The role of executive functioning in CBT: A pilot study with anxious older adults
ABSTRACT Cognitive behavior therapy (CBT) is an effective treatment for late life anxiety and depression. The successful use of CBT is assumed to rely on cognitive skills known as executive functions (EF; e.g., hypothesis generation, allocation of attention, self-monitoring) governed by the prefrontal cortex. Because older adults sometimes have executive deficits as a consequence of normal aging, EF may be a mediator of CBT outcome in older samples. The current pilot study tested the hypothesis that older adults with executive deficits (as measured by neuropsychological tests) would show decreased therapeutic benefit from CBT for generalized anxiety disorder, as compared to a group with intact EF. Results indicated differential response to CBT within the dysfunction group depending on the stability (and possibly, the etiology) of executive deficits from pre- to posttreatment. Those whose EF scores remained low from pre- to posttreatment did not respond to CBT, while those whose scores improved responded quite well, similar to an Intact EF group. Results indicate that some, but not all, older adults with executive dysfunction show decreased benefit from CBT, and are consistent with the assumption that executive skills are important for the successful use of CBT. However, some participants may show improvement on both mood and cognitive skills during treatment, which is discussed further.
- SourceAvailable from: Stacie L Warren
[Show abstract] [Hide abstract]
- "For example, an individual who has trouble shifting might need help planning strategies to transition more easily between daily tasks. It has been shown that the efficacy of current psychological treatments depends on adequate EF (Mohlman and Gorman, 2005). For example, CBT involves reappraisal, hypothesis generation , and self-monitoring, which all require EF (Mohlman and Gorman, 2005; Gotlib and Joormann, 2010). "
ABSTRACT: Emotion-cognition and motivation-cognition relationships and related brain mechanisms are receiving increasing attention in the clinical research literature as a means of understanding diverse types of psychopathology and improving biological and psychological treatments. This paper reviews and integrates some of the growing evidence for cognitive biases and deficits in depression and anxiety, how these disruptions interact with emotional and motivational processes, and what brain mechanisms appear to be involved. This integration sets the stage for understanding the role of neuroplasticity in implementing change in cognitive, emotional, and motivational processes in psychopathology as a function of intervention.Frontiers in Human Neuroscience 06/2013; 7:261. DOI:10.3389/fnhum.2013.00261 · 2.99 Impact Factor
[Show abstract] [Hide abstract]
- "Clients with some level of cognitive impairment (who may find cognitive or emotion-focused work challenging) may also benefit from more behaviorally oriented strategies such as BA. Notably, roughly 1 out of every 4 older adults age 65 or above are likely to have some level of mild to severe cognitive impairment (Graham et al., 1997; Unverzagt et al., 2001), and there is evidence to suggest that these individuals might have poorer outcomes in cognitively focused therapies (Caudle et al., 2007; Mohlman & Gorman, 2005), underscoring the need for clinicians to be sensitive to this issue when selecting appropriate interventions. BA's straightforward and structured approach may be particularly well suited for individuals with executive dysfunction and other cognitive impairments, and studies have found that BA is effective with dementia patients (Teri, Logsdon, Uomoto, & McCurry, 1997) as well as with geriatric psychiatry inpatients (Snarski, Scogin, DiNapoli, Presnell, McAlpine, & Marcinak, 2011). "
ABSTRACT: Behavioral activation (BA) has been shown to be effective for a number of psychological problems, most notably depression. Although only a few studies have examined the efficacy of BA-based interventions with bereaved older adults, there are a number of reasons to believe that this approach has the potential to bring about meaningful and substantial change for this population. This article provides a theoretical and empirical rationale for the relevance of BA for bereaved older adults and describes the procedures and unique clinical considerations of BA with this population, which is illustrated in two case examples.Clinical Gerontologist 07/2012; 35(4):303-315. DOI:10.1080/07317115.2012.680685 · 0.94 Impact Factor
[Show abstract] [Hide abstract]
- "Some studies also report small-to-moderate positive associations between reduced PPI and poor performance on measures of attention (Karper et al., 1996; Kumari et al., 2007) and executive function, in particular cognitive flexibility (Butler et al., 1991; Kumari et al., 2007), in schizophrenia, suggesting that deficient gating may interfere with higher order cognitive function. Given these observations , and previous findings indicating that relatively intact (pre-therapy) executive processing is associated with good clinical responsiveness to CBT across many disorders, including depression (Moorey et al., 2001; Julian and Mohr, 2006) and generalized anxiety disorder (Mohlman and Gorman, 2005), we hypothesised that there would be a positive association between pre-therapy PPI level and clinical response to CBTp in patients with schizophrenia. In addition, we explored the relationship between pre-therapy level of startle habituation and CBTp response. "
ABSTRACT: Prepulse inhibition (PPI) of the startle response refers to the ability of a weak prestimulus to transiently inhibit the response to a closely following strong sensory stimulus. PPI provides an operational index of sensorimotor gating and is reduced, on average, in people with schizophrenia, relative to healthy people. Given the variable response to Cognitive Behaviour Therapy for psychosis (CBTp) and positive associations between pre-therapy brain and cognitive functions and CBT outcome across disorders, we examined whether pre-therapy level of PPI is associated with clinical outcome following CBTp. Fifty-six outpatients stable on medication with at least one distressing symptom of schizophrenia and willing to receive CBTp in addition to their usual treatment were assessed on acoustic PPI. Subsequently, 28 patients received CBTp (CBTp+treatment-as-usual, 23 completers) for 6-8months and 28 continued with their treatment-as-usual (TAU-alone, 17 completers). Symptoms were assessed (blindly) at entry and follow-up. The CBTp+TAU and TAU-alone groups did not differ demographically, clinically or in PPI at baseline. The CBTp+TAU group showed improved symptoms relative to the TAU-alone group, which showed no change, at follow-up. Pre-therapy PPI level correlated positively with post-CBTp symptom improvement. Relatively intact sensorimotor gating is associated with a good clinical response following a 6-8months course of NICE compliant CBTp in schizophrenia. Pharmacological or psychological interventions capable of improving PPI may enhance the effectiveness of CBTp in people with schizophrenia, particularly in those who fail to show clinical improvement with currently available antipsychotic drugs and adjunctive CBTp.Schizophrenia Research 12/2011; 134(2-3):232-8. DOI:10.1016/j.schres.2011.11.020 · 3.92 Impact Factor