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.
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ABSTRACT: This study examined the neuropsychological profile, mental health outcomes, and coping strategies of chronic alcohol users involved in drug and alcohol counselling and investigated whether these factors could predict treatment outcome. The findings indicated that as compared with controls, chronic alcohol users demonstrated significant deficits in visuospatial, memory and executive functioning, and a higher level of emotional distress. At a 3-month follow-up, memory ability was found to significantly predict the percentage of goals achieved in counselling, the likelihood of dropout from therapy, and the likelihood of remaining abstinent. The value of further research into the influence of additional factors, such as executive functioning, mood, and coping strategies, on treatment outcomes in a larger sample was also supported.Australian Psychologist 10/2014; 49(5). · 0.61 Impact Factor
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ABSTRACT: I nterest in psychosocial treatment as non-pharmacologic treatment in the elderly has been in-creasing, and this treatment has became an important therapeutic approach for the following common psychiatric disorders: depressive disorder, anxiety disorder, some psychological con-ditions, and some cognitive disorders. Some examples of the psychosocial treatments frequently used with older people with psychiatric disorders are cognitive behavior therapy, interpersonal therapy, individual psychotherapy, reality orientation, validation therapy, reminiscence therapy, and cognitive training. Those treatment options should be used carefully in light of individual needs and optimal objectives for the elderly and their caregivers. It is crucial for the clinician to understand the characteristics and clinical applications of each psychosocial treatment for the el-derly in particular. Further studies are needed to demonstrate the feasibility and effectiveness of old and new psychosocial treatment modalities for older people with psychiatric disorders. Psy-chosocial treatments are very important with or without pharmacological treatment in the elderly with psychiatric problems. Clinician should become familiar with various psychosocial treatments.Journal of the Korean Medical Association 01/2010; 53(11). · 0.18 Impact Factor
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ABSTRACT: Chronic excessive alcohol consumption induces cognitive impairments mainly affecting executive functions, episodic memory, and visuospatial capacities related to multiple brain lesions. These cognitive impairments not only determine everyday management of these patients, but also impact on the efficacy of management and may compromise the absti-nence prognosis. Maintenance of lasting abstinence is associated with cognitive recovery in these patients, but some impairments may persist and interfere with the good con-duct and the efficacy of management. It therefore appears essential to clearly define neuropsychological management designed to identify and evaluate the type and severity of alcohol-related cognitive impairments. It is also essential to develop cognitive remediation therapy so that the patient can fully benefit from the management proposed in addiction medicine units. Alcoholism causes a multitude of social and health problems with negative impact on quality of life and secondary costs to society (1–3). Evidence suggests that numerous determinants such as envi-ronmental, individual, and genetic factors could favor evolution toward alcohol-dependence. These factors may also interact with each other. Among environmental factors, quality of the neighbor-hood (4) or socio-economic factors (e.g., lower educational level, employment status) (5, 6) for example may increase risks of alco-hol abuse. Individual and psychological characteristics including comorbid psychiatric disorders (7, 8), early life stress exposure (9), or impulsivity (10) are also risk-factors associated with chronic alcohol consumption. In addition, family, twin, and adoption studies have highlighted that genetic factors play an important role in the pathogenesis of alcohol-dependence (11–13). Heri-tability of alcohol-dependence is estimated between 50 and 80% (14) and is considered as a complex polygenic phenotype. In the same way, recent studies have examined cognitive endopheno-type in alcoholism. They have shown that non-alcoholic relatives of alcohol-dependent individuals performed worse on cogni-tive tasks (specifically executive functions) and presented greater impulsiveness compared to control [e.g., Ref. (15)]. From a neurobiological perspective, alcohol-dependence is a chronic disorder, which implies the dopaminergic system. As seen in other drugs abuses, alcohol consumption acutely stim-ulates dopamine (DA) release from the major terminal area of the mesolimbic DA system, nucleus accumbens (NAC). Enhanced DA transmission in the NAC plays a critical role in the positive rewarding aspects of drugs abuses and the initiation of addic-tive process. Chronic administration is associated with functional alterations of this important part of the brain reward system. Glob-ally, dysregulation of the dopaminergic system caused by chronic alcohol consumption produces drug dependence reinforcement and is most likely involved in the development of drug addiction (16–18). The harmful effects of chronic alcohol consumption on the brain and cognitive functioning have been well described in the literature over recent decades (19). Cognitive impair-ments observed in alcohol-dependent patients not presenting any other neurological complications are increasingly becom-ing the focus of attention of addiction medicine profession-als due to their impact on management, as, according to var-ious studies, between 50 and 80% of these patients present impaired cognitive function (20, 21). These impairments are moderate to severe but usually remain undiagnosed when they are not specifically investigated. However, detailed neuropsycho-logical assessment or screening of these cognitive impairments appears to be fundamental to optimally adapt patient management strategies.Frontiers in Psychiatry 07/2014;