The role of executive functioning in CBT: A pilot study with anxious older adults

Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, USA.
Behaviour Research and Therapy (Impact Factor: 3.85). 05/2005; 43(4):447-65. DOI: 10.1016/j.brat.2004.03.007
Source: PubMed


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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    • "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). "
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    • "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). "
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    • "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. "
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