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Cognitive behavioural therapy with older adults: enthusiasm without the evidence?

Published online by Cambridge University Press:  01 June 2009

Philip Wilkinson
Philip Wilkinson*
Affiliation:
Department of Psychiatry, University of Oxford, Warneford Hospital Headington, Oxford, UK
*
*Address for correspondence: Dr P. Wilkinson, Department of Psychiatry, University of Oxford, Warneford Hospital Headington, Oxford OX3 7JX, UK. (email: [email protected])
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Abstract

Cognitive behavioural interventions specifically for older people have been described and researched for the last 30 years. However, despite a robust evidence base to support the use of CBT in the treatment of mental disorders in younger adults, trials with older people have generally been of poor methodological quality. Therefore, the potential of CBT to improve the outcome of late-life mental illness has not yet been adequately tested and demonstrated. The priorities, if this is to happen, are to develop standardized, reproducible CBT interventions and to evaluate these in large trials alongside medication or as part of case-management interventions.

Keywords

CBTevidence-based practiceolder adults
Type
Review
Information
the Cognitive Behaviour Therapist , Volume 2 , Issue 2 , June 2009 , pp. 75 - 82
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2009

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References

Recommended follow-up reading

Areán, PA, Alexopoulos, GS (2007). Psychosocial interventions for mental illness in late-life. International Journal of Geriatric Psychiatry 22, 99–100.CrossRefGoogle ScholarPubMed
Laidlaw, K, Thompson, LW, Dick-Siskin, L, Gallagher-Thompson, D (2003). Cognitive Behaviour Therapy with Older People. Chichester: Wiley.CrossRefGoogle Scholar
Wilkinson, P (2008). Cognitive behaviour therapy. In: Oxford Textbook of Old Age Psychiatry (ed. Jacoby, R., Oppenheimer, C., Dening, T. and Thomas, A.), pp. 247–255. Oxford: Oxford Univesity Press.Google Scholar
Age Concern (2007). Improving services and support for older people with mental health problems (www.ageconcern.org.uk). Accessed 22 March 2008.Google Scholar
Alexopoulos, GS, Raue, P, Areán, PA (2003). Problem-solving therapy versus supportive therapy in geriatric major depression with executive dysfunction. American Journal of Geriatric Psychiatry 11, 46–52.CrossRefGoogle ScholarPubMed
Ayres, CR, Sorrell, JT, Thorp, SR, Loebach Wetherall, J (2007). Evidence-based psychological treatments for late-life anxiety. Psychology and Aging 22, 8–17.CrossRefGoogle Scholar
Brodaty, H, Green, A, Koschera, A (2003). Meta-analysis of psychosocial interventions for caregivers of people with dementia. Journal of the American Geriatrics Society 51, 657–664.CrossRefGoogle ScholarPubMed
Carney, S, Geddes, J (2002). Systematic reviews and meta-analyses. In: Evidence in Mental Health Care (ed. Priebe, S. and Slade, M.), pp. 72–80. London: Routledge.Google Scholar
Clark, DM (1989). Anxiety States. In: Cognitive Behaviour Therapy for Psychiatric Problems (ed. Hawton, K., Salkovskis, P. M., Kirk, J. and Clark, D. M.), pp. 52–96. Oxford: Oxford University Press.Google Scholar
Coon, DW, Gallagher-Thompson, D (2002). Encouraging homework completion among older adults in therapy. Psychotherapy in Practice 58, 549–563.Google Scholar
Department of Health (2005). Securing better mental health for older adults (www.dh.gov.uk). Accessed 22 March 2008.Google Scholar
