A handbook is what a handbook does: a book that one wants to go back to, consult and have at close hand, to use as a reference text to guide one's clinical practice. The editors have done a remarkable job in compiling a book that is both concise and comprehensive in presenting the evidence and the rationale for cognitive behavioral therapy (CBT) in the elderly. At the same time they provide solid case examples to bring the art of CBT practice to life with this specific patient group.
As a practicing general adult psychiatrist and CBT therapist I was initially skeptical that this book was really necessary. Would what we need to know about CBT in the elderly not really be better summarized in the standard CBT texts? This handbook makes an ample case for the modification of CBT to make it useful for the elderly. The contributing authors are very thorough in describing the specific psychological and physiological changes that need to be catered for when practicing CBT with an older person.
Each chapter starts with an epidemiological background of the mental health issue, highlights the specific issue of this condition in the elderly and moves on to the explaining the role of CBT in this age group. Diagnoses more traditionally “relevant to adults below the age of 65” are also being addressed, including personality problems, PTSD and alcohol use. Problems more specific to the elderly, including dementia, post stroke depression and carers’ support are comprehensively dealt with in separate chapters.
The book does not just stay with more established CBT techniques like cognitive restructuring and behavioral activation and behavioral experiments, and presents cutting edge “third wave interventions” like dialectical behavioral therapy. Positive psychology, the moving away from talking about deficits to talking about strengths and promoting their daily application, is so well placed in a book about a group of patients who need exactly that: shifting the balance, internally and externally, from ruminating about loss to taking pride in life experience and the gift of a meaningful life.
I was touched by the last chapter on positive aging. For example the “SOC” concept of selectivity, by limiting choices and doing less and doing less really well; optimization of existing skills by daily rehearsal; and compensation by using aids for areas of lost function, e.g. a wheelchair or electronic diaries. Could the younger population benefit from more SOC? The concepts of “forgiveness,” “altruism” and “gratitude” are paving the way for the future of CBT: the clarification of value systems and their ethical behavioral consequences will be more at the core of what CBT should be exploring with our patients. As far as I am concerned, everybody's positive aging should start from today. This book can be of immense help for this therapeutic and self-explorative challenge.
