Melinda Stanley

Publications (10)29.5 Total impact

• Article: Predictors of treatment satisfaction among older adults with anxiety in a primary care psychology program.

  Natalie E Hundt, Maria E A Armento, Bennett Porter, Jeffrey A Cully, Mark E Kunik, Melinda Stanley
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  ABSTRACT: Increasing numbers of patients are treated in integrated primary care mental health programs. The current study examined predictors of satisfaction with treatment in patients from a randomized clinical trial of late-life generalized anxiety disorder (GAD) in primary care. Higher treatment satisfaction was associated with receiving CBT rather than enhanced usual care. Treatment credibility, treatment expectancies, social support, and improvements in depression and anxiety symptoms predicted higher treatment satisfaction in the total sample. In the CBT group, only credibility and adherence with treatment predicted satisfaction. This suggests that older patients receiving CBT who believe more strongly in the treatment rationale and follow the therapist's recommendations more closely are likely to report satisfaction at the end of treatment. In addition, this study found that adherence mediated the relationship between treatment credibility and treatment satisfaction. In other words, patients' perceptions that the treatment made sense for them led to greater treatment adherence which then increased their satisfaction with treatment.
  Evaluation and program planning 04/2013; 37:58-63. · 0.89 Impact Factor
• Source

  Available from: Karon F Cook

  Article: Telephone-Administered Cognitive Behavioral Therapy: A Case Study of Anxiety and Depression in Parkinson’s Disease

  Connie Veazey, Karon F. Cook, Melinda Stanley, Eugene C. Lai, Mark E. Kunik
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  ABSTRACT: Parkinson’s disease (PD) is a chronic medical illness with a high incidence of psychiatric comorbidity, specifically depression and anxiety. Research on treatment of such psychiatric complications is scarce. Non-pharmaceutical treatment options are especially attractive. Cognitive behavioral therapy (CBT) is a psychotherapeutic treatment option that has been successful in other chronically medically ill populations with comorbid depression and anxiety. The current research had two aims. The first was to pilot the feasibility of screening and identifying PD patients with symptoms of anxiety and depression in a specialized outpatient clinic. The second aim was to pilot the feasibility of telephone-administered CBT for the treatment of depression and anxiety in persons with PD, which was done through a case series comparing telephone-administered CBT to a Support strategy. A fairly large portion (67.5%) of patients screened in the outpatient clinic were identified as having symptoms of anxiety and/or depression. Results also indicated that CBT delivered via the telephone is a useful approach for targeting psychiatric symptoms in this population. A case example is given to illustrate the clinical considerations associated with delivering therapy via telephone to persons with PD.
  Journal of Clinical Psychology in Medical Settings 04/2012; 16(3):243-253. · 1.49 Impact Factor
• Article: Characteristics of generalized anxiety disorder in patients with dementia.

  Jessica S Calleo, Mark E Kunik, Dana Reid, Cynthia Kraus-Schuman, Amber Paukert, Tziona Regev, Nancy Wilson, Nancy J Petersen, A Lynn Snow, Melinda Stanley
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  ABSTRACT: Overlap of cognitive and anxiety symptoms (i.e., difficulty concentrating, fatigue, restlessness) contributes to inconsistent, complicated assessment of generalized anxiety disorder (GAD) in persons with dementia. Anxious dementia patients completed a psychiatric interview, the Penn State Worry Questionnaire-Abbreviated, and the Rating for Anxiety in Dementia scale. Analyses to describe the 43 patients with and without GAD included the Wilcoxon Mann-Whitney two-sample test, Fisher's exact test. Predictors of GAD diagnosis were identified using logistic regression. Those with GAD were more likely to be male, have less severe dementia and endorsed more worry, and anxiety compared to patients without GAD. Gender, muscle tension and fatigue differentiated those with GAD from those without GAD. Although this study is limited by a small sample, it describes clinical characteristics of GAD in dementia, highlighting the importance of muscle tension and fatigue in recognizing GAD in persons with dementia.
  American Journal of Alzheimer s Disease and Other Dementias 11/2011; 26(6):492-7. · 1.45 Impact Factor
• Article: Psychosocial determinants of outcomes in knee replacement.

