Talking therapy: CBT research
From the spring 2016 edition of Care and cure magazine, we speak with Dr Joshua Stott about his research in to a type of talking therapy called cognitive behavioural therapy (CBT).
Dr Joshua Stott is a senior clinical tutor on the clinical psychology doctoral training course at University College London. He was recently awarded a clinical training fellowship by Alzheimer's Society to study the use of cognitive behavioural therapy for people with dementia.
My maternal grandmother was diagnosed with dementia when I was in secondary school. At the time, statutory support was minimal and the impact this had on all members of my family was significant.
The experience motivated me to work with people who have dementia and showed me the distress such a diagnosis could cause, both to the individual and their carers. The wish to understand and alleviate such distress was one of the things that led to my career choice as a clinical psychologist.
I have been a clinical psychologist since 2003 and have always worked with people with dementia. Among other things, I have tried to help people with dementia to decrease feelings of depression and anxiety by using a type of talking therapy called cognitive behavioural therapy (CBT). My research sprang from this clinical interest and was developed in collaboration with a group of people with dementia who worked as peer support workers in the same service as me.
We know that CBT is effective in reducing anxiety and depression for people who don't have dementia. Based on this, there have been large-scale government initiatives aimed at improving access to such therapies. There is, however, much less evidence as to whether CBT is useful for people with dementia. While there have been two small recent studies, with promising results, there is not agreement about how CBT might be best adapted to take account of the thinking, language, planning and memory problems that people with dementia experience.
My research is focused on understanding how best to adapt CBT for anxiety and depression so that it caters for the needs of people with dementia. There has not been much work in this area so my research is a first step, looking to understand what bits of CBT people with dementia might find difficult.
This involves meeting around 100 people with dementia in their homes or a clinic and giving them various tasks to do that mimic important parts of CBT. I will also compare performance to groups of people without dementia to help me understand which aspects of therapy are difficult for everyone, and which are difficult just for those with dementia.
Finally, as everyone with dementia is different I will be looking at which aspects of dementia might particularly affect important parts of CBT. In all, this will help me to understand how to adapt and individualise CBT offered to those with dementia.
As my research has just started I don't yet have results, but even when I do it will just be a step on the way to the end goal of ensuring that people with dementia have good access to effective psychological therapies. In future, I want to use the results to develop innovative psychological therapies for people with dementia who also experience anxiety or depression.
As an Alzheimer's Society fellow I am also enrolled in the Dementia Research Leaders programme and wish to influence others in research and practice. I am in a good position to do this – I work at University College London as a trainer for clinical psychologists, supervising dementia research, and can directly input results into the teaching of future healthcare professionals. My fellowship research has a number of trainee clinical psychologists involved in subprojects, and I hope this inspires them, as well as others I supervise and teach, to do research with people with dementia in future.
This project has been a collaboration and I am extremely grateful to Alzheimer's Society for awarding me this fellowship, to the people with dementia who are taking part in my research, and to the Research Network volunteers who are giving up their time to monitor my project. The support given to me by the peer workers who helped me develop the project, as well as that given to me by my line manager, Sue Watson, research supervisors, Georgina Charleswoth and Katrina Scior, and head of department, Peter Fonagy, has been invaluable.