Mohlman Jan, Gorman Jack M
Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, USA.
Behav Res Ther. 2005 Apr;43(4):447-65. doi: 10.1016/j.brat.2004.03.007.
Cognitive behavior therapy (CBT) is an effective treatment for late life anxiety and depression. The successful use of CBT is assumed to rely on cognitive skills known as executive functions (EF; e.g., hypothesis generation, allocation of attention, self-monitoring) governed by the prefrontal cortex. Because older adults sometimes have executive deficits as a consequence of normal aging, EF may be a mediator of CBT outcome in older samples. The current pilot study tested the hypothesis that older adults with executive deficits (as measured by neuropsychological tests) would show decreased therapeutic benefit from CBT for generalized anxiety disorder, as compared to a group with intact EF. Results indicated differential response to CBT within the dysfunction group depending on the stability (and possibly, the etiology) of executive deficits from pre- to posttreatment. Those whose EF scores remained low from pre- to posttreatment did not respond to CBT, while those whose scores improved responded quite well, similar to an Intact EF group. Results indicate that some, but not all, older adults with executive dysfunction show decreased benefit from CBT, and are consistent with the assumption that executive skills are important for the successful use of CBT. However, some participants may show improvement on both mood and cognitive skills during treatment, which is discussed further.
认知行为疗法（CBT）是治疗老年期焦虑和抑郁的一种有效方法。CBT的成功应用被认为依赖于由前额叶皮层控制的被称为执行功能（EF；例如，假设生成、注意力分配、自我监控）的认知技能。由于老年人有时会因正常衰老而出现执行功能缺陷，执行功能可能是老年样本中CBT治疗效果的一个调节因素。当前的初步研究检验了这样一个假设：与执行功能完好的组相比，有执行功能缺陷（通过神经心理学测试测量）的老年人接受CBT治疗广泛性焦虑症时，治疗效果会降低。结果表明，功能障碍组内对CBT的反应存在差异，这取决于治疗前到治疗后执行功能缺陷的稳定性（可能还有病因）。那些治疗前到治疗后执行功能得分一直很低的人对CBT没有反应，而那些得分提高的人反应良好，类似于执行功能完好组。结果表明，一些（但不是所有）有执行功能障碍的老年人从CBT中获得的益处减少，这与执行技能对CBT的成功应用很重要这一假设相一致。然而，一些参与者在治疗期间可能在情绪和认知技能方面都有所改善，这将进一步讨论。
