Conference Coverage

Cognitive-behavioral therapy modified for maximum efficacy in the elderly



– For elderly individuals with depression exacerbated by physical limitations and personal losses, cognitive-behavioral therapy is a powerful tool for improving quality of life, according to the faculty of a workshop on this topic at the annual meeting of the American Psychiatric Association.

“The focus is on coping skills. It is about how to persevere in the face of adversity,” explained David A. Casey, MD, professor and chair of the department of psychiatry and behavioral sciences at University of Louisville (Ky.).

Dr. David A. Casey, professor and chair, department of psychiatry and behavioral sciences, University of Louisville (Ky.) Ted Bosworth/MDedge News

Dr. David A. Casey

The principles of cognitive-behavioral therapy (CBT) are the same in older relative to younger patients, but the hurdles to progress may be greater in older individuals, demanding slower and more incremental gains in behaviors that lead to quality of life improvement.

“It is not always a fair characterization, but CBT is often perceived as a strategy to address negative thoughts that are not real – but many of my elderly patients have losses and difficulties that are very real,” Dr. Casey said.

In the elderly who become increasingly isolated because of the loss of spouses, friends, and siblings while contending with medical problems that cause pain and limit activities, depression can engender withdrawal, a common coping mechanism, he said.

“Withdrawal may be an unexamined response to a sense of helplessness created by the problems of aging, but it can create a vicious cycle when depression contributes to lack of physical activity and further withdrawal,” explained Dr. Casey, who believes that mild cognitive impairment does not preclude the use of CBT.

CBT provides a “here-and-now” approach in which patients are reconnected to daily life by first identifying the activities that once provided pleasure or satisfaction and then developing a plan to reintroduce them into daily life. Except for its value in identifying activities meaningful to the patient, the history that preceded depression or psychological distress is less important than developing an immediate strategy to rebuilding an active life.


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