Intervention for Anxiety After Falls

The purpose of this study is to determine whether a brief intervention for disabling anxiety is practical to conduct and beneficial for older adults injured by falls.

Falls are the most commonly occurring cause of traumatic injury among older adults. For many, the consequences include reduced mobility, difficulty performing basic self-care, social isolation, deteriorating health, or even death. Most interventions for falls do not address anxiety in the aftermath of falling.

After an initial study assessment, participants will complete 8 home-based sessions of a Cognitive-Behavioral therapy (CBT). The sessions will be led by a study clinician who will cover the 5 intervention components:(a) education (learning about anxiety and the rationale for treatment); (b) relaxation training (learning skills to reduce tension); (c) cognitive restructuring (learning skills needed to cope better with distressing thoughts); (d) behavioral activation (learning to initiate healthy activity); and (e) exposure (coaching in how to confront avoided thoughts, situations, and people).

Participants will also complete assessments following completion of the intervention and 3 months after completion of the intervention.

• Posttraumatic Stress Disorder (PTSD)
• Specific Phobia
• Anxiety

• Behavioral: Education
  Learning about anxiety
  Other Name: Psychoeducation
• Behavioral: Relaxation Training
  Learning skills to reduce tension
  Other Names:

  • Relaxation
  • Stress Reduction
  • Stress Reduction Training
• Behavioral: Cognitive Restructuring
  Learning skills needed to cope better with distressing thoughts
  Other Names:

  • Cognitive Reframing
  • Positive self-talk
• Behavioral: Behavioral Activation
  Learning to initiate healthy activity
  Other Name: Increasing physical activity
• Behavioral: Exposure
  Coaching in how to confront avoided thoughts, situations, and people)
  Other Names:

  • Imaginal exposure
  • In vivo exposure

Inclusion Criteria:

• age > or = 65 years
• English-speaking
• injured due to fall
• hospitalized
• returned home < or = 3 months
• ambulatory
• full or subsyndromal PTSD or Fear of Falling
• residing in one of the five boroughs of New York City

Exclusion Criteria:

• Inability to understand assessment questions
• Marked cognitive impairment
• Dementia
• Schizophrenia
• Bipolar Disorder
• Depression with psychotic features
• Delusional Disorder
• Substance Use Disorder or Dependence
• Active suicidal ideation, intent, or plan
• Active homicidal ideation, intent or plan
• Aphasia
• Acute or severe medical illness or life expectancy < 6 months
• Initiated psychotropic medications < 6 weeks prior
• Initiated mental health treatment < 6 weeks prior
• Psychosocial factors that would compromise study participation (such as not having a telephone)