Evans, S (2004). A survey of the provision of psychological treatments to older adults in the NHS. Psychiatric Bulletin 28, 411–414.Google Scholar
Fennell, MJV (1989). Depression. In: Cognitive Behaviour Therapy for Psychiatric Problems (ed. Hawton, K., Salkovskis, P. M., Kirk, J. and Clark, D. M.), pp. 169–234. Oxford: Oxford University Press.CrossRefGoogle Scholar
Frederick, JT, Steinman, LE, Prohaska, T, Satariano, WA, Bruce, M, Bryant, L, Ciechanowski, P, DeVellis, B, Leith, K, Leyden, K, Sharkey, J, Simon, GE, Wilson, N, Unützer, J, Snowden, M (2007). Community-based treatment of late life depression. An expert panel-informed literature review. American Journal of Preventive Medicine 33, 222–249.CrossRefGoogle ScholarPubMed
Gallagher, D, Thompson, LW (1982). Treatment of major depressive disorder in older adult outpatients with brief psychotherapies. Psychotherapy: Theory, Research and Practice 19, 482–490.CrossRefGoogle Scholar
Gallo, JJ, Bogner, HR, Morales, KH, Post, PE, Lin, JY, Bruce, ML (2007). The effect of a primary care practice-based intervention on mortality in older adults: a randomized trial. Annals of Internal Medicine 146, 689–698.CrossRefGoogle ScholarPubMed
Gaudiano, B (2008). Cognitive-behavioural therapies: achievements and challenges. Evidence Based Mental Health 11, 5–7.Google Scholar
Gloaguen, V, Cottraux, J, Cucherat, M, Blackburn, I (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders 49, 59–72.CrossRefGoogle ScholarPubMed
Granholm, E, McQuaid, JR, McClure, FS, Pedrelli, P, Jeste, DV (2002). A randomized controlled pilot study of cognitive behavioral social skills training for older patients with schizophrenia. Schizophrenia Research 53, 167–169.Google Scholar
Gum, AM, Areán, PA, Hunkeler, E, Tang, AL, Katon, W, Hitchcock, P, Steffens, DC, Dickens, J, Unützer, J (2006). Depression treatment preferences in older primary care patients. The Gerontologist 46, 14–22.Google Scholar
Hammond, MF (1998). Rating depression severity in the elderly physically ill patient: reliability and factor structure of the Hamilton and the Montgomery–Asberg Depression Rating Scales. International Journal of Geriatric Psychiatry 13, 257–261.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Hayes, SC (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy 35, 639–665.CrossRefGoogle Scholar
Herrmann, L, Goodwin, G, Ebmeier, K (2007). The cognitive neuropsychology of depression in the elderly. Psychological Medicine 37, 1693–1702.CrossRefGoogle ScholarPubMed
Hunkeler, E, Katon, W, Tang, L, Williams, JW, Kroenke, K, Lin, E, Harpole, L, Areán, P, Levine, S, Grympa, LM, Hargreaves, WA, Unutzer, J (2006). Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. British Medical Journal 332, 259–62.CrossRefGoogle ScholarPubMed
Improving Access to Psychological Therapies (2008). The IAPT Pathfinders: achievements and challenges. (www.iapt.nhs.uk). Accessed 19 January 2009.Google Scholar
James, IA (2008). Stuff and nonsense in the treatment of older people: essential reading for the over-45s. Behavioural and Cognitive Psychotherapy 36, 735–747.CrossRefGoogle Scholar
Kipling, T, Bailey, M, Charlesworth, G (1999). The feasibility of a cognitive behavioural therapy group for men with mild/moderate cognitive impairment. Behavioural and Cognitive Psychotherapy 27, 189–193.CrossRefGoogle Scholar
Laidlaw, K, Thompson, LW, Dick-Siskin, L, Gallagher-Thompson, D (2003). Cognitive Behaviour Therapy with Older People. Chichester: Wiley.Google Scholar
Mackin, RS, Areán, PA (2005). Evidence-based psychotherapeutic interventions for geriatric depression. Psychiatric Clinics of North America 28, 805–820.CrossRefGoogle ScholarPubMed
