Cognitive Behavioural Therapy (CBT) as a Treatment for Dementia
Cognitive behavioural therapy (CBT) aims to reduce the presentation of disruptive behaviours, emotions, and thought processes, through the use of psychotherapeutic tasks in the present. It is believed that these behaviours, emotions and thought processes can be controlled or even removed through altering the underlying causes. Recently, CBT therapies have been explored with regard to dementia, and though the findings are still relatively inconclusive (for a multitude of reasons, including a low amount of research conducted so far), some problematic behaviours such as incontinence and anxiety have been reduced.
Directions which have yielded promising results include faith-based therapy, in which patients discuss their faith and consider its potential healing power, either through prayer or personal reflection. Though this may seem an out dated approach to some, an article by Ceramidas in the most recent issue of the Journal of Christian Nursing (Ref 1) found promising results. Pot, Willemse and Blom, in the International Psychogeriatrics journal (volume 23, September 2011) (Ref 2) explored whether new mediums of delivering CBT (specifically, the internet) were also worth investigating. This study, though limited, shows that interest in the area persists, and that CBT is definitely worthy for consideration in the treatment of those with dementia.
In a recent book by Ian Andrew James (Ref 3), the use of CBT and other psychotherapies on dementia patients is explored in great detail. He argues that while CBT may be beneficial for patients when employed correctly, care must be taken not to “intervene inappropriately, lowering patients’ mood further and inadvertently reinforcing negative cognitions” (p. 12). This is interesting as it shows that CBT may be a hindrance rather than a help if used incorrectly. A study by Paukert et al (2010) (Ref 4), however, demonstrated the benefits of CBT interventions on those with dementia, when they showed that patients reported benefiting from ‘Peaceful Mind’, a cognitive-behavioural intervention, “in terms of [their] anxiety, depression, and collateral distress”
It is as the American Journal of Psychiatry concluded in its review of many papers into the effect of different therapies on dementia patients: “Lack of evidence regarding other therapies is not evidence of lack of efficacy. Conclusions are limited because of the paucity of high-quality research (only nine level-1 studies were identified). More high-quality investigation is needed.” Hopefully in the future, such research will be conducted, and will lead to disruptive behaviours (both to the patients and to carers) being reduced.
References:
1. Faith-Based Cognitive Behavioral Therapy: Easing Depression in the Elderly With Cognitive Decline
2. International Psychogeriatrics journal (volume 23, September 2011)
3. Cognitive Behavioural Therapy with Older People: Interventions for Those with and Without Dementia
4. Peaceful Mind: an open trial of cognitive-behavioral therapy for anxiety in persons with dementia
About the author:
Chris Lee wrote this article on behalf of the Maria Mallaband Care Group, who operate several dementia care homes across the UK.
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