Learning cognitive restructuring in later life: the role of cognitive flexibility on cognitive restructuring skill acquisition in older adults with anxiety and depression

Although there is consistent evidence supporting the efficacy of cognitive behaviour therapy for late-life anxiety and depression, there are still some suggestions that the use of cognitive restructuring should be modified or minimized with older adults due to declines in flexible and abstract thinking. There is some evidence that poorer executive functioning negatively impacts on cognitive behavioural therapy (CBT) efficacy, although it is unclear what specific executive functioning skills are important and what treatment components are affected. Older adults experience some age-related decline in cognitive flexibility skills, including the ability to consider multiple ideas, flexibly switch cognitive sets and inhibit habitual responding; skills which intuitively seem important for the successful use of cognitive restructuring. This thesis aimed to examine the role of cognitive flexibility on cognitive restructuring skill acquisition in older adults through four papers. The first paper examined the role of cognitive flexibility on cognitive restructuring skill acquisition in a normal community-dwelling sample of older adults. The second paper extended these findings, assessing cognitive restructuring skills in older adults with and without anxiety and depression, and the influence of cognitive flexibility on this relationship. The third paper examined the measurement of cognitive flexibility, comparing neuropsychological assessment and self-report measures in older adults. The final paper investigated the role of pre-treatment cognitive flexibility as a predictor of cognitive restructuring skill acquisition at the end of a group CBT intervention for late-life anxiety and depression, and as a predictor of treatment outcome. The results are expected to inform clinical practice for conducting CBT with older adults, and build on emerging research into treatment moderators and mediators for late-life anxiety and depression.