Mansfield, AK, Addis, ME (2001). Manual-based treatment. Part 2: the advantages of manual-based practice in psychotherapy. Evidence Based Mental Health 4, 100–101.CrossRefGoogle ScholarPubMed
Marks, IM, Cavanagh, K, Gega, L (2008). Computer-aided psychotherapy: revolution or bubble? British Journal of Psychiatry 191, 471–473.Google Scholar
Marriott, A, Donaldson, C, Tarrier, N, Burns, A (2000). Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. British Journal of Psychiatry 176, 557–562.Google Scholar
Mittelman, MS, Epstein, C, Pierzchala, A (2003). Counseling the Alzheimer's Caregiver. USA: AMA Press.Google Scholar
NICE (2004 a). Depression: management of depression in primary and secondary care (www.nice.org.uk). National Institute for Health and Clinical Excellence. Accessed 22 March 2008.Google Scholar
NICE (2004 b). Clinical guidelines for the management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. (www.nice.org.uk). National Institute for Health and Clinical Excellence. Accessed 22 March 2008.Google Scholar
NICE (2006). Dementia: supporting people with dementia and their carers. Clinical guideline (www.nice.org.uk). National Institute for Health and Clinical Excellence. Accessed 22 March 2008.Google Scholar
Nordhus, IH, Pallesen, S (2003). Psychological treatment of late-life anxiety: an empirical review. Journal of Consulting and Clinical Psychology 71, 643–651.Google Scholar
Reynolds, CF, Dew, MA, Pollock, BG, Mulsant, BH, Frank, E, Miller, MD, Houck, PR, Mazumdar, S, Butters, MA, Stack, JA, Schlernitzauer, MA, Whyte, EM, Gildengers, A, Karp, J, Lenze, E, Szanto, K, Bensasi, S, Kupfer, DJ (2006). Maintenance treatment of major depression in old age. New England Journal of Medicine 354, 1130–1138.CrossRefGoogle ScholarPubMed
Reynolds, CF, Frank, E, Perel, JM, Imber, SD, Cornes, C, Miller, MD, Mazumdar, S, Houck, PR, Dew, MA, Stack, JA, Pollock, BG, Kupfer, DJ (1999). Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older that 59 years. Journal of the American Medical Association 281, 39–45.CrossRefGoogle ScholarPubMed
Rybarczyk, B, Lopez, M, Schelble, K, Stepanski, E (2005). Home-based video CBT for comorbid geriatric insomnia: a pilot study using secondary data analyses. Behavioral Sleep Medicine 3, 158–175.CrossRefGoogle ScholarPubMed
Schneider, L, Reynolds, C, Lebowitz, BD, Friedhoff, AJ (1994). Diagnosis and Treatment of Depression in Late Life. Results of the NIH Consensus Development Conference. Washington: American Psychiatric Press.Google Scholar
Schuurmans, J, Comijs, H, Emmelkamp, PMG, Gundy, CMM, Weijnen, I, van den Hout, M, van Dyck, R (2006). A randomized, controlled trial of the effectiveness of cognitive-behavioral therapy and sertraline versus a waitlist control group for anxiety disorders in older adults. American Journal of Psychiatry 14, 255–263.Google ScholarPubMed
Scogin, F, Welsh, D, Hanson, A, Stump, J, Coates, A (2005). Evidence-based psychotherapies for depression in older adults. Clinical Psychology: Science and Practice 12, 222–237.Google Scholar
Segal, ZV, Pearson, JL, Thase, ME (2003). Challenges in preventing relapse in major depression. Report of a National Institute of Mental Health Workshop on state of the science of relapse prevention in major depression. Journal of Affective Disorders 77, 97–108.CrossRefGoogle ScholarPubMed
Teri, L, Gallagher-Thompson, D (1991). Cognitive-behavioral interventions for treatment of depression in Alzheimer's patients. The Gerontologist 31, 413–416.CrossRefGoogle ScholarPubMed
Thompson, LW, Coon, DW, Gallagher-Thompson, D, Somner, BR, Koin, D(2001). Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression. American Journal of Geriatric Psychiatry 9, 225–240.Google Scholar
