What Adaptations And Under What Circumstances

Adaptations are not always essential for older people to benefit from treatment with cognitive therapy for depression (Steuer & Hammen, 1983; Zeiss & Steffen, 1996). Modification of therapy may be indicated and may be required to take account of issues to do with normal age-related changes, such as the presence of chronic physical illness and slowed cognitive processing (Grant & Casey, 1995). Modifications are intended to enhance treatment outcome within the model of therapy (that is, CT), whereas adaptations are intended to alert clinicians to the possibility that the treatment model they have chosen may be inadequate for the circumstances (Laidlaw, 2001). Cognitive therapy is particularly appropriate as an intervention for older adults, as it takes into account normal age-related changes in the formulation of an individual's problems (Thompson, 1996). In more ways than not, cognitive therapy with older people is similar to therapy with younger people. Interestingly, Miller and Silberman (1996: 93) come to a very similar conclusion when discussing the issue of adapting IPT for use with older adults, concluding that 'IPT with elders shares far more similarities than differences to IPT with younger patients'.

When it is argued that adaptations are unnecessary, the assertion is that structural elements of cognitive therapy such as agenda setting, collaborative empiricism, cognitive conceptualisation, cognitive restructuring and homework setting are all essential elements. Cognitive therapy is a relevant and accessible therapy precisely because it deals with older people's current concerns, whether grief, physical limitations following a stroke or general emotional distress.

Two pieces of evidence from the empirical literature caution the clinician against drawing the conclusion that in order for cognitive therapy to be effective with older people it must be adapted. The first piece of evidence against the adaptation of CBT comes from the meta-analysis literature. Results of meta-analyses carried out in older adult populations report near identical effect sizes (Robinson et al., 1990; Scogin & McElreath, 1994) to those reported by meta-analyses studies looking at CBT across all age groups. In their review of empirical evidence of psychological treatments for late-life depression, Gatz et al. (1988) note that in studies little fundamental adjustment of techniques appears to be necessary. The idea that CBT has to be adapted for use with older people (see Wilkinson, 1997) has another very unfortunate consequence. The accumulated knowledge and empirical evidence demonstrating the effectiveness of CBT as an effective alternative to antidepressant medication is disregarded because of questions about the relevance and effectiveness of non-adapted psychological therapy.

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