**10. Treating trauma-related disorders in later life: moving forward**

#### **10.1 Treatment barriers**

Psychological treatment for older adults has been characterized by several barriers: myths about older adults' incapacity to change, low recognition of PTSD in primary care, the reluctance of older adults to use the services of mental health services for solving their problems and a limited body of evidence concerning trauma-focused treatment for older adults [12, 17, 21, 46]. Without addressing these barriers, older adults with PTSD will not gain access to treatment. By showing the potential of psychotherapy with older adult PTSD patients to achieve clinically meaningful results (both with NET and PCT), without compromising resiliency, the presented studies addressed the latter barrier.

#### **10.2 Adapting treatment formats**

Previously, age-specific modifications for standard treatments were proposed, such as increasing the structure of treatment, utilizing memory aids and simplifying materials [55]. These modifications mainly refer to form: i.e., the way in which treatment and its environmental conditions are personalized in response to patients' individual needs. These adaptations do not appear to exceed adequate personalization of treatment in general. The present research does not call for conceptually changing current treatment protocols when treating older adults. Full information and careful psycho-education have been found to prepare senior participants sufficiently for their treatment, either including direct trauma exposure or focusing on current stressors. As for treatment duration, extension was not considered to be justified. In treatment modules of 11 sessions, at least half of the participants achieved clinically meaningful treatment changes for PTSD symptoms. When addressing specific symptoms, such as traumatic grief, trauma-related systemic problems or nightmares, alternative interventions may be considered, such as Brief Eclectic Psychotherapy for traumatic grief or BEP-TG [56], interpersonal therapy [52], or imaginary rehearsal therapy [57]. In case of persisting maladaptive cognitions, schema therapy – found to be safe and effective with older adults - might serve as a sequel treatment [58].