Vernooij-Dassen, M, Downs, M (2005). Cognitive and behavioural interventions for carers of people with dementia (protocol). Cochrane Database of Systematic Reviews. Issue 1. Art. No.: 10.1002/14651858.CD005318.Google Scholar
Wilkinson, P, Alder, N, Juszczak, E, Matthews, H, Merritt, C, Montgomery, H, Howard, R, Macdonald, A, Jacoby, R (2009). A pilot randomised controlled trial of a brief cognitive behavioural group intervention to reduce recurrence rates in late life depression. International Journal of Geriatric Psychiatry 24, 68–75.CrossRefGoogle ScholarPubMed
Wilson, K, Mottram, PG, Vassilas, C (2008). Psychotherapeutic treatments for older depressed people. Cochrane Database of Systematic Reviews. Issue 1. Art. No.: 10.1002/14651858.CD004853.pub2.Google Scholar
Yon, A, Scogin, F (2007). Procedures for identifying evidence-based psychological treatments for older adults. Psychology and Aging 22, 4–7.CrossRefGoogle ScholarPubMed
Age Concern (2007). Improving services and support for older people with mental health problems (www.ageconcern.org.uk). Accessed 22 March 2008.Google Scholar
Alexopoulos, GS, Raue, P, Areán, PA (2003). Problem-solving therapy versus supportive therapy in geriatric major depression with executive dysfunction. American Journal of Geriatric Psychiatry 11, 46–52.CrossRefGoogle ScholarPubMed
Ayres, CR, Sorrell, JT, Thorp, SR, Loebach Wetherall, J (2007). Evidence-based psychological treatments for late-life anxiety. Psychology and Aging 22, 8–17.CrossRefGoogle Scholar
Brodaty, H, Green, A, Koschera, A (2003). Meta-analysis of psychosocial interventions for caregivers of people with dementia. Journal of the American Geriatrics Society 51, 657–664.CrossRefGoogle ScholarPubMed
Carney, S, Geddes, J (2002). Systematic reviews and meta-analyses. In: Evidence in Mental Health Care (ed. Priebe, S. and Slade, M.), pp. 72–80. London: Routledge.Google Scholar
Clark, DM (1989). Anxiety States. In: Cognitive Behaviour Therapy for Psychiatric Problems (ed. Hawton, K., Salkovskis, P. M., Kirk, J. and Clark, D. M.), pp. 52–96. Oxford: Oxford University Press.Google Scholar
Coon, DW, Gallagher-Thompson, D (2002). Encouraging homework completion among older adults in therapy. Psychotherapy in Practice 58, 549–563.Google Scholar
Department of Health (2005). Securing better mental health for older adults (www.dh.gov.uk). Accessed 22 March 2008.Google Scholar
Evans, S (2004). A survey of the provision of psychological treatments to older adults in the NHS. Psychiatric Bulletin 28, 411–414.Google Scholar
Fennell, MJV (1989). Depression. In: Cognitive Behaviour Therapy for Psychiatric Problems (ed. Hawton, K., Salkovskis, P. M., Kirk, J. and Clark, D. M.), pp. 169–234. Oxford: Oxford University Press.CrossRefGoogle Scholar
Frederick, JT, Steinman, LE, Prohaska, T, Satariano, WA, Bruce, M, Bryant, L, Ciechanowski, P, DeVellis, B, Leith, K, Leyden, K, Sharkey, J, Simon, GE, Wilson, N, Unützer, J, Snowden, M (2007). Community-based treatment of late life depression. An expert panel-informed literature review. American Journal of Preventive Medicine 33, 222–249.CrossRefGoogle ScholarPubMed
Gallagher, D, Thompson, LW (1982). Treatment of major depressive disorder in older adult outpatients with brief psychotherapies. Psychotherapy: Theory, Research and Practice 19, 482–490.CrossRefGoogle Scholar
Gallo, JJ, Bogner, HR, Morales, KH, Post, PE, Lin, JY, Bruce, ML (2007). The effect of a primary care practice-based intervention on mortality in older adults: a randomized trial. Annals of Internal Medicine 146, 689–698.CrossRefGoogle ScholarPubMed
