Cognitive Behavioural Therapy (CBT) is a psychological approach that was first developed for the treatment of depression by A.T. Back in the ‘60s, however, modern CBT derives from “cognitive revolutions” set in the ‘70s (Westbrook, Kennerley and Kirk, 2011).
In the past fifty years, research proved CBT to be an effective treatment for a wide range of mental issues such as depression, anxiety disorders, psychotic and eating disorders (Westbrook, 2011; Butler, Chapman et al. 2005). In the UK CBT is the most used treatment for these conditions (Nice 2009; 2011; 2014) and it is a recommended treatment for depression and anxiety symptoms in older people, and also for patients affected by dementia (NICE, 2006).
However, few studies can be found that show the effectiveness of CBT with older patients. This happened because CBT practice with older people started being discussed only thirty years ago, when there were some concerns about its applicability with this age group. Nonetheless, there is evidence of its efficacy, especially in the treatment of depression and anxiety (Wilkinson, 2013; Kraus, Seignourel et al 2008; Cristea, Huibers et al. 2015).
One of the strengths of the CBT approach is that it is personally tailored on the client’s needs. Some problems – physical ones, memory issues, cognitive problems – might occur more often later in life. For these reasons, some adjustments to CBT model were proposed and tested to meet the specific needs of elderly patients. The most common modification is in regards to the length and the number of sessions offered (shorter session but for longer time), the use of memory aids, a variegate presentation of the material and a more frequent use of summarizing (Cox, 2011; Evans, 2007).
Laidlaw et al. (2004) propose a modified conceptualization framework that takes into account some age-specific challenges. Role investment (e.g the loss of the role as worker when retiring), cohort beliefs (as strong stigma attached to mental illness), intergenerational linkage (with the common difficulties in communication within different generations) and socio-cultural context is some of the information that is taken into account.
Moreover, this model considers age-specific issues that might interfere with the therapy as ageism, passivity and dependency, beliefs regarding mental health problems and therapist’s beliefs (Evans, 2007).
Beliefs, such as “old people cannot have as much fun as younger people” or, “I am too old to do physical exercise” are examples of a negative attitude: these beliefs do not only reflect an influence of ageism and prejudice, but are also connected with the loss of a social network and with bereavement. These are examples of thoughts that the modified CBT model takes into account while challenging unhelpful thoughts, core beliefs and unwanted behaviours.
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Butler, A.C., Chapman, J.E., Forman, E.M. Beck, A.T. (2005) ‘The empirical status of cognitive-behavioural therapy: a review of meta-analysis’, Clinical Psychology Review, 26, pp. 17-31.
Cox, D. (2011) ‘Cognitive behavioural therapy with older adults’, BC Medical Journal, 53(7), pp.348-352.
Cristea, I.A., Huibers, M.J.H., David, D., Hollon, S.D., Andresson, G., Cuijipers, P. (2015) ‘The effects of cognitive behaviour therapy for adult depression on dysfunctional thinking: a meta-analysis’, Clinical Psychology Review, 42, pp.62-67.
Evans, C. (2007) ‘Cognitive-behavioural therapy with older people’, Advances in psychiatric treatment, 13, pp. 111-118.
Kraus, C.A., Seignourel, P., Balasubramanyam, V., Lynn Snow, A.L., Wilson, N.L., Kunik, M. Schulz, P.E., Stanely, M.A. (2008) ‘Cognitive-behavioral treatment for anxiety in patients with dementia’, Journal of Psychiatry Practitioner, 24(3), pp. 186-192.
Laidlaw, K., Thompson, L.W., Gallagher-Thompson, D. (2004) ‘Comprehensive conceptualization for cognitive-behavioral therapy for late life depression’ , Behavioral and Cognitive Psychotherapy, 32, pp. 389-399.
National institute of health and clinical excellence (2006) Dementia: supporting people with dementia and their carers in health and social care NICE guidelines CG42. London.
National institute of health and clinical excellence (2009) Depression in adults: recognition and management. NICE guidelinesCG90. London. Available at: https://www.nice.org.uk/guidance/cg90 Last access: 10.01.16
National institute of health and clinical excellence (2014) Psychosis and schizophrenia in adults: prevention and management. NICE guidelines CG178. Available at: https://www.nice.org.uk/guidance/cg178 Last access: 10.01.16
National institute of health and clinical excellence (2014) Generalised anxiety disorder and panic disorder in adults: management. NICE guidelines CG113. Available at: https://www.nice.org.uk/guidance/cg113 Last access: 10.01.16
Westbrook, D., Kennerley, H. and Kirk, J. (2011) An Introduction to Cognitive Behaviour Therapy Skills and Applications. 2nd Edition. SAGE Publications Ltd, London.
Wilkinson, P. (2013) ‘Cognitive behavioural therapy with older people’, Maturitas, 79, pp. 5-9.