Cognitive Therapy with Aged Persons: Implications of Research Design for Its Implementation and Evaluation
Hayslip, Bert, Jr., Caraway, Marsha L., Journal of Cognitive Psychotherapy
On the basis of intervention research with elderly persons, numerous research design issues are discussed that influence the implementation and evaluation of cognitive therapy with aged individuals. These issues reflect a concern for the impact of placebo effects, sampling, and attrition on treatment efficacy, as well as attention to the measurement of rational thinking in the aged. Moreover, environmental support for rational solutions to everyday problems among older persons may vary. It is argued that given the limited research to date, an awareness of such issues must temper conclusions about the effectiveness of cognitive interventions with older persons.
A review of the cognitive therapy literature by Dush, Hirt, and Schroeder (1983) suggests thatrelative to that done with overpopulations, little research has emerged evaluating cognitive therapeutic approaches with the aged. Of the 70 studies reviewed by Dush et al. (1983) dealing with self-statement modification, only one involved elderly persons. Although this dearth of work with the aged may reflect a bias about older persons' potential for change, Ritter (1985) suggests that such research might be particularly difficult to accomplish with elders who have experienced deficits in sensory function, abstract thinking, or learning/memory ability (Steuer & Hammen, 1983; Thompson, Davis, Gallagher, & Krantz, 1986). Such difficulties may have contributed to the relative lack of cognitive therapeutic research with older individuals (see Dush et al., 1983).
Given the popularity of cognitive therapies with other populations, research that yields objective data regarding a therapy's potential may be particularly important for the gerontological counselor. It has been pointed out that older persons may be skeptical and/or unrealistic about receiving professional help (Gatz, Smyer, & Lawton, 1980). One contributing factor to such reluctance may be the counselor's negative expectations of the older person' s therapeutic potential (Gatz, Popkin, Pinos, & Vanden Bos, 1985; Goodstein, 1982). Data substantiating therapeutic efficacy with older clients could easily influence the counselor's readiness to employ a particular therapeutic technique with aged persons.
In addition to the benefits for the counselor, data supporting the impact of interventions on thinking patterns and behaviors may be particularly valuable to aged persons as well. Keller, Croake, and Brooking (1975) point out that the ability to make rational decisions may be critical to many older persons. Elderly individuals, who are often the objects of age stereotyping, frequently internalize these samemythsthatareoftenfactuallyincorrect(Bennett&Eckman, 1973). Additionally, those aged who are isolated, institutionalized, or impaired often lack feedback from others regarding both the consequences of aging and their own thought process/ behavior relationships. This lack of feedback further impairs their ability to rationally separate fact and myth, interfering with their adjustment. They may overgeneralize or personalize the negative aspects of the aging process, or catastrophize unnecessarily regarding the anticipated consequences of ill health, retirement, institutionalization,orwidowhood. Given predominantly negative self-expectations, these individuals may also be more prone to adopt only the negative stereotypes of aging (Atchley, 1982; Brubaker & Powers, 1976).
Despite these circumstances, those persons who suffer a loss of self-esteem (Daly & Burton, 1983) and/or who are depressed (Thompson et al., 1986) may demonstrate irrational thinking that is amenable to cognitive interventions. Among its virtues, cognitive therapy is time-limited and presents the client with straightforward, easily understood techniques for dealing with well-defined target problems (Thompson et al., 1986). Regardless of these advantages, conclusions about whether cognitive therapies are effective with older persons must nevertheless rest upon the weight of the evidence concerning treatment efficacy (Dush et al. …