Gaudiano, B (2008). Cognitive-behavioural therapies: achievements and challenges. Evidence Based Mental Health 11, 5–7.Google Scholar
Gloaguen, V, Cottraux, J, Cucherat, M, Blackburn, I (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders 49, 59–72.CrossRefGoogle ScholarPubMed
Granholm, E, McQuaid, JR, McClure, FS, Pedrelli, P, Jeste, DV (2002). A randomized controlled pilot study of cognitive behavioral social skills training for older patients with schizophrenia. Schizophrenia Research 53, 167–169.Google Scholar
Gum, AM, Areán, PA, Hunkeler, E, Tang, AL, Katon, W, Hitchcock, P, Steffens, DC, Dickens, J, Unützer, J (2006). Depression treatment preferences in older primary care patients. The Gerontologist 46, 14–22.Google Scholar
Hammond, MF (1998). Rating depression severity in the elderly physically ill patient: reliability and factor structure of the Hamilton and the Montgomery–Asberg Depression Rating Scales. International Journal of Geriatric Psychiatry 13, 257–261.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Hayes, SC (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy 35, 639–665.CrossRefGoogle Scholar
Herrmann, L, Goodwin, G, Ebmeier, K (2007). The cognitive neuropsychology of depression in the elderly. Psychological Medicine 37, 1693–1702.CrossRefGoogle ScholarPubMed
Hunkeler, E, Katon, W, Tang, L, Williams, JW, Kroenke, K, Lin, E, Harpole, L, Areán, P, Levine, S, Grympa, LM, Hargreaves, WA, Unutzer, J (2006). Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. British Medical Journal 332, 259–62.CrossRefGoogle ScholarPubMed
Improving Access to Psychological Therapies (2008). The IAPT Pathfinders: achievements and challenges. (www.iapt.nhs.uk). Accessed 19 January 2009.Google Scholar
James, IA (2008). Stuff and nonsense in the treatment of older people: essential reading for the over-45s. Behavioural and Cognitive Psychotherapy 36, 735–747.CrossRefGoogle Scholar
Kipling, T, Bailey, M, Charlesworth, G (1999). The feasibility of a cognitive behavioural therapy group for men with mild/moderate cognitive impairment. Behavioural and Cognitive Psychotherapy 27, 189–193.CrossRefGoogle Scholar
Laidlaw, K, Thompson, LW, Dick-Siskin, L, Gallagher-Thompson, D (2003). Cognitive Behaviour Therapy with Older People. Chichester: Wiley.Google Scholar
Mackin, RS, Areán, PA (2005). Evidence-based psychotherapeutic interventions for geriatric depression. Psychiatric Clinics of North America 28, 805–820.CrossRefGoogle ScholarPubMed
Mansfield, AK, Addis, ME (2001). Manual-based treatment. Part 2: the advantages of manual-based practice in psychotherapy. Evidence Based Mental Health 4, 100–101.CrossRefGoogle ScholarPubMed
Marks, IM, Cavanagh, K, Gega, L (2008). Computer-aided psychotherapy: revolution or bubble? British Journal of Psychiatry 191, 471–473.Google Scholar
Marriott, A, Donaldson, C, Tarrier, N, Burns, A (2000). Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. British Journal of Psychiatry 176, 557–562.Google Scholar
Mittelman, MS, Epstein, C, Pierzchala, A (2003). Counseling the Alzheimer's Caregiver. USA: AMA Press.Google Scholar
NICE (2004 a). Depression: management of depression in primary and secondary care (www.nice.org.uk). National Institute for Health and Clinical Excellence. Accessed 22 March 2008.Google Scholar
NICE (2004 b). Clinical guidelines for the management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. (www.nice.org.uk). National Institute for Health and Clinical Excellence. Accessed 22 March 2008.Google Scholar
