Cognitive-behavioral therapy (CBT) refers to a collection of therapies which emphasize the individual’s ability to alter the relationship between a stimulus and the response through their cognition (Ellis 1973).
From the CBT perspective, mental health challenges are believed to be sustained through these cognitive factors (Hofmann et al. 2012). Research examining CBT’s effectiveness for the older population has increased in the last decade, and the most recent findings are reported here.
Key Research Findings
Research into CBT-based interventions has focused on three key mental health challenges, depression, anxiety, and insomnia (See “Mental Disorder”), for older adults. Depression is one of the most prevalent mental health challenges for older adults (World Health Organization 2015), so it is not surprising it has been the target of a considerable amount of research. A review into the effectiveness of CBT in older adults found it effective for older adults experiencing symptoms of major depression and dysthymia (Zalaquett and Stens 2006). There is similar support for CBT regarding anxiety disorders (Schuurmans et al. 2009). Furthermore, CBT aims to reduce symptoms of depression comorbid with anxiety for older adults (Weitz et al. 2018; Wuthrich et al. 2016). The third key area of CBT research for older adults is insomnia due to the changes in sleep patterns in aging (Buysse 2004). Again, CBT has been effective in reducing insomnia, and there is some evidence treatment for insomnia reduces clinical markers of risk of disease (Carroll et al. 2015; Morin 2010). Medication in conjunction with CBT has also been found effective for depression, anxiety, and insomnia (Cherukuri et al. 2018; Rosnick et al. 2016; Wuthrich et al. 2016).
Methods of delivering CBT in older adults also vary. While many CBT approaches are offered face-to-face, other methods are increasing in availability as many older adults have difficulty with mobility (Webber et al. 2010). Home-delivered, telephone-delivered, and online approaches have been found effective for reducing anxiety and anxiety symptoms (Barrera et al. 2017; DiNapoli et al. 2017; Gratzer and Khalid-Khan 2016; Scogin et al. 2018). CBT can also be offered in a group-based format and remain effective (Graham 2013; Wuthrich et al. 2016). CBT is also effective for a diverse older adult population, including rural, ethnical older adults (DiNapoli et al. 2017; Scogin et al. 2018), individuals with dementia (Tay et al. 2018), and older adults with attention deficit hyperactivity disorder (Solanto et al. 2018).
Unfortunately, there are some limitations with the use of CBT. The most revealing is the lack of non-Western studies examining CBT for older adults. Only one study, examining CBT in older Chinese adults with generalized anxiety disorder, was found for this review. This is problematic as populations become more diverse and there being a need to adapt therapies to different cultures (Lau and Kinoshita 2019). Mental health wise, most studies focus on older adults showing symptoms of a mental health disorder rather than those being diagnosed with a clinical disorder making it difficult to know if CBT would work for those who need it most (Cuijpers et al. 2009).
Future Directions of Research
Further research is needed to improve the universality of CBT for more diverse populations and mental health challenges. This does not just relate to the increase practice of CBT in non-Western countries, but also in recognition that Western countries are becoming more diverse and mental health issues more prevalent, both which are now appearing in the clientele (Cuijpers et al. 2009). Another direction is examining the different aspects of CBT to understand why some approaches are effective and others are not for older adults. Considering there are limited financial resources for helping older adults, any potential redundancies in therapy must be removed to use resources better (Jeste et al. 1999).
Another potential area of future research is discovering what aspect of CBT is effective and for whom. As mentioned, CBT is a group of interventions based on the same concept; the techniques involved though may vary. Potential differences between studies for older adults could be less about CBT and more about the techniques used. This could explain why some CBT interventions can focus on similar issues but have different outcomes (Beissner et al. 2009; Goode et al. 2018). This leads to the broader difficulty of knowing if it was CBT or the counselling experience in general which led to client improvements (McLaughlin and McFarland 2011). There is evidence CBT is effective in targeting specific cognitions, but its effectiveness compared to other therapies varies (Spinhoven et al. 2018).
Finally, the use of technology with CBT must be further investigated for older adults as they are one of the populations facing the most limitations regarding mobility. While this includes the general use of computers and phones, virtual reality is another option to explore. Virtual ability would allow the use of CBT techniques, such as in vivo exposure, from the home. Also, older adults can have a reduced ability to create mental images, an important ability for several CBT techniques, which can be counteracted using virtual reality (Grenier et al. 2015).
In summary, CBT is an umbrella term for many different therapies based on the same concept. It has been shown to be effective for older adults, but the research is limited, and the population examined is also limited. As a result, there are many possible directions for future research which will help us further understand how CBT can help older adults.
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