  Maria A Lopez-Olivo, Glenn C Landon, Sherwin J Siff, David Edelstein, Chong Pak, Michael A Kallen, Melinda Stanley, Hong Zhang, Kausha C Robinson, Maria E Suarez-Almazor
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  ABSTRACT: To identify potential psychosocial and educational barriers to clinical success following knee replacement. Patients and The authors evaluated 241 patients undergoing total knee replacement, preoperatively and 6 months after surgery. Outcomes included the Western Ontario McMaster (WOMAC) scale and the Knee Society rating system (KSRS). Independent variables included: the medical outcome study-social support scale; depression, anxiety and stress scale; brief COPE inventory; health locus of control; arthritis self-efficacy scale and the life orientation test-revised. Multiple regression models evaluated associations of baseline demographic and psychosocial variables with outcomes at 6 months, controlling for body mass index, comorbidities and baseline outcome scores. Patients' mean age was 65 ± 9 years; 65% were women. Most patients improved outcomes after surgery. Several psychosocial variables were associated with outcomes. Regression analyses indicated lower education, less tangible support, depression, less problem-solving coping, more dysfunctional coping, lower internal locus of control were associated with worse WOMAC scores (R(2) contribution of psychosocial variables for pain 0.07; for function, 0.14). Older age, lower education, depression and less problem-solving coping were associated with poorer total KSRS scores (R(2) contribution of psychosocial variables to total KSRS model 0.09). Psychosocial variables as a set contributed from 25% to 74% of total explained variance across the models tested. Patients' level of education, tangible support, depression, problem-solving coping, dysfunctional coping and internal locus of control were associated with pain and functional outcomes after knee replacement. The findings suggest that, in addition to medical management, perioperative psychosocial evaluation and intervention are crucial in enhancing knee replacement outcomes.
  Annals of the rheumatic diseases 07/2011; 70(10):1775-81. · 8.11 Impact Factor
• Article: Early response to psychotherapy and long-term change in worry symptoms in older adults with generalized anxiety disorder.

  Andrea Bradford, Jeffrey Cully, Howard Rhoades, Mark Kunik, Cynthia Kraus-Schuman, Nancy Wilson, Melinda Stanley
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  ABSTRACT: To determine the association of early and long-term reductions in worry symptoms after cognitive behavior therapy (CBT) for generalized anxiety disorder (GAD) in older adults. Substudy of larger randomized controlled trial. Family medicine clinic and large multispecialty health organization in Houston, TX, between March 2004 and August 2006. Patients (N = 76) aged 60 years or older with a principal or coprincipal diagnosis of GAD, excluding those with significant cognitive impairment, bipolar disorder, psychosis, or active substance abuse. CBT, up to 10 sessions for 12 weeks, or enhanced usual care (regular, brief telephone calls, and referrals to primary care provider as needed). Penn State Worry Questionnaire (PSWQ) administered by telephone at baseline, 1 month (mid treatment), 3 months (posttreatment), and at 3-month intervals through 15 months (1-year follow-up). The authors used binary logistic regression analysis to determine the association between early (1 month) response and treatment responder status (reduction of more than 8.5 points on the PSWQ) at 3 and 15 months. The authors also used hierarchical linear modeling to determine the relationship of early response to the trajectory of score change after posttreatment. Reduction in PSWQ scores after the first month predicted treatment response at posttreatment and follow-up, controlling for treatment arm and baseline PSWQ score. The magnitude of early reduction also predicted the slope of score change from posttreatment through the 15-month assessment. Early symptom reduction is associated with long-term outcomes after psychotherapy in older adults with GAD.
  The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 04/2011; 19(4):347-56. · 3.35 Impact Factor
• Article: Generalized anxiety disorder in older medical patients: diagnostic recognition, mental health management and service utilization.