NICE (2006). Dementia: supporting people with dementia and their carers. Clinical guideline (www.nice.org.uk). National Institute for Health and Clinical Excellence. Accessed 22 March 2008.Google Scholar
Nordhus, IH, Pallesen, S (2003). Psychological treatment of late-life anxiety: an empirical review. Journal of Consulting and Clinical Psychology 71, 643–651.Google Scholar
Reynolds, CF, Dew, MA, Pollock, BG, Mulsant, BH, Frank, E, Miller, MD, Houck, PR, Mazumdar, S, Butters, MA, Stack, JA, Schlernitzauer, MA, Whyte, EM, Gildengers, A, Karp, J, Lenze, E, Szanto, K, Bensasi, S, Kupfer, DJ (2006). Maintenance treatment of major depression in old age. New England Journal of Medicine 354, 1130–1138.CrossRefGoogle ScholarPubMed
Reynolds, CF, Frank, E, Perel, JM, Imber, SD, Cornes, C, Miller, MD, Mazumdar, S, Houck, PR, Dew, MA, Stack, JA, Pollock, BG, Kupfer, DJ (1999). Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older that 59 years. Journal of the American Medical Association 281, 39–45.CrossRefGoogle ScholarPubMed
Rybarczyk, B, Lopez, M, Schelble, K, Stepanski, E (2005). Home-based video CBT for comorbid geriatric insomnia: a pilot study using secondary data analyses. Behavioral Sleep Medicine 3, 158–175.CrossRefGoogle ScholarPubMed
Schneider, L, Reynolds, C, Lebowitz, BD, Friedhoff, AJ (1994). Diagnosis and Treatment of Depression in Late Life. Results of the NIH Consensus Development Conference. Washington: American Psychiatric Press.Google Scholar
Schuurmans, J, Comijs, H, Emmelkamp, PMG, Gundy, CMM, Weijnen, I, van den Hout, M, van Dyck, R (2006). A randomized, controlled trial of the effectiveness of cognitive-behavioral therapy and sertraline versus a waitlist control group for anxiety disorders in older adults. American Journal of Psychiatry 14, 255–263.Google ScholarPubMed
Scogin, F, Welsh, D, Hanson, A, Stump, J, Coates, A (2005). Evidence-based psychotherapies for depression in older adults. Clinical Psychology: Science and Practice 12, 222–237.Google Scholar
Segal, ZV, Pearson, JL, Thase, ME (2003). Challenges in preventing relapse in major depression. Report of a National Institute of Mental Health Workshop on state of the science of relapse prevention in major depression. Journal of Affective Disorders 77, 97–108.CrossRefGoogle ScholarPubMed
Teri, L, Gallagher-Thompson, D (1991). Cognitive-behavioral interventions for treatment of depression in Alzheimer's patients. The Gerontologist 31, 413–416.CrossRefGoogle ScholarPubMed
Thompson, LW, Coon, DW, Gallagher-Thompson, D, Somner, BR, Koin, D(2001). Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression. American Journal of Geriatric Psychiatry 9, 225–240.Google Scholar
Vernooij-Dassen, M, Downs, M (2005). Cognitive and behavioural interventions for carers of people with dementia (protocol). Cochrane Database of Systematic Reviews. Issue 1. Art. No.: 10.1002/14651858.CD005318.Google Scholar
Wilkinson, P, Alder, N, Juszczak, E, Matthews, H, Merritt, C, Montgomery, H, Howard, R, Macdonald, A, Jacoby, R (2009). A pilot randomised controlled trial of a brief cognitive behavioural group intervention to reduce recurrence rates in late life depression. International Journal of Geriatric Psychiatry 24, 68–75.CrossRefGoogle ScholarPubMed
Wilson, K, Mottram, PG, Vassilas, C (2008). Psychotherapeutic treatments for older depressed people. Cochrane Database of Systematic Reviews. Issue 1. Art. No.: 10.1002/14651858.CD004853.pub2.Google Scholar
Yon, A, Scogin, F (2007). Procedures for identifying evidence-based psychological treatments for older adults. Psychology and Aging 22, 4–7.CrossRefGoogle ScholarPubMed
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