Cognitive-behavioral therapy (CBT) is widely recognized as an efficacious treatment of anxiety and related disorders—however, recent research suggests that some older adults may derive reduced benefit from CBT as compared to younger adults. Age-related declines in cognition (e.g., memory, attention) may be a contributing factor to the reduced benefit seen in this population. Augmentation strategies for optimizing CBT are now under way (e.g., exercise, medication), and indicate that cognitive support and enhancement strategies can improve both cognitive skills and treatment outcome in anxious older clients. This review discusses the current literature on enhancement strategies that target CBT aptitude directly (e.g., memory aids for therapeutic material) and indirectly (e.g., use of standardized cognitive tasks unrelated to CBT) as methods of augmenting CBT. Recommendations for clinicians and directions for future research are provided.
Cognitive -behavioral therapy (CBT) is widely recognized as one of the world ’s leading interventions across mental health problems and age groups (Gaudiano, 2008). Despite CBT ’s strong empirical roots and global rise in popularity, accumulating evidence has revealed special populations that may experience reduced benefits from the therapy (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012; Nathan & Gorman, 2007). A range of clinical groups may be at risk for poor therapeutic response , including (a) individuals who abuse substances (e.g., Aharonovich, Nunes, & Hasin, 2003) ; (b) bipolar individuals (e.g., Cuijpers, Smit, Bohlmeijer, Hollon, & Anderson, 2010) ; ( c ) patients with traumatic brain injury (e.g., Hsieh, Ponsford, Wong, & McKay, 2012) ; ( d ) individuals with learning disabilities (e.g., Hassiotis et al., 2012) ; and ( e) anxious, depressed, or cognitively impaired older adults (e.g., Gould, Coulson, & Howard, 2012; Mohlman & Gorman, 2005; Scogin, Fairchild, Yon, Welsh, & Presnell, 2013) . Despite the many therapeutic advances made by CBT, a comprehensive review of meta – analyses across a range of disorders yielded response rates of 38 –۸۲%, which implicates a need for optimization (Hofmann et al., 2012). To address this problem, initial investigations of augmented versions of CBT are under way, with a diverse range of strategies being applied to enhance its potency , such as exercise, mindfulness, and cognitive rehabilitation. Some of these augmentations have a solid theoretical rationale for combining with CBT, while others take a more pragmatic approach.