Cognitive behavioural therapy (CBT) for dementia

What is cognitive behavioural therapy (CBT)?

Imagine that you are sitting on a bench in a park, you can hear ducks quacking and water lapping in a nearby lake. You might be thinking ‘what a lovely day’ and you might feel happy.  Alternatively, you might be thinking ‘I wish my partner was here’ and feel sad as a consequence. The feelings you have might then cause you to act differently. If you are feeling happy you might take a stroll around the lake with a friend and treat yourself to an ice-cream. If you are feeling sad and low you might leave the park and go home feeling upset with yourself.

The above is an example of how the way in which we think affects our feelings, which, in turn, affect how we then behave. Cognitive behavioural therapy or CBT is a talking therapy that aims to help people understand these links between their thoughts, feelings and behaviours and use this understanding to make positive changes. CBT doesn’t work for everyone but it has become a popular way of helping people to cope with anxiety, depression and other mental health problems.

Dr Josh Stott is an Alzheimer’s Society-funded researcher based at University College London. He is investigating whether CBT could be altered to help people in the early stages of dementia, who also have anxiety and depression. We sat down with Dr Stott to learn more about his research.

How could CBT help people with dementia?

Depression and anxiety are more common in people living with dementia than in people who don’t have dementia. We know that having depression and anxiety in addition to dementia can worsen dementia symptoms. Depression and anxiety are not an inevitable result of dementia.

Is CBT more difficult for people with dementia?

Every individual living with dementia is unique. Like the rest of the population, CBT is likely to  work for some people with dementia and not for others. 

While we don’t yet know exactly who with dementia might benefit most from CBT, a few things may make it more difficult.  CBT is a language based therapy, and for people with dementia who struggle with language, CBT may be more challenging.

In general, greater levels of cognitive impairment may make it more difficult to engage with CBT, however, it may be possible to tailor CBT according to an individual’s level of functioning. One of the things that I have been working on is developing questionnaires that will help us to understand which type of CBT a particular individual living with dementia might be most able to engage with.

What would be the ideal stage to start CBT?

CBT is only relevant if you have both dementia and anxiety or depression. If you do have this combination of difficulties, it is good to start as early as you can. In an ideal situation, people would be assessed at the time of diagnosis with dementia and introduced to CBT then, if it seems like it might be appropriate.

One intriguing idea is that CBT may be helpful before someone even develops dementia. This has yet to be researched, but we know that people who have anxiety or depression are more likely than the general population to develop dementia in future and it would be very interesting to investigate whether CBT or other interventions to treat anxiety and depression might have dementia preventative effects.

What is next in the research?

We are hopeful that CBT will prove to have positive outcomes for people with dementia, we are also very interested in investigating the potential preventative effects of CBT and other psychological therapies as mentioned above.