Characteristics and effectiveness of cognitive behavioral therapy for older adults living in residential care: a systematic review

Phoebe Chan*, Sunil Bhar, Tanya E. Davison, Colleen Doyle, Bob G. Knight, Deborah Koder, Ken Laidlaw, Nancy A. Pachana, Yvonne Wells, Viviana M. Wuthrich

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)


Objectives: Cognitive behavioral therapy (CBT) for depression and anxiety for older adults living in residential aged care facilities (RACFs) needs to accommodate the care needs of residents and the circumstances of RACFs. This systematic review examines the delivery and content characteristics of these interventions, in relation to participant satisfaction, staff appraisal, uptake rate, attrition rate, and treatment effectiveness. Such a review could provide important information for the development of future CBT-based interventions. Method: Studies that examined the application of CBT for depression or anxiety in RACFs were identified by systematically searching a number of relevant databases. Reference lists of all included studies were examined, and citation searches on the Web of Science were conducted. Two independent reviewers were involved in screening articles and in extracting data and assessing methodological quality of the selected studies. Results: Across the 18 studies included in this review, the most common therapeutic strategy was pleasant activities scheduling. Studies varied on treatment duration (2–24 weeks), number of sessions (6–24), and length of sessions (10–120 min). Residents and staff members were satisfied with the CBT interventions. The average uptake rate was 72.9%. The average attrition rate was 19.9%. Statistically significant results were reported in 8 of the 12 randomized controlled trials (RCTs). In these eight RCTs, CBT was characterized by psychoeducation, behavioral activation, and problem-solving techniques; further, the therapists in six of these studies had training in psychology. Conclusion: CBT interventions for depression and anxiety are acceptable to RACF residents and judged positively by staff members. Effective studies differed from non-effective studies on content and training characteristics, but not on other delivery features.

Original languageEnglish
Pages (from-to)187-205
Number of pages19
JournalAging and Mental Health
Issue number2
Early online date9 Nov 2019
Publication statusPublished - Feb 2021


  • cognitive behavioral therapy
  • residential aged care
  • characteristics
  • systematic review
  • depression
  • anxiety


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