A/Prof Carly Johnco

👉 Key takeaway message: it’s not chronological age that matters, but individual differences in cognitive processes. Older adults can learn and use CBT skills—and we shouldn’t withhold therapy based on assumptions about rigidity.

Older adults' skills were comparable to children, with younger adults doing best. BUT - after accounting for individual differences in cognitive flexibility (particularly perseveration), there were no age differences in skills.

Many people assume that older adults are too rigid in their ways of thinking to benefit from therapeutic techniques like cognitive restructuring. But our research shows that’s not the case.

Developmental Differences in Cognitive Restructuring Skill Acquisition across the Lifespan: Age Differences between Children, Adults and Older Adults, and the Role of Cognitive Flexibility - Cognitive Therapy and Research Purpose Replacing irrational or unhelpful thoughts with more rationale and helpful ones is a core skill in Cognitive Behavioural Therapy, but there is limited research examining the neuropsychological mechanisms underpinning this process. This study examined age-differences in cognitive restructuring skill acquisition between children, younger adults and older adults; whether individual differences in cognitive flexibility influences the ability to learn cognitive restructuring across the lifespan; and whether cognitive flexibility explains age-differences in cognitive restructuring ability. Method Participants were 114 individuals with anxiety disorders, including 35 children (aged 7–12, M = 9.14, SD = 1.44), 32 younger adults (aged 18–53, M = 23, SD = 7.84) and 47 older adults (aged 61–78, M = 66.81, SD = 4.43). Participants completed neuropsychological measures of cognitive flexibility and learned cognitive restructuring, which was coded for quality and efficacy. Results More than half the participants of all ages showed good quality cognitive restructuring skill acquisition with only brief instruction. Older adults showed comparable cognitive restructuring skills to children, with slightly better skills among younger adults. However, after accounting for individual differences in cognitive flexibility, there were no age-differences in cognitive restructuring quality. Greater perseveration was associated with poorer cognitive restructuring skill acquisition in younger and older adults, and mediated age-differences in cognitive restructuring skill acquisition. Conclusions Among younger and older adults, individual differences in perseveration, rather than chronological age, underpins the ability to learn cognitive restructuring. There is little evidence that cognitive flexibility plays a role in cognitive restructuring skill acquisition among children.

🚨 New paper: You can teach an old (person) new therapy tricks. More than half of children, younger and older adults showed good cognitive restructuring skills. Individual differences in cognitive flexibility (perseveration) predicts skill, not age. bit.ly/3IARYx2 #CBT #ClinPsy #MentalHealth

A Systematic Review and Meta-analysis of Diagnostic Remission, Treatment Response, Attrition and Relapse Following Cognitive Behavior Therapy (CBT), Other Psychological Therapies and Pharmacological T... Anxiety disorders are some of the most common mental disorders in older age,1,2 and are associated with poor quality of life, increased disability, healthcare use, as well as increased risk of dementi...

Full paper here: www.ajgponline.org/article/S106...

🔎 Which anxiety treatments work best for older adults?

📊7x more likely to recover with CBT (54%)
📊2x more likely with meds (36%) (vs controls)

😬 We found 13 definitions of ‘treatment response’ - messy!

📄 Open access: bit.ly/3ZRZ6KP

🔁 Please share!

#Anxiety #OlderAdults #ClinPsy #MentalHealth

Even better! I’m a big fan of exposure-based treatments - and the clinicians that do them 👏

Thanks for sharing our findings. Inhibitory learning theory predicts BE would be best. I thought it was possible there would be no group differences. However the results (small preference for BE, but little penalty from doing CR first) aligns with clinical experiences. 👉🏻✨ threat expectancy change

It's always encouraging to hear that the findings resonate with clinical experience. Treatment tolerability is a key consideration. There was only a small difference between BE and doing cognitive restructuring before exposure - with both approaches emphasising change in threat expectancies (key).

Both of these approaches that emphasise threat expectancy change are better than habituation-focused exposure. But if clients are willing, BE might be preferable given that there are consistently small benefits for clinical outcomes, plus it is faster (? more time for extra exposure trials)

Yes, this is correct. There is very little penalty for doing cognitive work first, which is what inhibitory learning models suggest. This is great news, given that cognitive restructuring often increases clients willingness to attempt exposure tasks.

So pleased you were able to share this with your supervision group! I’d love to hear what the feedback was, and how this relates to others’ experience in clinical practice?

Exposure therapy is such a powerful treatment technique. Our findings support that either application of exposure that ALSO focused on changing threat beliefs, was great! Habituation-focused exposure without the cognitive work, was less effective.

Absolutely! There was a non-significant, small effect size difference when using cognitive restructuring first - so there isn’t any real penalty from doing the cognitive work first.

What’s the most effective way to deliver exposure therapy for anxiety? We tested:
🔹 Behavioural experiments (BE)
🔹 Cognitive restructuring before exposure
🔹 Habituation-based approaches

BE had the best outcomes.

🧠 How do you implement exposure?

🔗 bit.ly/3YTlR0n

#mentalhealth #ClinPsy