CBT with older adults

Question 1

What does the equality act 2010 do?

Answer 1

Makes it illegal to discriminate against any of the protected charactersitics: age, race, gender etc

Question 2

What are some key findings of CBTs effectiveness with old people?

Answer 2

-Reviews & meta-analyses: CBT can reduce depression & anxiety in ‘young old’ with and without chronic physical health conditions (Gould 2012a,b; Orgeta 2018; Reavell 2018; Shang 2020; Williams 2020; Zhang, 2020).
-Practice-based evidence: In IAPT, service users age 65+ are more likely to do better than those under 65 (Saunders et al., 2021). -However: Older adults are under-represented, suggesting filtering
OA are more likely to be offered interpersonal therapy (IPT) or counselling rather than CBT.

Question 3

What are some of the adaptations we might need to apply to older people?

Answer 3

• Beliefs about age
• Physical disabilities & sensory deficits
• Neurocognitive deficits
• History (illness & treatments inc psychological therapy)
• Adverse life circumstances inc environmental context
• Dependency on others / lack of autonomy

Question 4

What are some of the barriers to address in CBT when working with older people?

Answer 4

• The understandability trap (fallacy of good reasons)
  Too much respect
  Therapeutic nihilism
  Therapist fears of ageing, dependency & death
  Neurocognitive overshadowing
  Living in the shadow of adultism

Question 5

What are some of the things on the realistic negative thought protocol?

Answer 5

-Identify the personal meaning of the thoughts; challenge underlying distortions
-Identify & address barriers to emotional expression; enhance self-compassion
-Enhance personal control (self-efficacy); problem-solve & use coping strategies;
-Examine the usefulness of the NATs (metacognition)
-Schedule worry/grief & take time out from the struggle
-Plan for the future: “hope for the best; prepare for worst” (whatever is at the bottom of the anxiety downward arrow)