  Jessica Calleo, Melinda A Stanley, Anthony Greisinger, Oscar Wehmanen, Michael Johnson, Diane Novy, Nancy Wilson, Mark Kunik
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  ABSTRACT: Primary care physicians often treat older adults with Generalized Anxiety Disorder. Objective To estimate physician diagnosis and recognition of anxiety and compare health service use among older adults with GAD with two comparison samples with and without other DSM diagnoses. Participants were 60+ patients of a multi-specialty medical organization. Administrative database and medical records were reviewed for a year. Differences in frequency of health service use were analyzed with logistic regression and between-subjects analysis of covariance. Physician diagnosis of GAD was 1.5% and any anxiety was 9%, and recognition of anxiety symptoms was 34% in older adults with GAD. After controlling for medical comorbidity, radiology appointments were increased in the GAD group relative to those with and without other psychiatric diagnoses, chi(2) (2, N = 225) = 4.75, p < .05. Most patients with anxiety do not have anxiety or symptoms documented in their medical records.
  Journal of Clinical Psychology in Medical Settings 01/2009; 16(2):178-85. · 1.49 Impact Factor
• Article: Anxiety in dementia: a critical review.

  Paul J Seignourel, Mark E Kunik, Lynn Snow, Nancy Wilson, Melinda Stanley
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  ABSTRACT: Until recently, little attention has been paid to anxiety symptoms in dementia. However, anxiety is common in this population, and associated with poor outcome and quality of life. The current review examines the existing literature around three major themes: the definition of anxiety in dementia, the properties of available instruments for assessment, and the clinical characteristics of anxiety in this population. Defining anxiety in individuals with dementia is complicated by the overlap between symptoms of anxiety, depression and dementia, and by the influence of the source of information. Several instruments are available to assess anxiety in this population, including general neuropsychiatric instruments and two scales designed specifically for this purpose. The reliability of these instruments is acceptable, but their validity has not been sufficiently examined, and they may discriminate poorly between anxiety and depression. Anxiety may be higher in vascular dementia than in Alzheimer's Disease, and it decreases in the severe stages of dementia. It is associated with poor quality of life and behavioral disturbances, even after controlling for depression. Little is known, however, about its social and environmental correlates. Limitations of the existing literature and key directions for future research are discussed.
  Clinical psychology review 04/2008; 28(7):1071-82. · 4.90 Impact Factor
• Article: Investigation of cognitive behavior therapy.

  Nancy A Skopp, Diane Novy, Mark Kunik, Patricia Daza, Jennifer Harned Adams, Ashley Senior, Melinda Stanley
  American Journal of Geriatric Psychiatry 04/2006; 14(3):292. · 3.64 Impact Factor
• Source

  Available from: tamiu.edu

  Article: The utility of somatic symptoms as indicators of depression and anxiety in military veterans with chronic obstructive pulmonary disease.

  Christopher J Ferguson, Melinda Stanley, Julianne Souchek, Mark E Kunik
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  ABSTRACT: The interrelationship between medical illnesses and psychological distress has received increasing attention in the last several years. Partly at issue is the best way to diagnose mental health problems such as depression and anxiety in medical populations. Specifically, are somatic symptoms a valid indicator of depression and anxiety in a medical population? Furthermore, do anxiety and depression remain as distinct constructs for this population, or do they combine to represent general distress? We examine these issues using confirmatory factor analysis in a sample of 202 military veterans with chronic obstructive pulmonary disease. Results indicate best fit for a model of depression and anxiety for which the constructs remained separate rather than as combined indicators of general distress. Furthermore, in this model, somatic symptoms are retained as valid indicators of psychological distress for this sample.
  Depression and Anxiety 02/2006; 23(1):42-9. · 4.18 Impact Factor
• Source

  Available from: vaprojectaccess.org

  Article: Cognitive-Behavioral Therapy: Innovations for Cardiopulmonary Patients With Depression and Anxiety

  Jeffrey A. Cully, Amber Paukert, Jessica Falco, Melinda Stanley
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  ABSTRACT: Medically ill patients face unique physical and emotional challenges that place them at increased risk for symptoms of depression and anxiety. Despite high prevalence and significant impact, depression and anxiety are infrequently treated in the medically ill because of a variety of patient, provider, and system factors. The current article describes the development of an innovative, modular-based cognitive-behavioral intervention (Adjusting to Chronic Conditions Using Education Support and Skills [ACCESS]) that integrates treatment for symptoms of anxiety and depression with medical disease self-management in patients with heart failure and chronic obstructive pulmonary disease. Data from 3 patients who participated in an ongoing open clinical trial are reviewed to illustrate the feasibility, acceptability, and potential strengths and limitations of this intervention.
  Cognitive and Behavioral Practice.