differences in which skills were reported to be covered and used by patients after therapy ended. These findings support the expectation that the benefits of therapy are extended by continuing to use helpful skills learned in therapy. (Contains 8 tables.)

There is growing evidence that psychosocial treatments incorporating behavioral intervention strategies can be effective in the treatment of depression in older adults with cognitive impairment. However, less work with such cases has focused on the use of cognitive interventions in tandem with these behavioral intervention strategies. This case study describes how cognitive behavioral intervention strategies and related homework assignments were tailored and integrated to successfully treat depressive symptoms in an older African American diagnosed with probable Alzheimer's disease. Examples of the homework strategies utilized are introduced by phase of treatment. We also discuss ways to overcome barriers to homework completion as well as methods to incorporate the client's sociocultural context and personal history into homework.