Cognitive–behavioural therapy with older people

Abstract

Cognitive–behavioural therapy (CBT) is an effective treatment for a number of psychiatric disorders in adults of all ages. With the proportion of the population aged 65 or over increasing steadily, it is important to be aware of how the CBT needs of this age group can be best met. This article provides an overview of CBT and the historical context of using it with older people. Although an understanding of the individual, irrespective of age, is at the core of CBT, potential modifications to the procedure and content aimed at optimising its effectiveness for older people are discussed.

Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

“…30 Our findings also support guidance for the adaptation of CBT for older populations, particularly the recommendation to avoid approaches relying on rigid manualisation. 117 The process evaluation complemented the intervention development work by highlighting the work required to develop an intervention that would 'make sense' to key groups whose participation was expected and/or required. …”

A randomised controlled trial of cognitive behaviour therapy vs treatment as usual in the treatment of mild to moderate late life depression

“…Cognitive Behaviour Therapy (CBT) with older people is an active, directive, time-limited, and structured treatment approach whose primary aim is symptom reduction (Laidlaw et al, 2003). CBT is probably the most systematically researched psychosocial treatment for depression in later life (Scogin et al, 2005;Evans, 2007) with recent meta-analyses providing support for its use as a treatment for late life depression (Pinquart and Sorensen, 2001;Cuijpers et al, 2006;Pinquart et al, 2006). Nonetheless the use of CBT as a treatment remains uncommon despite recognition of its efficacy (Wei et al, 2005).…”

Caring for the carer: a systematic review of pure technology-based cognitive behavioral therapy (TB-CBT) interventions for dementia carers

“…This may have biased the intervention effect in several ways. On one hand, the intervention effect may be underestimated due to age-based differences in the mechanisms of CBT, where older people typically require longer exposure to an intervention in order to learn and adopt techniques and thus, demonstrate therapeutic gain (Evans, 2007). Conversely, the results may have been biased as an older sample of carers is less likely to include sandwiched generation carers.…”

“…The remaining trial (Steffan, 2000) reported significant differences between participants who completed the trial and those who withdrew, with greater numbers of younger participants opting to withdraw. This is a noteworthy difference given that research has indicated that older individuals may take longer to learn CBT techniques, and thus demonstrate benefit from CBT-based interventions (Evans, 2007;Zeiss & Steffan, 1996).…”