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Cognitive–behavioural therapy for anxiety in dementia: pilot randomised controlled trial

  • Aimee Spector (a1), Georgina Charlesworth (a1), Michael King (a2), Miles Lattimer (a3), Susan Sadek (a4), Louise Marston (a5), Amritpal Rehill (a6), Juanita Hoe (a7), Afifa Qazi (a3), Martin Knapp (a6) and Martin Orrell (a8)...
Abstract
Background

Anxiety is common and problematic in dementia, yet there is a lack of effective treatments.

Aims

To develop a cognitive–behavioural therapy (CBT) manual for anxiety in dementia and determine its feasibility through a randomised controlled trial.

Method

A ten-session CBT manual was developed. Participants with dementia and anxiety (and their carers) were randomly allocated to CBT plus treatment as usual (TAU) (n = 25) or TAU (n = 25). Outcome and cost measures were administered at baseline, 15 weeks and 6 months.

Results

At 15 weeks, there was an adjusted difference in anxiety (using the Rating Anxiety in Dementia scale) of (–3.10, 95% CI −6.55 to 0.34) for CBT compared with TAU, which just fell short of statistical significance. There were significant improvements in depression at 15 weeks after adjustment (–5.37, 95% CI −9.50 to −1.25). Improvements remained significant at 6 months. CBT was cost neutral.

Conclusions

CBT was feasible (in terms of recruitment, acceptability and attrition) and effective. A fully powered RCT is now required.

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Copyright
Corresponding author
Aimee Spector, University College London, 1–19 Torrington Place, London WC1E 7HB, UK. Email: a.spector@ucl.ac.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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Cognitive–behavioural therapy for anxiety in dementia: pilot randomised controlled trial

  • Aimee Spector (a1), Georgina Charlesworth (a1), Michael King (a2), Miles Lattimer (a3), Susan Sadek (a4), Louise Marston (a5), Amritpal Rehill (a6), Juanita Hoe (a7), Afifa Qazi (a3), Martin Knapp (a6) and Martin Orrell (a8)...
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eLetters

Reply to Spector et al

The work of Spector’s group on various psychological interventions in dementia is to be welcomed. It represents hard work in a difficult area. Of course, none of the interventions have shown a large effect size[1] – and their latest work on manualised Cognitive Behavioural Therapy (CBT) for anxiety in dementia shows effects that fall short of statistical significance across the board[2].



Whatever the relative benefits and drawbacks of their major work so far – Cognitive Stimulation Therapy – surely a far bigger confounder is present in CBT for anxiety disorder in dementia.



The component analyses for CBT done initially in the late 1990s tended to show that cognitive interventions may not add much over behavioural interventions in the emotional disorders[3,4,5]. This is also the case in anxiety disorders in particular[6,7]. Little work has been done since that refutes these analyses[8]. Without belittling cognitive interventions, clearly attendance at ten sessions of psychotherapy provides behavioural activation and many natural examples of the presentation of anxiety-provoking stimuli.



Treatment as usual should be clearly defined as typically it means inactivity. On the other hand, the social engagement and behavioural activation that come from attending community groups may provide benefits akin to CBT, at no additional training cost to the health service.



If the larger randomised controlled trial ends up showing an effect of therapy, it may well be that the act of attending therapy is the therapy itself.





[1] Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev. 2012 Feb 15;2:CD005562.

[2] Spector A, Charlesworth G, King M, Lattimer M, Sadek S, Marston L, Rehill A, Hoe J, Qazi A, Knapp M, Orrell M. Cognitive-behavioural therapy for anxiety in dementia: pilot randomised controlled trial. Br J Psychiatry. 2015 Jun;206(6):509-16.

[3] Jacobson NS, Dobson KS, Truax PA, Addis ME, Koerner K, Gollan JK, Gortner E,Prince SE. A component analysis of cognitive-behavioral treatment for depression. J Consult Clin Psychol. 1996 Apr;64(2):295-304.

[4] Gortner ET, Gollan JK, Dobson KS, Jacobson NS. Cognitive-behavioral treatment for depression: relapse prevention. J Consult Clin Psychol. 1998 Apr;66(2):377-84.

[5] Dimidjian S, Hollon SD, Dobson KS, Schmaling KB, Kohlenberg RJ, Addis ME, Gallop R, McGlinchey JB, Markley DK, Gollan JK, Atkins DC, Dunner DL, Jacobson NS. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol. 2006 Aug;74(4):658-70.

[6] Borkovec TD, Newman MG, Pincus AL, Lytle R. A component analysis of

cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. J Consult Clin Psychol. 2002 Apr;70(2):288-98.

[7] Ougrin D. Efficacy of exposure versus cognitive therapy in anxiety disorders: systematic review and meta-analysis. BMC Psychiatry. 2011 Dec 20;11:200. doi: 10.1186/1471-244X-11-200.

[8] Longmore RJ, Worrell M. Do we need to challenge thoughts in cognitive behaviour therapy? Clin Psychol Rev. 2007 Mar;27(2):173-87.
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