NB This article on CBT for Older Adults is based on the author’s entry of Cognitive-Behavioral Therapy to the Encyclopedia of Gerontology and Population Aging. See reference at the bottom of this web page.
Cognitive Behavioural Therapy is one of the most widely used therapies in the mental health field, so it is no surprise that research has been conducted to examine its effectiveness for older adults.
The available research however focuses on a much narrower range of mental health issues compared to other populations, and older adults can face unique challenges.
Researched Mental Health Challenges
Depression, insomnia, and anxiety are the three main mental health challenges which have been the focus of research into CBT for older adults. CBT has been found effective for older adults experiencing symptoms of depression and dysthymia; this is also true for older adults with symptoms of anxiety, and for those with symptoms of depression and anxiety.
While depression and anxiety are common focuses in CBT in general, insomnia is more heavily researched in older populations as they are more prone to this issue. Fortunately CBT has been shown to be effective in treating insomnia as well.
The problem is that research into the use of CBT for other mental health challenges in older adults is limited. There is some evidence it can be useful for older adults dealing with Dementia or ADHD for example, but these studies are few and far between. This is no surprise, as research into older adults tends to underestimate the heterogeneity found in this age group. It can be hard to remember older adults have had years to become their own person, with their own unique story and way of living; yet still be a group of individuals who might have dealt or are dealing with the same mental health issues the younger generations face.
Furthermore, research that focuses on older adults faces the challenge of medication more often than research into other populations. Many older adults have multiple prescriptions which can negatively influence their cognitive health and cause symptoms of mental health challenges. This conflicts with the nature of research, which often excludes individuals whose symptoms can be the result of medication. Research into CBT and older adults needs to be able to take this challenge into account, for the research to apply for the general older population.
CBT has been used with older adults in a variety of formats.
The traditional format of one-on-one therapy is perhaps the most common but there has also been research into group therapy.
CBT’s ability to be structured and manually presented has also made it a good therapeutic contender for research using home-delivered, telephone-delivered and online approaches. The older adult population is also quite attractive for these different formats as many might face mobility issues or have other challenges preventing them from accessing traditional forms of treatment.
Using CBT with Older Adults
While general knowledge about the use of CBT and older adults is useful, it can be difficult to apply in practice for counsellors and psychologists. These tips below will help therapists to adapt CBT for older clients.
- Older adults will also have things to teach you – CBT involves teaching clients new skills and giving them new information. It must not be forgotten however, that older adults have lived long lives, resulting in them having many skills and pre-existing knowledge, so a more equal relationship than that when using CBT with other demographics will facilitate the therapy further. This may mean the therapist changing their approach from teaching, to demonstrating respect for what the client has learned, and being open to learning from their client.
- Older adults are a very heterogenous population – As previously mentioned, older adults have lived many years and had more opportunities to become different from one another. When using CBT with older people, the therapist must keep these differences in mind and be aware that their approach might require more adaptation, than when working with other populations. This might seem like common sense but because society has a habit of grouping older adults together, it can be easy to forget every older adult can be so different.
- Older adults have had very different life experiences – We live in a time when it is a struggle to understand the life experience of individuals less than a decade older than us. For young counsellors and psychologists, it can be a challenge to understand the experiences of someone who has lived many more years, and in very different decades. Even older counsellors and psychologists themselves, need to be mindful when counselling someone who has had decades to live a completely different life, and different thoughts and behaviours hammered into them. As with other approaches, being aware of the different life experiences can provide the therapist with insight into the thoughts and behaviour of their clients, leading to more effective counselling.
In summary, CBT can be an effective therapy for older adults. Counsellors and psychologists must keep in mind however that the research is more limited than for other populations and that greater adaptation might be required.
Author: Hannah Jensen-Fielding, BA (Psychology) Hons, M Couns., PhD Candidate.
Hannah Jensen-Fielding is a Brisbane therapist working from a strengths-based integrative approach, as she believes more momentum is gained by looking forward at the future and who we can become. She utilises mindfulness in therapy where appropriate, to help her clients reduce stress and achieve greater perspective.
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- Jensen-Fielding, H (in press). Cognitive-Behavioral Therapy. In D. Gu & M.E. Dupre (Eds.), Encyclopedia of Gerontology and Population Aging. Singapore: Springer.